Managed Care

 

Never Rest

Never Rest

Steven Peskin, MD
In my Saturday morning Torah study, we focused on Jacob’s “settling in” with his family. After years of struggle, Jacob becomes complacent, comfortable. We discussed whether Jacob’s complacency — his relative inaction — contributed to the animosity that led Joseph’s brothers to sell him into slavery and to report to their father that his then youngest son had been killed.

So what is the connection to managed care? After two decades of struggle, innovation, and change — some that proved valuable and some that proved detrimental — payers, purchasers, and providers became relatively complacent. During the past decade, we have witnessed an erosion in trust ("The Trust Crisis in Healthcare: Causes, Consequences, and Cures"), costs that are once again significantly outpacing the CPI, and an acceleration in the decline in interest among medical students and internal medicine residents in pursuing careers in primary care.

We were jolted out of our complacency by the Affordable Care Act. Some positive signs: more adequate and more reasonable reimbursement for primary care clinicians through the patient-centered medical home model; private and public sector pilots/demonstration projects, including episode-of-care reimbursement, payment tied to outcomes and quality versus volume; or simply trying to rein in costs by reducing fees. A recent example is BCBS of Massachusetts's Alternative Quality Contract, as discussed in the New England Journal of Medicine: Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

Steven R. Peskin, MD, MBA, FACP is executive vice president and chief medical officer of MediMedia USA, which publishes Managed Care. He is Associate Clinical Professor of Medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014