For Those Who Can’t Leave Well Enough Alone


It’s our nature to experiment with the world and, after that, to experiment with the systems we’ve created to live here. Such experimentation readies the stage from which the great leaps of imagination and technology spring.

This month’s cover story on direct contracting is really a look at some of the experimentation constantly going on in managed care. As most of the experts we talked with point out, direct contracting really can’t become a nationwide system as long as small employers are discouraged from forming insurance purchasing consortiums. Even if that should occur, the safe bet is that most employers would still rather avoid the headaches.

Yet, the experiments go on — most notably in Minnesota, where the Buyers Health Care Action Group claims to have been contracting directly since 1997. Has it? One of our sources swears that if you squint your eyes and tilt your head a bit — experiment with the view, if you will — the BHCAG looks very much like an HMO.

Despite this criticism — who knows? Maybe, a few years down the line, thanks to what’s going on in Minnesota today, someone will have figured out how to make direct contracting work everywhere and a whole new system will be launched.

The experimenting we do at this magazine also prepares the way for major new endeavors. This month we unveil one of those as we solicit, for peer review, scientific studies that examine clinical and financial aspects of managed care. In preparation, we have expanded our editorial advisory board and compiled guidelines for submitting papers. (See “Managed Care Launches Peer-Reviewed Section“)

Guided by Alan L. Hillman, M.D., we will begin to publish reports of original research on a range of topics. This modest step is taken in the same hopeful, but mostly hidden, spirit in which so many scientists approach their daily struggles: to understand and, perhaps a little, to change the world.

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