Editor's Memo

What You're Reading Is a Well-Oiled Machine

Timothy Kelley

We planned it this way, of course. The magazine you hold in your hand is a vast, comprehensively interlocking mechanism of Swiss-like design, each gear delicately calibrated, each peg precisely grooved and fluted, the whole an awesomely purring informational machine.

Our cover article, "Whatever Happened to Exclusive Contracting?" (page 36) discusses a onetime Jackson Hole Group vision of managed competition — each health plan with its dedicated providers — and why it has so far failed to come true. One inspiration for that vision, of course, was the early staff-model HMOs. Even they are now moving away from full reliance on exclusive provider relationships. And so, with the kind of subtle coordination with which this issue is replete, we also explore recent changes at three of these historic HMOs in "Pioneer Not-for-Profit Plans Struggle To Remain Leaders" on page 48.

We knew, of course, that consultant Lucy Johns was going to tell cover-story author Jean Lawrence that current payment systems offer physicians "a substantial opportunity to cost-shift onto Medicare." We also knew that bills trimming Medicare growth and offering new managed Medicare options would be the hot item in the capital as we went to press (Washington Initiatives, page 18). So we planned an article on Medicare's HMO payment methodology and the possible effects of changing it ("Projecting a Leaner Managed Medicare," page 83). Such was our grand design that we also assigned writer Peter Wehrwein to prepare a chronology of a Louisiana HMO now making a big push in the Medicare market ("Diary of the Birth of an HMO," page 69.) Letter-writer C. Papas, M.D., (page 8) may even have sensed that the Employee Retirement Income Security Act would be the subject of a new Texas law (State Initiatives, page 20).

Others may slack off in summertime, but not us.

We did it all on purpose.

And if you believe that . . .

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