Never Rest

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