Managed Care 101 in 2010 (Part XV): "Hello! Managed Care"

Managed Care is an opportunity to do just that—manage the care and create a balance of its three interdependent components: access, cost and quality.

Managed Care is an opportunity to do just that—manage the care and create a balance of its three interdependent components: access, cost and quality.

What are the necessary steps to effect managed care?

First: We should take a moment to review the Institute of Medicine's definition of quality. It is: "The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

Second: Please visit this link—Managed Care—to find Wikipedia's definition. However, for the purposes of this discussion, it is: measure and manage; recognize and pay better for doing better—ie, better outcomes, given the acuity of the illness(es). If you want further information, please refer to ManagingManagedCare.com; a REACH? and "The Real Reason for Managed Care."

The praxis of change begins at a very personal level with the initial investment and buy-in.

Third: Pay better for doing better (and visa versa). For one of the better answers on how to accomplish this, please see "Crossing the Quality Chasm: The IOM Health Care Quality Initiative" that suggests [edited and paraphrased]:

• "The goals of any payment method should be to reward high-quality care and to permit the development of more effective ways of delivering care to improve the value obtained for the resources expended. These goals are relevant regardless of whether care is delivered in a predominantly competitive or regulated environment, and whether the ultimate purchaser is an employer or the patient/consumer. Payment policies should not create barriers to improving the quality of care."

• Provide fair payment for good clinical judgement in the management of a variety of patients.

• Provide feedback and an opportunity for participating practitioners to share in the benefits of continuous quality improvement.

• There should also be opportunities for patients and purchasers to recognize quality differences (given the level of illness, of course).

• It is necessary to align financial incentives with the implementation of care processes based upon 'best practices' and the achievement of better patient outcomes.

• It is vital to reduce fragmentation of care.

Fourth: Treat the whole patient and use the bio-psycho-social model to do so.

Fifth: Communicate and document. Maintain privacy and confidentiality, but don't impede care in doing so.

Sixth: Care, follow-up and care some more

Hello! Holistic healthcare; the medical home concept; Hello to the three-legged stool of Access, Quality and Cost. Hello! Getting the right care at the right time and place.

Hello! Managed Care.

Readers: Is it possible to extricate cost management from quality assurance or accessibility? Please comment.