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QUALITY/POLICY/HEALTH PLANS: Good article on pay for performance

Nothing radically new in this but a very good general journalistic article on the arrival of Pay for Performance in middle America.  Keeping score on physicians is well worth a read if you haven’t seen it.

You can use this as an open thread as the one on DM below is getting a bit long!

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Ron GreinerAaron McKethanAbby Recent comment authors
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Ron Greiner
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German HillaryCare — Socialism is Dead, sorry. — “Health care is delivered through what are known as Krankenkassen’s or (translated into Clintonese) “regional health plans” that are non-profit and heavily regulated in terms of what they charge and the care they deliver. If someone changes his job or is fired -”
OH Matthew – tax free HSAs are the CENTERPIECE of President Bush’s 2006 Domestic Agenda. D-Day is the State of the Union — Shockwave of Reform. Blue Cross’s monopoly is over, they’re dead.
http://washingtontimes.com/functions/print.php?StoryID=20060115-103622-7968r

Aaron McKethan
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Aaron McKethan

BTW, it seems to me that a major shortcoming of many DM initiatives focusing on call centers is that there is often little, if any, diagnostic or other patient data transmitted from patients to call centers back to primary care docs who can help support treatment plans. Successful DM requires interactive and ongoing communication between the patient population with chronic diseases and their health care providers. Does anybody know of models of DM that try to do this?

Aaron McKethan
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Aaron McKethan

Abby – you should try the following Enthoven articles:
Enthoven, A. (1993). The History And Principles Of Managed Competition. Health Aff, 12, 24-48.
Enthoven, A. C. (2003). Employment-Based Health Insurance Is Failing: Now What? Health Aff.
I can send these to you by email, if interested.

Abby
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Abby

Matthew,
Can you cite a good Enthoven article on how managed competition should work. Presumably, if a diabetic is unsatisfied with his level of care in his current organization, after a reasonable period, he ought to be able to switch. Has anyone figured out how to get the risk adjustment right to pay the new managed care organization/ insurer teh right amount?