Managed Care Fails Again and in a Randomized Study

"As the health care system continues to embrace managed care for its promise of efficiency, cost savings and containment, and reduction of waste, there is an economic imperative to ensure that managed care as a financing mechanism is truly effective. It is critically important that the managed care paradigm maximizes access to clinically appropriate care and demonstrates improved patient health outcomes." via Stuart Figueroa in the Incidental Economist. His review of this study is worth review.

His work is in response to a managed care study that involved a randomized population - a very rare and more valuable research design. This study did not demonstrate advantages for managed care focus - which is becoming increasingly dominant. Fewer and larger and more powerful corporations dictate managed care - and US health care design.

Another review of the CMS Innovation Center illustrates the problem of innovations involving micromanagement. CMS was 5 for 52. Their directors admit their failure, but want to do even more manipulation. There is no sense of the abuses or the fact that innovation and micromanagement has been a costly and distracting boondoggle.

The major theme that stands out to me in managed care, micromanagement, and innovation is that quality outcomes is that the population is what shapes costs and quality outcomes

Managed Care Change Is Not Helpful

Changes in health care policies are a serious and growing problem. The impacts are most seen on the smaller facilities and practices. Rapid changes that involve shifts in personnel, more personnel, or more for delivery personnel to do are often hidden and damaging changes.

The Failed Promise of Efficiency

Over and over management and micromanagement focus promises to save costs or prevent waste. And over and over the changes have failed to yield significant improvements. The studies that demonstrate minimal improvements are not good quality and are often seeking to find what the study is designed to find.

Why Do We Keep Rolling On Toward Bigger Health with Worse Designs?

An article in Forbes highlighted how data science has been so distorted. Often data science is used to promote decisions that we have already made. Health care micromanagement is a primary example of assumptions that have been made with data, information, and internet focused on justifying micromanagement. Almost every step in critique or scientific rigor has been compromised.

Failures in Basic Health Access Continue

The United States health care design clearly compromises basic health access. There are few changes that have not made the situation worse. This is what should be expected from

• Stagnant to declining revenue
• Increasing usual costs of delivering care
• Added costs of micromanagement
• Declines in productivity, care, and caring via meaningless micromanagement - not to mention burnout impacts on those who deliver the care

Why Do We Continue Innovation Focus When Innovation Fails Consistently and often costs more not to mention disrupting the personal and professional lives of those who deliver the care. Why not terminate innovation rather than replicate?

https://www.dhirubhai.net/pulse/terminate-innovation-focus-cms-center-robert-bowman/

Value Based Care – no progress since 1997 

https://thehealthcareblog.com/blog/2020/10/12/value-based-care-no-progress-since-1997/

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians - Another Meaningless Change for No Difference Once Again Pointing to Patients and Populations Shaping Outcomes - not plans, practices, reorganizations, etc.

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1678

Value Based Payment Problems Are Deadly to Basic Health Access

Designs that increased the costs of delivery while not increasing revenue defeat health access. Micromanagement focus has been demonstrated by research to impair the personal and professional lives of those who deliver the care. Outcomes are about predominantly people factors and drivers of health outcomes other than clinical interventions. Designs that cannot improve health outcomes need to be terminated, not replicated. https://www.dhirubhai.net/pulse/value-based-payment-problems-deadly-basic-health-access-robert-bowman/