 |
 |
 |
 |
 |
 |
|
| ||||||
|
|
Home > Resources > eNews > Dec 1999 Part2 |
|
|
|
|
The Managed Care Insider eNews Volume One Number 5 December 1999 PART TWO of TWO Welcome to The Managed Care Insider eNews. You are receiving this because you have subscribed; the eNews is never sent unsolicited. Subscribe/unsubscribe information can be found at the end of this eNews. The Managed Care Insider eNews is published, copyrighted, and owned by The Scheur Management Group, Inc. (SMG), http://www.scheur.com and is distributed monthly, free to subscribers. If you wish to forward this edition, you may do so only if the edition is forwarded in its entirety. No reproduction of any part of this publication is permitted without the express permission of the publishers. ---------------------------------------------------------------- This edition of The Managed Care Insider eNews focuses on the past as an influence on the future of health care. In Part One we focused on philosophical views related to changes being implemented by various health care organizations in an attempt to try to build a more positive image as they react to negative public opinion polls in which consumers note their continued dissatisfaction with the delivery of health care. In Part Two, we present an esoteric discussion of a real life situation which personifies the very essence of this consumer dissatisfaction. As always, we welcome and encourage your comments and suggestions. Email us at insider@scheur.com. Also, we would like to encourage you to please visit our archives page on our web site at http://www.scheur.com/smghome.nsf/webcontent/ezinearchives.html where you can rate our eNews! Please take a moment to do so. Thank you! Health Care Into the Millennium By Robert S. Eichler It was the fifth day of the month, the fourth month before the end of the year, the end of the century, and, I am told, the end of a millennium. The young woman standing behind me in line at the pharmacy was probably not much older than twenty. Her clothes were appropriate to the New Hampshire early autumn, and clean, but not fancy. I was in line because, although I had called in my prescription ahead of time, the pharmacist had not filled it. "Your insurance has expired," he explained. Through my employer, we had, indeed, changed health care plans within the past few weeks. I shared my new health care benefits card with the cashier, and the pharmacist proceeded to fill my prescription, the entire cost of which would not reach the co-payment amount required by either my new or old health plan. Now the young woman was subjected to the same ritual. "Your insurance has expired, so we didn't fill the prescription." The woman appeared as stunned as I had been at this response. She replied that she knew that it had expired; she was prepared to pay for it herself; her child needed the medicine. The pharmacist began his work at the computer terminal, investigating the formulary. He called to the cashier in a voice loud enough for all to hear, "Does she realize it will be $76?" The young mother's face went slack. She recovered her composure and opened her checkbook. As she reviewed her bank balance, she stated, slowly, "Well, I do have the money, and my baby needs this medicine." Her voice audible only to me, she said softly, but clearly, "There goes the rent." The pharmacy experience epitomizes the current specter of our health care system as more concerned with patients' ability to pay than with their own responsibility to improve health through services and products. A number of scenarios had not been played out, any one of which would have provided better service, filled prescriptions more efficiently, and avoided public embarrassment. None of the scenarios requires technology any more complicated than the telephone. Why had the pharmacist not called to inform us of our lapsed insurance plans, and determine our desire for filling the prescriptions by some other payment? Why did he not offer a generic medicine to the young woman, or offer to call her physician to determine if an alternative treatment or lesser dosage would suffice? Could he have filled half the prescription at a time? The glossy media are filled with hopeful and boastful articles about the progress we may expect in the new millennium. In particular, health care information technology vendors promise their products will prepare us for the new millennium. Well I, for one, probably won't make it very far into the next millennium. Actuaries tell me that, barring any truly groundbreaking advances in health care, I'll push statistical probability to reach half way into the next century. What are our opportunities for affecting events through the next millennium? Skip back to the beginning of the past millennium. What seminal events transpired a thousand years ago that shaped our current civilization and society? Were the 5,000 soldiers who accompanied William the Conqueror into the Battle of Hastings (October 14, 1066) aware that their victory would decisively establish England's link to Western Europe, setting the stage for the Eurodollar? Were the soldiers in that battle ready for the Crusades? Martin Luther's 95 Theses? The discovery, conquering, and settlement of the continents of the Western Hemisphere? Gutenberg's press? Societies where most, rather than a select few, can read? Electricity? Internal combustion engines? Telephones? Ice cream cones? Airplanes? Radio? The atomic bomb and nuclear energy? Television? A Declaration of Independence? Or the medical advances of Anton van Leuwenhoek, Marcello Malpighi, Crawford Long, Marie Curie, Edward Jenner, or Jonas Salk? We have seen how quickly information technology has moved in only the last two decades, or just 2% of this past millennium. Technologists only a decade ago had no whisper of the Internet, Java scripts, or web browsers and were pursuing revisions of proprietary legacy systems as proprietary client-server applications. How can we prepare for the next five years, let alone one thousand? We currently grapple with data definitions to describe clinical events and medical status, to establish a computerized patient record and technical interconnectivity to provide for its availability to the team of health care professionals collaborating on a patient's care. There are corollary business, economic, and political issues to be resolved, including each patient's right to privacy. The establishment of computerized patient records, integrated with case and disease management systems, holds the promise (over and above reimbursement and payment systems) for improving the provision of health care to individuals over their lifetime. Medical knowledge and treatment paths, when available to providers at the point of care and based upon accepted medical standards, become the touchstone for customizing treatment for individuals, rather than imposing standard treatments in spite of individual case differences. Aggregated, such information may be the key to understanding and improving the health of a population. The value of a population health database becomes compromised to the extent that it excludes information about diagnoses, treatments, outcomes, or any individuals in the population. In order to benefit all of us, health care must reach each of us. To truly lay the groundwork for a new millennium, we should challenge ourselves to establish a societal paradigm that ensures that health care advances -- clinical and informational technology and indemnifying and delivery systems -- are available to promote the health of the population, where an individual's access to health care is no longer a choice between treatment and rent. About the author: Robert S. Eichler is an expert in managed care operations and systems, assisting Scheur Management Group clients in tracking information flow, designing effective resource allocation, functionally analyzing and evaluating system applications and strategies. Eichler has achieved national recognition for his expertise in the evaluation and restructuring of Other Party Liability (COB and subrogation) programs for managed care plans, insurers and self-insured employers. ---------------------------------------------------------------- What's New at SMG? SMG president, Barry S. Scheur, announces the launch of Venture Health Partnership Group (VHPG) whose mission is to purchase managed care organizations (MCOs) and improve them, from a provider and consumer perspective, administratively, operationally, and financially. Scheur notes, "Our goal as owners is to develop locally based provider partnerships that deliver quality, accessible health care which will reverse the stigma that has been too long associated with managed care." For more information on VHPG, contact Public Relations at nbelle@scheur.com ---------------------------------------------------------------- Sites and Sounds on the Internet: In keeping with this issue's focus on the impact of the past on the future of health care, and the public opinion polls related to health care, we present the following websites for your review. SMG takes no ownership of the following sites, nor does SMG endorse these sites which are presented solely as a resource for subscribers. Public Agenda Online, http://www.publicagenda.org/ : Is a nonpartisan, nonprofit public opinion research and citizen education organization with public opinion polls and research on a number of topics, including health care. The Communications Department of the University of Kansas, http://www.ukans.edu/cwis/units/coms2/po/index.html: Has a worldwide listing of resources on conducting, using, and finding research related to public opinion polls. The Agency for Health Care Policy and Research, http://www.ahcpr.gov/data/: Has a multitude of data and surveys related to health care. Visit http://www.pohly.com/salary.shtml for surveys and statistics related to health care compensation and salaries. Visit http://www.straffordpub.com/healthcare/ to purchase surveys on various health care trends and industries. ---------------------------------------------------------------- End of PART TWO of TWO, The Managed Care Insider eNews, Volume One, Number 5. Scheur Management Group (SMG) is one of the most experienced specialized health care operations management and business revitalization consulting firms in the country. Our expertise is in time-sensitive analyses, strategic business and market planning, operational re-engineering, and communications, as well as implementation of start-ups, expansions, and new products. The firm's clients cover the spectrum of insurers, managed care organizations, physician groups, integrated delivery systems, hospitals, employers, governmental entities, vendors, and other providers. Contributors to this edition are Barry Scheur and Rob Eichler. Editing and Research by Judith Jaffe. Production Coordinator is The Gracefield Group at http://www.gracefield.com/gg/index.html TO SUBSCRIBE: visit http://www.scheur.com/smghome.nsf/webcontent/ezine.html or send e-mail to insider@scheur.com with the word SUBSCRIBE in the subject and name, email, company, title, and country in the message. TO UNSUBSCRIBE: send email message to insider@scheur.com with the word UNSUBSCRIBE in the subject. Please take a minute to visit our eNews page at http://www.scheur.com/smghome.nsf/webcontent/ezine.html for archives, subscriber information and to RATE our ezine. Get up-to-the-minute health care news on-line at www.scheur.com |
|
Scheur & Associates, Inc. One Gateway Center, Suite 810 Newton, MA 02458 Copyright 2003, Scheur & Associates, Inc. All rights reserved. |
