Summary
The plans that figure out how to get doctors to self manage best of breed chronic care will certainly spend less money treating their insured lives. For example, preventing a colon cancer, cervical cancer, heart bypass, transplants, premature infant, stroke or MI saves big bucks. It saves lives and is a better way to practice medicine. The key is getting doctors to assume both financial and medical management of the patient by enforcing agreed upon standards of care. The goal is better outcomes in terms of patient satisfaction and lower cost. General Motors spent $3 billion in 2004 into its retirement health trust fund or three times earnings. They buy insurance for 450,000 workers. Clearly, this is not sustainable and employers and government are acting to stop the bleeding.
Analysis
Industrialization of medicine is here with the flag bearer being "population based management". P4P historically rewards groups of physicians for effectively meeting practice standards on very large populations. A sorely unmet need is how to do it with individual doctors with high cost individual patients.
In recent years, Evidence Based Medicine, Outcomes Management and Pay for Performance appear to finally be merging into something managegable, and that measures the cost, and healthiness of patients in terms of reducing admissions and avoiding health attacks caused by ineffective management of chronic conditions. Noticeably lacking are indices that measure patient satisfaction of being returned to health. Also lacking is physician leadership to assure they and not a governmentally appointed committee will be fixing health standards and practice standards for you and me.
