Managed Care

 

You Don't Need X-Ray Vision To Spot a Job Well Done

MANAGED CARE January 2005. © MediMedia USA
Editor's Memo

You Don't Need X-Ray Vision To Spot a Job Well Done

John A. Marcille
MANAGED CARE January 2005. ©MediMedia USA

John A. Marcille

If the White House indeed takes on tort reform this year, it will be interesting to see if any meaningful legislation results and what effect it might have on health care. Doctors in this litigious age tend to practice defensive medicine, and that means more use of expensive imaging technology — as our cover story makes clear.

"It is a conundrum," says William Corwin, MD, medical director for utilization management and clinical policy for Harvard Pilgrim Health Care. "Where does your judgment and confidence in your diagnosis preclude your concern about the judicial system? Doctors tend to err on the side of ordering the test. What they need to do is pause and ask themselves, Will ordering this $1,500 test change the way I manage this case?"

The story does not lay all the blame at the feet of physician, of course. The problem of imaging costs is complex, and author Maureen Glabman describes that complexity — and the techniques of plans that do a good job on this — with aplomb.

And while Harvard Pilgrim, along with every other insurer, has imaging problems, it apparently has no image problem, as our story about that company's recent fortunes makes clear. Much of the credit for Harvard Pilgrim's amazing turnaround goes to CEO Charles Baker, whose hands-on approach includes seeing how the claims process works for his own family. "I have a wife and kids, and we have the same things going on as everybody else," says Baker.

Well, not exactly the same things. A lot of families may include parents who have made a name for themselves in business. But how many have a father who is now being mentioned as a possible Republican candidate for governor of Massachusetts? The business community, says the Boston Globe, "adores Baker's braininess," and Democratic politicians "respect it." Interesting.

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015