Managed Care


Creativity Required Equally In Short Run and Long Run

MANAGED CARE June 2008. © MediMedia USA
Editor's Memo

Creativity Required Equally In Short Run and Long Run

John Marcille
MANAGED CARE June 2008. ©MediMedia USA

John Marcille

Supply meeting demand isn’t always good. We watched for years as young doctors displayed less and less interest in primary care. They’re only human, after all. An income difference between primary care physicians and specialists that can be measured in hundreds of thousands of dollars is difficult to ignore.

That’s why the point made by Barbara Starfield, MD, subject of this month’s Q&A, serves as a warning. “The specialist, oversuspecting the likelihood of a serious illness, will do a very expensive and unnecessary workup. And all the things that are done in an unnecessary and expensive workup have a finite chance of an adverse side effect, including death… If you don’t have something that requires a specialist, it’s dangerous to see one.”

It’s difficult to see how the marketplace can fix this problem, since the marketplace seems to be the cause. Health plans will need to come up with some creative approaches.

That’s what they seem to be doing in response to the economic slowdown that’s afflicting the country and industry, according to our cover story by Contributing Editor Martin Sipkoff. Some companies have decided to focus on underserved populations to help get them through.

“Insurers have the ability to change to meet the needs of the culture, and that is what they’re doing,” says Aetna spokesman Mohit Ghose.

Ghose’s remarks underscore just how proactive insurers need to be these days, a sentiment echoed by Paul Ginsburg, PhD, president of the Center for Studying Health System Change.

“Whether plans can continue to adjust to a changing market remains an open question,” says Ginsburg. “Those who do will survive. Those who fail to adjust fail to survive.”

A pretty stark assessment. Good luck.


2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
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Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
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