Managed Care

 

Never Being Satisfied Part of Job Description

MANAGED CARE March 2011. © MediMedia USA
Editor's Memo

Never Being Satisfied Part of Job Description

John Marcille
MANAGED CARE March 2011. ©MediMedia USA

John Marcille

Industrious human beings love to tinker to figure out better ways to do things. Probably one of the beauties of living in the United States is that such tinkering is not discouraged because entire financial empires have sprung up from somebody just trying to work it a little differently. We’ve taken tinkering and commoditized it.

Even science, with its strict procedures and close attention to cause and effect, bows to this idea. You never know what can come from blue-sky research, or from just getting out of your office and walking about.

As our cover story relates, one day Ken Kim, MD, a hospitalist and CMO at CareMore, was making the rounds. CareMore serves Medicare patients, and on that particular day Kim was horrified to find that 10 foot amputations were needed. Something needed to be done so the plan created a wound-care program that Kim describes as very unusual. CareMore also describes it as very successful, with the result being a reduction in diabetic amputations of more than 50 percent, according to CareMore CEO Leeba Lessin.

The point for me, at least, is that we can be dazzled by new technology — pharmaceuticals, surgeries, devices, whatever — but process improvement often pays bigger dividends. The story looks at two other health plans and their efforts to improve processes. The problems those plans — HealthPartners Medical Group, and Kaiser Permanente — faced did not present themselves in such a dramatic fashion. Still, the medical directors and others couldn’t leave well enough alone. They thought that there must be a better way to ensure appropriate use of imaging (HealthPartners), and that variation in quality across facilities and regions might be eliminated (Kaiser).

They came up with better ideas. It’s a challenge all of our readers face every day. Hopefully, these success stories will inspire more success.

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