We're in a quandary, says Paul R. Berger, MD, a consultant with William M. Mercer, pointing out that consumers do indeed mind having to pay more for choice. Technology has so often been pointed to as coming to the rescue of the health care system that you'd think that by now an expert such as Berger might be looking to another solution. You'd think wrong.
"The next phase of managed care that we're going to see over the next three to five years is going to include the notion of what we call high-performing networks," says Berger. "We're going to try to find, through the use of very credible software, which specialists are efficient in treating or giving diagnosis through what we call an episode of care. Employers are going to want that data, and are going to steer their people to the more efficient specialists."
Senior Editor Frank Diamond asked Berger about specialists during the course of research for our cover story on that topic. That consumers want less-impeded access to specialists is best illustrated by the dramatic rise of PPOs. "The growth in PPOs is fairly dramatic, and it's basically taking business away from the HMO platform," says Berger.
Berger is not the only one placing hope in technology. Alain Enthoven, PhD, has been promoting his managed competition theory for nearly 20 years now. This time he thinks it might take, partly because the employer-based system, in his view, has failed, and partly because new technology makes his proposal even more practical.
Making it work, in fact, is the unspoken subject of all our features and departments. From how coupons can help curb drug spending to Wendy Everett's look at pressures on the health care system to plans' need to use the proceeds of premium increases to better position themselves in the marketplace.
That progress can't solve many problems, and can even create new ones, is somehow beside the point. Like it or not, it's coming and folks like Enthoven and Berger and Wendy Everett, ScD, of the Health Technology Center and New England Healthcare Institute are encouraging you to catch the wave