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Confronting the Reality of Poorly Performing Plans

MANAGED CARE July 1998. © MediMedia USA
Editor's Memo

Confronting the Reality of Poorly Performing Plans

John A. Marcille
MANAGED CARE July 1998. ©1998 Stezzi Communications

John A. Marcille

Religious philosophers have often begun their discourses with a discussion of what's wrong with the world. The "bad" is a fact as plain as potatoes; what's "good" can be harder to pin down.

Novelists bemoan the difficulty of creating "good" characters who are interesting. Fascinating villains abound.

But in the business of health care, the focus is on the good, not the bad. Experts say finding good plans is easier than finding consistently bad ones and, anyhow, "Just how do you define bad plans?" and "Plans could be good at some things and bad at others" and....

Do these reactions point to a question flawed by oversimplification or do they point to an industry hampered by an unwillingness to police itself?

Our cover story looks at many issues related to identifying and dealing with health plans that miss the mark. I am heartened by some of the observations we report. But, apparently out of professionalism and perhaps some fear of retribution, most of the experts we consulted pulled their punches.

We are encouraged that there are so many pressures for quality in today's environment, but discouraged that physicians and small (and some not-so-small) employers are basically ignoring indicators of health plan quality in favor of cost and income considerations.

A pessimist would say that bad plans don't die, but live on, incorporated into another organization. But that's like saying a chicken doesn't die before you eat it. Its protein is incorporated into your body, but all the instructions for using it are yours, not the chicken's. In the present climate of corporate consolidation, recycling inefficient plans with poor processes for clinical improvement is one realistic and effective way that the market is confronting the issue.

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