As there is a dearth of evidence in the literature to clearly demonstrate that managed care models are consistently out-performing traditional Medicare models. Differences in model type (HMO, PPO, POS), in network access (broad versus narrow), and in regional influences and illness burden greatly complicate this effort. However, from a theoretical standpoint managed care should be superior to unmanaged care.
The pursuit of patient satisfaction surveys and quality and efficiency metrics should be encouraged and required for all health plans regardless of model type. Those that outperform should be recognized with additional compensation – as noted by my colleague Dr Bithoney, happily this is happening today albeit on a limited basis – and promoted broadly to expand their membership.
AHRQ, NQF, NCQA and others have worked diligently over a few decades to create measures that can be calculated with administrative data. With the growing availability of real-time lab and pharmacy data newer metrics are being enhanced. And as physicians convert from paper records to electronic platforms the task of evaluating the health status of populations over time and against predicted trends will be possible and should be encouraged – particularly by Medicare. Through the greater use of data including that from diverse and non-traditional sources or ‘big data’ we should be able to determine the best health plans and optimal delivery models, and secure the financial future of this most important program.
Ray Fabius MD
Chief Medical Officer