Tuesday, January 10, 2012

That scary term - managed care

We all can remember when the concept of managed care came out. It was done by insurance companies and designed to benefit us. Yeah right. It meant we couldn't see the doctors we wanted because of they are out of network or the care we needed was denied. Well, now there is a new concept in health care which has two key differences from managed care.
  1. The name. Its now called Accountable Care.
  2. Its now focused on improving patient care. The managed care version was designed to "benefit everyone but patients".
So we have a fancy new name that is supposed to improve patient care. Why do we think us cynical Americans have no faith or trust in their health insurance companies? Because possibly we don't trust them? You mean the people who approve a procedure and then decide to 'unapprove' it once you have it done and you are stuck with a giant bill? Once burned twice shy, as the saying goes.

So what is Accountable Care anyway? Its called team work. Accountable care includes doctors, nurse care managers, pharmacists, health coaches, and more. Its a new concept being piloted by Medicare in certain parts of the country, including Eastern Massachusetts.

"Primary care doctors and some specialists increasingly are leaning on other staff members to help care for such patients. Staff pharmacists explain patients’ medication schedule and watch for negative drug interactions, health coaches teach people about their diseases or help them to lose weight, and nurse care managers take on a wide variety of tasks, including making sure a patient gets necessary lab work and follow-up care.

“Patients will feel that there’s more contact, that there are people who know them better, who are looking after them and providing them with more feedback,’’ Gilfillan said."

Traditionally doctors are paid for face to face appointments with their patients. Under Accountable Care,they will be compensated and rated on: "the care that their patients get throughout the health care system. That’s meant to encourage more coordination between hospitals and with other providers, so that physicians, for example, become more involved in the care their patients receive at rehabilitation facilities."

As a professional patient, I am all for looking at the big picture. Now I think medical facilities and doctors are concerned with the care that the patients receive under their care and less on the overall big picture. They don't care because there is no compensation for other care or for focus on the big picture. Patients are responsible for juggling appointments and getting test results from one place to another. We can't see our doctors or anyone with the flexibility we need to get the emotional support that our health is really being cared for.

When did the 'care' leave 'health care'? Maybe under 'accountable care', there will be 'care' again. But its still a pilot program so we will need to be patient patients while we wait for the 'care' to return.

1 comment:

Alley James said...

Accountable care start with first yourself. If you are willing to know or are curious for breast awareness then all system start working for you. So never stop yourself by lying that you know how healthy you are????