Check out this article in the Archives of Internal Medicine by Smith and colleagues. They studied the impact of a two mailings designed to promote the long-term use of beta blocker medications among survivors of a heart attack. They found the intervention had a modest impact, but that’s not the point. During the course of planning the study, the authors received feedback from patient focus groups suggesting ‘they would be most likely to open and read a letter if it came from the clinician; resource constraints prohibited this goal, but the letter did come from a health plan physician administrator’ [italics mine].
Wait a minute. Closer reading reveals this study was conducted ‘prepaid integrated care delivery’ sites in the Kaiser system, at Harvard Pilgrim and at HealthPartners. Aren’t Integrated Delivery Systems (IDS) already supposed to have the resources necessary to coordinate care around the most appropriate physician?
Or, do they frequently turn out to be some version of same old managed care?
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