Outside of the DMCB's imagination, however, a very real version of the Transmogrifier lives on thanks to the Congressional plans for Medicare. How else can Medicare dial in ‘value based purchasing,’ ‘quality and efficiency,’ ‘accountability,’ and taxpayer savings’ without the use of an imaginary cardboard box and even more imaginary money?
Armed with these key insights about just what defines managed care, DMCB compared some key features of the U.S. Senate Finance Committee’s Framework to see if ‘managed care’ belongs on the dial. It may:
Selective Contracting: Under value based purchasing, only hospitals that meet yet-to-be-determined quality thresholds will receive favorable payment rates..
Predetermined Monthly Premiums: While unmentioned in the Framework, the payment mechanism for patients assigned to Medical Home pilots is likely to be a monthly fee. This is otherwise known as partial capitation, which is a common approach in managed care networks.
Utilization and Quality Controls: Physicians that exceed, compared to their peers, ordering high cost imaging services will be penalized. The only difference here is that physicians won’t have much of an opportunity to not agree.
Financial Incentives: That ‘I’ word is used to encourage Medicare beneficiaries to participate in healthy lifestyle programs that meet yet to be determined criteria.
Financial Risk: Under accountable care organizations, providers would be able to keep half of any savings they achieve for the Medicare program. While there are safeguards to promote quality, the fact is that the physicians will be under pressure to balance the patient’s needs against the need for cost control.
In the meantime, the DMCB plots its nefarious revenge on its wannabe Susan Derkins DMCB spouse.