tag:blogger.com,1999:blog-9181810725696409953.post2801909154471624720..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: Another Look At An "All Payer" System For Hospitals.Jaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-9181810725696409953.post-4998214245655242122011-11-10T10:38:39.430-05:002011-11-10T10:38:39.430-05:00The myth is the 'managed care plans', mana...The myth is the 'managed care plans', managed anything. Truth be known they discounted, and where it was a percentage basis deal, the units where merely increased, Where it was an RBRVS based conversion factor, the units where likewise increased. That began to shift in the full, partial or specialty carveout practices, though public push back, i.e., the 'as good as it gets' moment, began the unraveling of the capitated delivery system. <br /><br />Further, even in the most aggressive delegated full risk scenarios where large IPAs or multispecialty medical grougs (you know the ones who had the leverage, not some tepid health plan with one or a few medical directors) could play hardball, the UM denial rates rarely rose to 1% of total volume.<br /><br />Managed care was/is discounted care. They didn't manage the risks inherent in the population for who, they assumed responsibility.<br /> <br />Mature IDNs, e.g., KP, Mayo, ? Geisenger, were somewhat of a different story. They could more effectively 'manage care' via captive physician organizations and an integrated care culture, but they shadow priced in the market ergo premiums rose in tandem with their less mature breatheren IPAs layered on top of fee for services solo physicians for whom managed care was business as usual plus a withhold - pretty tame, and a formula guaranteed to fail.<br /><br />So, bottom-line, these insights are right on but not new, nor necessarily ground breaking.<br /><br />Thanks for piece Jaan.Gregg Mastershttp://acowatch.comnoreply@blogger.com