Sunday, April 17, 2005

AMA's American Medical News for a change has good news -HMOs are in trouble

The March 18, 2005 issue reports news from the annual National Managed Health Care Congress where speakers gave bad news to those who might think HMO's are the way to save money and improve quality of care. In that regard, one speaker talked about "broken promises". HMO members are down from 80.9 mllion in 2000 to 68.8 million in 2004 and the remaining HMOs are talking less about gatekeeping and more about open access. Richard Nixon in 1971 talked about HMOs as an alternative to the "illogical incentives" of the then status quo wherein he alleged that doctors and hospitals profited from illness not health and HMOs would reverse that incentive. The rhetoric was HMOs would profit from health, the reality has been they profit from not spending money on illness. The bad news from the meeting was the fact that Disease Management programs are still being sold as means of -guess what-saving money and improving quality and Pay for Performance is still on the front burner.

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