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Health Care Checks & Balances - What Goes Around Comes Around



 Now we have insurance companies buying hospitals and provider practices...didn't we see this before?  It did not work last time, why is it going to work this time?  Sorry, Yogi, but it is like deja vu all over again!

While there are many faults of the current healthcare system in America, we do, theorectically, have checks and balances.  The payers oversee that the providers are performing valid services and charging appropriately for them.  The providers "police" the payers to ensure fair and accurate payments (as much as they can given the cloak of darkeness around the reimbursement rules).  The Government should be the entity overseeing the whole system to ensure it best meets the American public's needs and the needs of our society.

CHeck & Bal  08.10.2011

Unfortunately, over the past 30 years, the blurring of lines between these entities has reduced the effectiveness of all of them.  Healthcare is a complex problem/issue/expense and in order to optimize the processes, we need to have clear roles and responsibilities outlined so that entities can work effectively in their space.  When payers buy providers or providers become the payer, this reduces the effectivenss of the parts.  Can synergies be created through staff model HMOS?  Certainly, Kaiser and others have demonstrated an effective way to make this work.  But, that does not mean all payers can effectively run the delivery of healthcare.

The Government has also gotten too far into the trees, that they do not see the forest.  Both Federal and State Governments has lost their perspective to provide oversight by being actively involved in the payment and delivery of healthcare.  While we keep arguing about National Healthcare, with over 50% of our healthcare bill being paid by the Government through Medicare, Medicaid and other programs, the US is the largest Government run healthcare system in the world.

The 25 criteria to achieve meaningful use, edi transactions sets and all the other government regulations will not solve the healthcare crisis in America.  Neither will payers buying providers in the search for an Accountable Health Plan.  Accountability, like morality, cannot be legislated -- it takes each of us to "do the right things for the right reasons" and to look at the totality of a situation, not just how do I maximize MINE.


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