A Managed Medical Network and Taking Out The Trash

Without implementing a national Medical Network strategy it is difficult to see how we can really save health care.  Burdened by growing medical costs due to over treatment, health care consumes too much of our national treasure without providing any real benefit. As for us, the payers for health care insurance, premiums continue their inexorable rise.

Managed Medical Networks can change all that.  By bringing all cooperative providers together into a single, well managed medical network, we  can improve health care while taking out the trash (getting rid of waste and unnecessary care).  The key is in having a single, non-competitive network.  This will allow us to rationalize health care in a way that is impossible now.  For example:

• The Network would provide health care services to all insurers and their policyholders; this would eliminate the possibility of health care providers playing insurers off against each other and setting their own fees – in other words, providers cannot game the system;
• The Network can collect data on best practices nationwide in one  coherent database; this aspect is critical for rationalizing health care.  If we don’t know what works, we can’t advise providers on best practices;
• The Network can pay providers based on negotiated contracts in which the objective is to pay fairly and promptly.  Do we want doctors to prescribe based on clinical finding or do we want to fight with them?  Pay them fairly and get them on our side;
• The Network can obtain voluntary agreements for all participating providers to provide services under the principles of “lean medical care”; that is, care providers only prescribe services indicated by the clinical findings; this is key to eliminating the waste and unnecessary care in the current health care system;
• The Network is managed by medical professionals, not payers; payers always are concerned with costs, the Network is only concerned with appropriate care for patients and factors necessary to provide that care;
• In a rational system, all participants must benefit equally; we must recognize their needs and respond clearly and unequivocally;

What the Managed Medical Network is not.

• The Network is not an insurer;
• The Network does not determine who gets health care and who does not; that is the role of the insurer, private or public;
• The Network does not ration care;
• The Network does not focus on cutting health care costs; rather, it tries to assure that all patients receive appropriate care as defined by “lean medical care” and best practices.

The use of a Managed Medical Network offers a type of health care reform that can truly work.  It allows for a single payer system without government intervention.  It lowers medical losses and insurance costs which can translate into lower insurance premiums. Most importantly, it is the only approach that can “Take Out The Trash” (lower costs) without rationing.