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Here is the interview with the guy at Clalit on what they did to cut diabetes price by 40%. <http://healthcareeuropa.com/articles/20120523> It must be NICE to own the entire network from primary care to hospitals and do your own IT... On 23 May 2012 14:03, Joseph White <[log in to unmask]> wrote: > perhaps of interest, attached. from ted. > > Israel is the closest I can think of to a case. > > The ACO requirements appear to be written in such a way as to limit > accountability, as the industry insisted that actually being accountable > for saving money was mean and unfair. HMOs do compete with each other > but most HMOs aren't real HMOs; most U.S. insurance is PPOs, a different > animal; the competition in California is partly Kaiser versus > not-really-HMOs, but the not-really-HMOs are contracting with group > practices (each of which contracts with many different insurers). Or > there is some form of "integration" through IPAs. This is a gigantic mess; > for a sense of the complexity one might check out Ruth McDonald's work on > P4P in California. Ted and I have our name on one paper but it's all her > research: "Paying for Performance in Primary Medical Care: Learning > about and Learning from ‘Success’ and ‘Failure’ in England and California." > *Journal of Health Politics, Policy and Law *34:5, 2009, 747-776. > > cheers, > Joe > > On Wed, May 23, 2012 at 5:43 AM, Tom Foubister <[log in to unmask]>wrote: > >> ** >> If 'heavily regulated' means open enrolment, some kind of standardised >> benefits package, premium controls, risk adjustment across different >> competing HMOs... It's hard to see how this kind of framework has ever been >> present in the US in the HMO market. In so far as there is an HMO 'market', >> of course - do HMOs compete with one another, the 'managed' and the >> 'regulation' issues aside? In all one reads about Kaiser, one comes away >> with the impression that Kaiser competes with the more standard type of >> insurance arrangement, rather than with other HMOs, but I could be totally >> wrong. >> >> Also, in terms of new requirements coming from the ACA, I realise I don't >> know what special implications the ACA requirements have for HMO-type >> organisations, in so far as these implications differ from the implications >> for normal insurers... Could somebody perhaps clarify if possible? >> >> Good point about Israel - unlike Israel, other European countries with >> similar funding arrangements limit regulated / managed competition to >> purchasers and tend to see, within this context, vertical integration - or >> at least ad-hoc vertical integration - as anti-competitive (Hans Maarse >> mentions this in a HEPL paper, I don't have the reference off-hand). >> >> Max's point also points to the possible benefits (although the link would >> need to be established) of purchaser-provider integration for effective (in >> financial terms at least) care coordination and chronic disease management. >> In the US, I wonder, is there evidence that HMOs outperform, in this >> respect, the approaches to disease management of, say, Aetna and UHC? >> >> Sorry so many questions... >> >> Tom >> ------------------------------ >> *From: * Max Hotopf <[log in to unmask]> >> *Sender: * Anglo-American Health Policy Network <[log in to unmask]> >> *Date: *Wed, 23 May 2012 08:06:36 +0100 >> *To: *<[log in to unmask]> >> *ReplyTo: * Max Hotopf <[log in to unmask]> >> *Subject: *Re: 'integrated care' >> >> Does Israel not have competition between HMOs? Israelis are insured >> nationally and are then free to go to whichever HMO they wish. They can >> switch every two months. >> >> The largest, Clalit, has 15 hospitals, 1,500 outpatient clinics and 4.5m >> patients. It has just claimed that chronic disease management programmes >> have enabled it to cut the cost of diabetic patients from 3.5 times the >> average to just under 2 times - a 40% cut (that would save the UK £4bn). >> >> On 22 May 2012 23:23, Joseph White <[log in to unmask]> wrote: >> >>> Simon appears to have ignored the phrase "heavily regulated". >>> >>> The degree of integration could also be questioned. UCLA is heavily >>> integrated with what, by whom? >>> >>> >>> On Tue, May 22, 2012 at 5:44 PM, Fred Hyde <[log in to unmask]> wrote: >>> >>>> Re: "managed competition" >>>> >>>> Another unicorn, Michael, spotted only in the minds of those surveying >>>> the Jackson Hole scenery, long ago, and not since. Like more >>>> recent "unicorn" phenoms, the fact that we can name it does not mean that >>>> it exists. >>>> >>>> Fred Hyde, MD >>>> Fred Hyde & Associates, Inc. >>>> 57 Main Street >>>> Ridgefield, CT 06877 >>>> (203) 894-1412, (203) 417-3159 (c), fax (203) 894-1414, >>>> [log in to unmask] >>>> >>>> [Clinical Professor, Department of Health Policy and Management, >>>> Mailman School of Public Health, Columbia University, New York, NY] >>>> >>>> >>>> -----Original Message----- >>>> From: Michael Gusmano <[log in to unmask]> >>>> To: AAHPN <[log in to unmask]> >>>> Sent: Tue, May 22, 2012 5:33 pm >>>> Subject: Re: 'integrated care' >>>> >>>> It is not clear to me that something that looks like managed >>>> competiton exists in southern California...but even if it does, we have not >>>> been able to replicate this anywhere else in the country. >>>> >>>> *Sent from my Verizon Wireless Phone* >>>> >>>> >>>> -----Original message----- >>>> >>>> *From: *"Stevens, Simon L" <[log in to unmask]>* >>>> To: *Michael Gusmano <[log in to unmask]>, " >>>> [log in to unmask]" <[log in to unmask]>* >>>> Sent: *Tue, May 22, 2012 21:29:21 GMT+00:00* >>>> Subject: *RE: 'integrated care' >>>> >>>> ....southern California perhaps? >>>> >>>> -----Original Message----- >>>> From: Anglo-American Health Policy Network [mailto:[log in to unmask]<[log in to unmask]> >>>> ] >>>> On Behalf Of Michael Gusmano >>>> Sent: Tuesday, May 22, 2012 3:48 PM >>>> To: [log in to unmask] >>>> Subject: Re: 'integrated care' >>>> >>>> Following on that, has anything that looks like heavily regulated market >>>> competition among integrated care organizations ever been established >>>> anywhere? >>>> >>>> Cheerfully, >>>> Michael >>>> >>>> Sent from my iPad >>>> >>>> On May 22, 2012, at 12:38 PM, "Calum Paton" <[log in to unmask]> >>>> wrote: >>>> >>>> > Chris, >>>> > >>>> > No offence - was having fun being Mr. Grumpy. >>>> > >>>> > Re the serious debate: I do feel strongly that the health reform >>>> > industry in England has (what's the quote from Harold Wilson) taken >>>> > minutes* and wasted years. >>>> > >>>> > (*in this case, produced myriads of policy changes in cyclical and >>>> > indeed circular direction of travel) >>>> > >>>> > I know you can have 'integrated care' in a market context, or shall we >>>> >>>> > say in a 'post-purchaser/provider split' politics. Competing >>>> > HMOs/Enthoven's original model of managed competition (for Bismarck >>>> > rather than Beveridge >>>> > contexts): in England, citizens could choose among 'HMOs' ie >>>> > commissioner/provider organisations with no geographical catchment >>>> > basis as PCTs/CCGs had/have.....OR.....HAs/ PCTs/CCGs could be the >>>> > purchaser/commissioner choosing among 'integrated care organizations' >>>> > ie the citizen is still with the geographical purchaser, which chooses >>>> >>>> > among different 'integrated' providers. >>>> > >>>> > But to me these are Heath Robinson-esque, tortuous means of ticking >>>> > the 'market' box. This is done either on the grounds of ideology or >>>> > out of pragmatism (ie Old Tory/ New Labour/Coalition neo-liberalism is >>>> >>>> > the only show in town) ....OR on the grounds that integrated care >>>> > without competition is bound to lead to what Simon Stevens calls >>>> > doctors colluding behind the bike-sheds. >>>> > >>>> > But the 'empirical' question then becomes: is 21 years of market >>>> > economics moderated by 'garbage-can' (Cohen, March and Olsen) politics >>>> >>>> > more efficient/effective than a planned, integrated health service >>>> > with appropriate targets and outcome criteria? Put it another way: if >>>> >>>> > all the investment' in commissioning/the market/whatever had been >>>> > applied instead to improving and integrating a non-market NHS, would >>>> > we have got just as much benefit or more? >>>> > >>>> > Best, Calum >>>> >>>> This e-mail, including attachments, may include confidential and/or >>>> proprietary information, and may be used only by the person or entity >>>> to which it is addressed. If the reader of this e-mail is not the >>>> intended >>>> recipient or his or her authorized agent, the reader is hereby notified >>>> that any dissemination, distribution or copying of this e-mail is >>>> prohibited. If you have received this e-mail in error, please notify the >>>> sender by replying to this message and delete this e-mail immediately. >>>> >>>> >>> >> >