America's Best Health Plans
Managed care doesn't have to be cold and uncaring. The highest-ranking plans have a positive attitude.
On the quality side, the flow of information is building. Many health plans also contract with private vendors to provide members with more in-depth information about hospital--and in some cases physician--performance. That allows consumers to push for providers with the best track records for procedures like coronary bypass, for example.
Now health plans are taking data mining to the next level to measure providers' efficiency at handling an "episode of care" --calculating the resources a physician uses to treat a case of pneumonia, for example, relative to his peers. Coupled with quality information, this efficiency quotient can be a powerful information tool for newly price-conscious consumers. "If a doctor is 20 percent more efficient, with equal quality outcomes, then you have a good notion of value," says David Gregg, a principal and senior consultant with Mercer Human Resource Consulting.
Whether such initiatives will take root and Americans will take to consumer-driven healthcare is an open question. But even critics applaud the notion of consumers' taking charge and agitating for better care. "Consumer power is crucial," says Berwick. "It's the only thing that will change the system: frustrated consumers demanding change." And melding a few of those changes just might make healthcare better--and more affordable--for more people.
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