title: Stages of managed-care evolution.
abstract: In the United States, health care is undergoing a transformation. The stages of evolution to a managed-care setting could be characterized as follows: (1) "The Push," (2) "The Squeeze," (3) "The Purge," and (4) "The Promise." Although the pace of change differs in various locations, these same stages will be experienced throughout the country. In the first stage, the move is toward per diems for hospitals, and payers are still focused on volume. In stage 2, integrated systems are beginning to develop, and payers are purchasing volume by negotiating deals. Primary physicians begin to flex their muscles, and specialists begin to panic. In stage 3, price clout rules, and results of quality measures will be reported. In the final stage, fewer health-care providers will be available, but they will be coordinated in large groups, and capitation contracts will prevail. Capitation--a fixed payment per health plan enrollee being paid to a provider for a defined set of services for a prescribed period--will replace a fee-for-service arrangement. In this managed-care setting, the management of diabetes, which afflicts 14 million Americans, is a major issue. It accounts for 14.7% of every health-care dollar spent in the United States, and much of that investment is for treatment of unnecessary complications. Positioning of the clinical endocrinologist as the primary-care physician for patients with diabetes is proposed as the optimal strategy for appropriate management of the patient and attainment of cost control.
authors.affiliation: MIIX Healthcare Group, Lawrenceville, NJ 08648, USA.
authors.forename: D
authors.initials: D
authors.lastname: Knowlton
authors.forename: M H
authors.initials: MH
authors.lastname: Group
authors.forename: N A
authors.initials: NA
authors.lastname: NA