Business-plan

I have read this book, and it does, indeed, provide a compelling view of how HMO's and managed care MIGHT change America and its health for the better; unfortunately, I belong to an HMO, the largest in the nation; and quite contrary to what Ken Jennings says (managed care will strive to ANTICIPATE patients needs, and meet them in advance), my HMO, the largest in America, has repeatedly proven it WANTS to anticipate my medical needs, and is more than willing to find any way possible to DEFLECT covering that need.

It has gone so far as to lose multiple sets of medical reasons under excuses so lame I wouldn't let my child pull them on their middle school teacher. (i.e. the mail ate your records- your doctor never sent your records- our computer had to be purged--- a new excuse every week.

I have repeatedly been shuffled from one manager to the next without resolution; I have been denied access to my neuro specialist for 7 months, to the point my specialist had to stop his practice due to the number of HMO's doing this very thing to him; my treatments were denied retroactively, leaving me exposed to thousands of dollars of care, which, without notice, my MCO insurer decided were not medically necessary. By the way, when I demanded to know the qualifications of 9 of the case managers who were handling my denials, none of them was a physician, none had any training in medicine, in fact, there was not even one NURSE involved in cancelling my treatment, or decision making regarding my care. Non-physicians (read clearks) have no business making medical decisions that affect the lives and health of real people. This book doesn't even begin to go into that arena.

In the meantime, my internist has notified me, after years of a chronic disease, that the insurer has DEMANDED that the physicians allow ONE 30 tablet bottle (a month) of medicine per patient per year be allowed on one of my symptoms. He said the next step will be (even though I am paying 9 grand a year for double insurance) will be that he will have to write ALL prescriptions for me, which my insurer will refuse to pay, and for which I will have to pay for with cash. Out of my pocket.

This is medical blaspheme.

Ken Jennings may have his eyes set on the stars, and may see wonderful things ahead with managed care, but from my experience, this is a dreamy fiction, based, not on reality, but on a PR based promo for managed care, and what it MIGHT, but will never become. This book is sheer fantasy. And if anyone of its readers thinks the day will come when consumers' needs will be anticipated, and then proactively filled by these nebulous managed care companies in the future, as this book predicts, I strongly suggest a long stretch in therapy. It will never happen in America. THIS is a total fiction, and although it makes for a pleasant, futuristic read, its basis in reality does not exist.

This book is absolute non-sense, and may be fine for a dreamer. But its application in real life, will never be realized unless there is major regulation in HMO's and managed care, to move it towards CARE for the individual, not careless-ness. Modern managed care is DESIGNED to limit care, limit access, and deny, delay, and stress the patient to the point they stop trying to fight the system, and give up, thus costing the insurer nothing. This book contains none of this, and therefore needs to be listed in the fiction area, not non-fiction. This is sheer myth.

A recent editorial in the NEJM (6/25/98) noted, "An old management-consulting adage reads: 'Good, fast, cheap: pick any two.' In health care, the contemporary equivalent seems to be: 'Quality, accessibility, affordability: have all three.'" In this book Jennings, et al provide a comprehensive and detailed vision as to how these three seemingly conflicting ambitions can be simultaneously achieved. A number of modalities to achieve this, including integrating patient/consumer empowerment and responsiveness, and the intelligent implementation of information technology are described and elucidated by example. This book better than any single source I've found provides a coherent strategy for the evolution of health care enterprises. This may become the Rosette Stone to the successful metamorphosis of the US health care system.

"Few health care organizations will survive or succeed without undergoing transformation," said Ken Jennings, co-author of Changing Health Care and a partner in Andersen Consulting's Healthcare practice. "They are beginning to realize that what kept them going in the past will not necessarily serve them well in the future." Andersen Consulting authors Jennings, Kurt Miller and Sharyn Materna collectively have more than 50 years of experience helping hundreds of clients in health care and related industries. Changing Health Care forecasts that successful organizations will transcend today's competition on cost and, instead, gain marketshare by customizing health care services to the individual. A "New Breed of Consumer" Savvy new consumers are assuming greater responsibility for their own care, arming themselves with previously restricted information and redefining the very nature of health care services, said Kurt Miller, co-author of Changing Health Care and a partner in Andersen