Number of comparisons HMO care was better than FFS care 4 HMO and FFS care were equivalent 19 HMO care was worse than FFS care 21 Total number of comparisons 44 Source: Kip Sullivan, “Managed care plan performance since 1980: Another look at two literature reviews,” American Journal of Public Health 1999;89:1003-1008.
“We find that higher levels of local managed-care penetration are associated with substantial increases in consolidation in hospital and physician markets. In the average market … between 1981 and 1994 … [t]his is equivalent to moving from 10.4 equal-sized hospitals to 6.5…. In the physician market, … [t]his implies a decrease in the percentage of doctors in solo practice from 38 percent in 1986 to 24 percent by 1995.” “We find that higher levels of local managed-care penetration are associated with substantial increases in consolidation in hospital and physician markets. In the average market … between 1981 and 1994 … [t]his is equivalent to moving from 10.4 equal-sized hospitals to 6.5…. In the physician market, … [t]his implies a decrease in the percentage of doctors in solo practice from 38 percent in 1986 to 24 percent by 1995.” David Dranove et al., “Is managed care leading to consolidation in health-care markets?” Health Services Research 2002;37;573-594.
“When Congress passed the health care law, it envisioned doctors and hospitals joining forces, coordinating care and holding down costs…. Now, eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups....” [P A1] “’If accountable care organizations end up stifling rather than unleashing competition,’ said Jon Leibowitz, the chairman of the [FTC], ‘we will have let one of the great opportunities for health care reform slip away.’” [P A27] “When Congress passed the health care law, it envisioned doctors and hospitals joining forces, coordinating care and holding down costs…. Now, eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups....” [P A1] “’If accountable care organizations end up stifling rather than unleashing competition,’ said Jon Leibowitz, the chairman of the [FTC], ‘we will have let one of the great opportunities for health care reform slip away.’” [P A27] Robert Pear, “As health law spurs mergers, risks are seen,” New York Times, November 21, 2010, A1.
“Events of the past year demonstrate beyond a doubt that managed care has failed – and failed dismally. The greatest single ethical crisis facing American health care as we move into new year is what to do about it.” “Events of the past year demonstrate beyond a doubt that managed care has failed – and failed dismally. The greatest single ethical crisis facing American health care as we move into new year is what to do about it.” Art Caplan, director of the Center for Bioethics at the University of Pennsylvania ("In 2001, managed care our No. 1 health crisis," MSNBC, December 21, 2001 http://www.msnbc.com/news/671464.asp, accessed December 23, 2001).
“Managed care is basically over. People hate it, and it's no longer controlling costs. Health-care inflation is now back in the double digits. So if it's not saving money, then why should we have it? But like an unembalmed corpse decomposing, dismantling managed care is going to be very messy and very smelly, and take awhile.” “Managed care is basically over. People hate it, and it's no longer controlling costs. Health-care inflation is now back in the double digits. So if it's not saving money, then why should we have it? But like an unembalmed corpse decomposing, dismantling managed care is going to be very messy and very smelly, and take awhile.” George Lundberg, former editor of JAMA who as recently as 1996 had co-authored an article defending managed care (Linda Marsa, “Former JAMA editor laments the state of medical care,” Los Angeles Times, March 26, 2001, http://www.latimes.com/print/health/200103 26/t000026016.html, accessed March 28, 2001).
“The ACO model builds on similar initiatives that Medicare has implemented in the past several years. Starting in 2005, the Physician Group Practice Demonstration engaged ten provider organizations and physician networks, ranging from freestanding physician group practices to integrated delivery systems, in a ‘shared savings’ reform. The providers in the demonstration continue to receive all of their usual fee-for-service payments.” “The ACO model builds on similar initiatives that Medicare has implemented in the past several years. Starting in 2005, the Physician Group Practice Demonstration engaged ten provider organizations and physician networks, ranging from freestanding physician group practices to integrated delivery systems, in a ‘shared savings’ reform. The providers in the demonstration continue to receive all of their usual fee-for-service payments.” Mark McClellan et al., “A national strategy to put accountable care into practice,” Health Affairs 2010;29:982-990, 983-984.
“[T]he model for the ACO program … has been tested in the PGP demonstration project that began in 2005. In the demonstration, 10 group practices … were permitted to receive bonus payments if they passed quality-of-care thresholds and achieved savings…. [T[he year 2 evaluation report documented that the essential reason for the overall savings across the 10 sites of about 1% … was from diagnosis coding changes the PGP sites initiated….”
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