The Financial Manager's Guide to Managed Care & Integrated Delivery Systems: Strategies for Contracting, Compensation & Reimbursement

Rating:
Summary: Outstanding First Look into Managed Care
Review: Paul DeMuro's book is a fine start for a financial manager to gain an understanding of the profound effects of Managed Care's penetration into healthcare in the U.S.

One of the many strengths of this book is the author's reasonably balanced, factual analysis of the financial incentives and financial risks of healthcare providers and insurers, and the role that incentives and risks play in either sustaining or endangering a variety of healthcare provider organizations' business models.

Of course, we all have our biases, and an analysis can remain both balanced and illuminating even when it is biased. Mr. DeMuro accepts, with virtually no examinatione, that capitation (payment to providers based largely on patient populations, rather than on services provided to actually-seen patients) is not only the future of U.S. healthcare, but an appropriate future. He does not, and does not really need to, examine this contention. However, it is worth noting for posterity that the mainstream justification for the "appropriateness" of managed care in healthcare's future is the controversial assertion that managed care's allegedly fresh new, business-like emphasis on cost saving incentives will punish (or reward) newly-capitated healthcare providers, most of whom historically emphasized restorative medicine heavily over preventative medicine, if they do not (or do) quickly transform their professional culture to effectively champion preventative medicine. Although we often hear these concepts "spun" as "incentives" for PR reasons, the reality looks a bit more like financial punishment for business as usual by slow-to-change healthcare providers. If providers can really accomplish this transformation to prevention (which, from this patient's perspective, seems a long ways from being widely accomplished at this point) -- and empower their patient populations to really avoid illness and injury -- the providers can thereby improve the profitability with their capitated patient population. Of course, if they cannot, overall patient satisfaction with managed healthcare will continue on it's current downward slide, while providers suffer financially and howl in complaint, due in part to what may be futile attempts with these alleged "incentives" that appear to be more "stick" than "carrot". Anyway, if you seek evidence to support the assertion that patients do not benefit from managed care (and you are actually reading a review of this book) you consideringt the wrong book, friend.

Having said all of that, its very important to note that understanding capitation and managed care remains an obviously necessary foundation for understanding healthcare in the U.S. Precious few experts are predicting managed care's impending withdrawal. As such, the author's bias ends up being practical, and, of course, completely acceptable in light of the book's title and in light of the "real-world, real solutions, right now" industry-insider perspective of the "Healthcare Financial Management Association" (HFMA), which endorses this fine book.

Since this book was publised in 1995, many changes in healthcare have occurred. Some of these changes, such as Medicare's adoption of "Ambulatory Patient Groupings" (now called "Ambulatory Patient Classifications"(APC's), were predicted here by the Mr. DeMuro. So, unless you, the prospective reader, are already an experienced healthcare financial pro, the book's lack of completely up-to-date currency is insignificant when compared with it's clear presentation of authoritative information.

In closing, Mr. DeMuro's opening remarks about his "uniquely valuable perspective" as a commentator on Managed Care are, happily, very well supported by his fine book. Although, in additon to this book, you may need additional resources to construct an actual payor-provider contracting strategy, you will likely find that some, if not all, chapters reward your eyes with clear, authoritative explanations of the many complex financial relationships among today's healthcare players. If this book's title appears relevant to your needs, then will be satisfied. Good reading!