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Martin Wolf on making Britain's financial sector smaller.

Atul Gawande on some of the most expensive health care in America.

Tim Fernholz on the youngest congressmen.

Matt Crawford on the joys and virutes of manual labor.

Aaron Kagan on a truly disgusting cup of tea.

By Ezra Klein  |  May 26, 2009; 6:00 PM ET
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Whoa. Atul Gawande knocked it out of the park.

This: "One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States."

Well, Atul then goes on to suggest this model be repeated, and, I think that's where we need to consider something that's been left out of the health reform conversations thus far: FTC and hospital/insurer negotiations. You've got some tension back and forth encouraging the doctors to meet and share best practices, but the FTC sometimes considering such meetings - if those same doctors attempt to negotiate as a group - illegal collusion. "Clinical Integration" is defined very loosey-goosey by the FTC (and it has erred on the side of insurers recently) but what Atul's advocating is, in fact, clinical integration. Now, per the FTC, providers that are truly clinically integrated can negotiate together. Insurers aren't going to go for that. Tricky.

Posted by: ThomasEN | May 27, 2009 11:12 AM | Report abuse

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