Stage One would use the traditional fee for service approach, with a crude utilization review approach to managing care costs. Stage two would use capitation, with per member per month cost, but with good data systems to let providers know what was going on. Stage three, A truly integrated health care system with real information about procedures, costs and outcomes Curry thinks we are still in stage one. The data systems have been the Achilles heel for the managed care system. Medical care is not like an automated teller machine.
People keep the same pin number for years.
The move to automate the health care industry, which was the kingpin of savings, efficiency and better decision making simply did not materialize. Products could not keep up with market consolidation. Health plans, instead of saving money, were often fleeced by products that were smoke and mirrors or could not handle the capacity of some of these systems. With the failure to automate health care, some of the promised advances in outcomes and enhanced decision making could not come about either. What Curry would like to see is direct contracting between employers and providers.