The health reform debate is over—sort of. Thank goodness the President was able to sign into law a version of health reform that has enough going for it that it feels like a positive development. That may sound like a lukewarm endorsement. For someone who in his heart of hearts wanted single payer and at the very least a strong public option, my “endorsement” does come with a partial lack of enthusiasm.

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Toyota has long been the gold standard among business world thought-leaders for how it has managed to exemplify a seemingly impossible collection of achievements: optimal efficiency, optimal quality, and optimal profit. As it turns out, Toyota's seemingly impossible success may be turning out to have been actually impossible. Without commenting too deeply on the issue, because I don't know enough about it to come to any reasonable conclusions, it appears as though something in their famously regimented production and control systems fell by the wayside. With Toyota's image terribly tarnished for years and years to come, what companies do you think might take up the place at head of the line for quality and accomplishment? What do you think are the likely lessons to be learned from this experience?

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I just stumbled upon a really interesting article published in the Online Journal of Issues of Nursing (under the auspices of the American Nurses Association), and wanted to share it on this forum. The authors (three nurses and one MPH/MBA) set out to discuss how process innovation is crucial to health care practice. It is always invigorating to know that these conversations are happening around the country. The article highlights several specific examples of how innovative practices are being constructed and implemented. There seem to be concentrations of innovative energy in the Boston area, already a hotbed of medical, scientific and health-related activity, as well as within the Kaiser Permanente system. Related, also worth reading is a recent article in the NY Times Magazine about the fascinating work going on at Intermountain Health.

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Independence Blue Cross announced this Fall that they are discontinuing their Special Needs Plans for persons who are dually eligible for Medicare and Medicaid and their low-fee plan for other low-income Medicare beneficiaries.  Why?  They say the reimbursement rates from Medicare are not sufficient to provide case management, managed care, prescription drugs and additional services.  As many as 40,000 individuals in Southeastern Pennsylvania are affected by this and we just learned Aetna is also pulling out of the market.  While Aetna currently only has about 1,000 beneficiaries in its plan, all low-income beneficiaries will have fewer options as they choose new plans or return to traditional Medicare.  And, since IBC is by far the largest provider, the two remaining providers in the market will be taking on a particularly large burden.

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