Current and future developments in managed care in the United States and implications for Europe.

The paper reviews and evaluates current and future approaches to cost containment in the United States. Managed care was once seen as an effective approach to supporting health care quality while containing costs in the USA. In recent years payors started to look in other directions, since prospects for limiting expenses faded.

Benchmarking and clinical pathway implementation on a multihospital basis.

Hospital utilization data for communities with high levels of managed care penetration can be readily used to develop utilization benchmarks in any proactive efforts to prepare for oncoming prospective pricing system (PPS) initiatives. In a cooperative effort among all four Syracuse, NY hospitals, the combined average hospital LOS for one surgical and three medical DRGs was compared with benchmarks derived from similar populations in three heavily managed care-penetrated west coast communities. Implementation of clinical or critical paths are a widely accepted approach to shortening hospital lengths of stay and improving both resource usage and clinical outcomes.

Benchmarking for clinical pathways in hospitals: a summary of sources.

Benchmarks are criteria and standards for resource expenditure, as well as other variables, derived from organizations or communities which have been identified as models of the most effective and efficient practices. The development of benchmarks is crucial to reducing lengths of stay and related costs in hospitals. Useful sources for benchmarking data and how to access them are summarized.

Enlisting physician support for practice guidelines in hospitals.

Available experience indicates that physician support is crucial if clinical pathways are to support quality of care while reducing lengths of stay and resource use. Enlisting such support requires understanding of physician perspectives concerning the quality and delivery of health care. It also requires the development of data systems as a means of communication with physicians.

Development and implementation of a program to reduce hospital stays and manage resources on a community-wide basis.

The study describes an effort to reduce hospital stays and limit the use of expensive resources in the metropolitan area of Syracuse, New York. The program included the implementation of clinical pathways for a number of surgical procedures and medical diagnoses. The effort involved the identification of specific resource variables in a wide range of clinical disciplines.