The entry of the United States health care system into the “era of accountability” was heralded by Arnold Relman, MD, then editor of The New England Journal of Medicine, in 1987. This new era of medicine was envisioned to involve a greater emphasis and reliance on evidence in setting policies and, most especially, a system whereby provider groups or even individual providers could be evaluated on the quality, effectiveness, and efficiency of the care that they delivered. Since that widely acclaimed heralding, health care constituencies have entered this “house of accountability,” but they have not made it much past the front foyer.
Clearly, considerable resources and efforts have been invested in making decision-making in health care based more on evidence. Although all clinical researchers have long lived by the “evidence-based decision-making” credo, one of the two major accomplishments of managed care in the 1990s was enhanced integration of this basis for decision-making into processes for establishing clinical policies, health policies, and coverage policies.
However, the brief era of managed care in the United States did not establish substantial capabilities to evaluate the quality or value of care delivered. Rather, the focus of the managed care environment in the 1990s was on micromanagement rather than on more global analyses and interventions. Managed care companies attempted to improve the value of the care that they managed for patients and employers, as purchasers, through focus on and scrutiny of individual care decisions, often at the point of delivery. Although such attempts at point-of-care...
If the inline PDF is not rendering correctly, you can download the PDF file here.
William T. McGivney, PhD, is the Chief Executive Officer of the National Comprehensive Cancer Network and a recognized expert in coverage policy and drug and device regulatory policy. Before joining the NCCN in 1997, Dr. McGivney directed the Division of Health Care Technology at the American Medical Association and worked for Aetna Health Plans as Vice President for Clinical and Coverage Policy. Awarded the FDA Commissioner's Medal of Appreciation in 1989, Dr. McGivney has served on numerous national boards and committees. He earned his PhD at the University of North Carolina at Chapel Hill and completed a postdoctoral fellowship in the Department of Psychiatry at the Harvard Medical School.