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It’s the Right Care, the Right Place, It’s McKesson


Posted by Dr No on 04 October 2009

martini.jpgOne of the more toxic forms of health care delivery is a system known a “managed care” – an American import which takes a car fleet maintenance approach to looking after the punters.

At it’s heart – not that it’s really got one – managed care is about driving down costs by standardising care packages. You know the sort of thing: buy the brake pads in bulk to keep costs down, and fit them as per the schedule.

One thing such a system can never be is patient-centric. And yet that is exactly what McKesson UK, a subsidiary of the American Fortune 500 McKesson Corporation, a managed care provider, says it is.

Now, the McKesson UK website home page is not that easy on the eye. It uses a lot of orange, of the shade normally favoured by a mobile phone company. It also has a copy-writer who clearly likes the word “power”. There’s a whole lot of Power going on, and even some Empowering, for when Power alone is not enough. At times, there’s so much Power and Empowering Powering up that you might even be able to dispose of your normal energy supplier and just hook up to McKesson for all your Power needs.

On it’s website’s commissioning page, McKesson UK says:

“McKesson works with Healthcare Commissioners and Providers to develop and support evidence based competence in healthcare commissioning and delivery. Placing the patient at the centre of these competencies, our framework promotes Right Care, Right Place, Right Time.”

You can almost hear that Martini ad jingle in the background. Quite what that paragraph actually means is another matter.

There then follows a “commissioning tree” diagram, with text that is impossible to read without military grade image enhancement. A couple of paragraphs later (and after some more Empowering) comes the payload:

“Supporting comprehensive, collaborative Case and Care Management throughout a patient’s life:

In North America, over 1200 Managed Care Organisations and 3700 hospitals rely on us to help them meet their patient care and financial goals.”

The page then helpfully lists those goals, which include “cost stabilisation”, “reliable measurement and reporting” (which involves “unrivalled engagement with patients and providers by leveraging superior data and innovative technology applications”, whatever that means) and “provider engagement” amongst other Empowerment technologies.

Nothing about the patient being at the centre of things. This isn’t patient-centric care, this is managed care. Pure and simple. It’s about standardising care to drive down prices.

Should any doubt remain, a bit further on we have:

“McKesson has many years of working within the Managed Care organisations in the United States, and is able to bring innovative approaches to the challenges of UK health care planning and supply. Our full solution set includes:

  • Contract Management.
  • Disease Management
  • Health Promotion programmes
  • Telephone led pro-active outreach services
  • Internet based services for patients and doctors”

Telephone led services? Since when have telephones known how to lead?

What managed care means in practice is that some jumped up suit in an office tells doctors what to do. If you think that sounds a bit harsh, consider this from another page on McKesson’s website:

“Using information found in the medical record or supplied by healthcare providers, a care management reviewer determines whether a patient’s clinical status matches the criteria for a specific intervention or placement at a specific level of care. When there isn’t a match, a reviewer or clinical advisor can work with the attending clinician to decide on an appropriate course of action.”

A reviewer or clinical advisor? Who the hell are they? And who the hell said my clinical details can be shared with a giant American healthcare corporation?

What makes this alarming is that McKesson UK have already got their feet nicely under the NHS table. They run the NHS HR/payroll system and so already have a presence in every trust. Their American company has a vast managed care empire. Their UK website is loaded with Empowering (ie managed care) solutions. They are remarkably well placed to provide a managed care service for the NHS. It would be rather odd if they didn’t try to do so.

And – as it turns out - in fact they have. Buried deep in the website (after passing through more Power: “The Power of Evidence… …The Power to ensure appropriate care”) we come to:

“McKesson’s Appropriateness of Care solution InterQual ® provides evidence-based guidance to Rotherham Health and Social Care Economy to ensure right care, right place, right time.

Introduced by ITN's Martin Lewis, this video sets the scene for Rotherham Health and Social Care Economy Partnership’s use of InterQual, the undisputed Gold Standard in evidence based medicine. Currently utilised by no less than 5000 healthcare organisations in the USA; Rotherham is now pioneering its use here in the UK and proving beyond question its legitimacy and benefit to UK healthcare.”

Managed care is right here, right now, right or wrong. And that’s bad news, Mr Lewis.

6 comments:

Thank you for this excellent post, Dr No.

This is entirely the way in which the future will go under Labour or Conservative administrations, whoever is in power, as they have both sold their souls to the devil thanks to the appalling Anthony Blair.

To remind you of Edmund Burke's aphorism.

The only thing for evil to prevail is for good men to do nothing.

JD.

Thanks JD. I don't know whether I am more worried about the fact it has happened - we now have American managed care operating in the NHS - or the way it appears to have been done - by stealth.

The price of liberty is eternal vigilance and all that.

Burke's been hiding up at the top of my blog all along!

My apologies, Dr. No. I didn't see the quote hiding at the top of your page. That makes my comment somewhat superfluous.

I sometimes wonder if it is only people like you and me who care any more.

JD.

JD No need to apologise, and I don't think your reference to Burke was superfluous: what it actually shows is that we independently have the same view of what is happening: two separate votes as it were instead of one.

I agree with JD that this is an excellent analysis of what is happening and should serve as a warning. However with regard to the oft quoted excerpt from an Edmund Burke speech, what can good men do about it?

I think this is a timely question. We approach a general election in this country at about the same time that U.S. health reforms could lead to the managed care rats deserting that sinking ship only to jump aboard the NHS as a lifeboat.

I was impressed by the Civitas publication "Putting Patients Last" (Peter Davis & James Gubb) and wonder if something along similar lines from the likes of you 2 good men aided by Drs Crippen, Grumble, Northern Doc plus Militant Nurse and others might well be worth considering? I imagine a book along the lines of the Bad Science compilation of Ben Goldacre but instead based on themes that are covered in your and similar blogs.

I would be happy to act as an editor and write a background piece to try to draw the various threads together.

By collaborative working a few good men and women might just be able to contribute to a more informed debate in time for the proposed leadership debates before the next general election.

Are you (both)"up" for this? I have the time if you have the inclination!

PrisonerofHope - Thanks for your comment. Your remark about American rats jumping into an NHS lifeboat is very much to the point.

Thanks for your offer to put together a compilation. It's an interesting idea but I think it would founder on the matter of editorial control - we bloggers are all horribly independently minded - and of course we would quarrel mercilessly about who had pole position.

Getting back to Burke: what we can do is keep on exposing what is going on - and that is what we do. It is the first step towards getting accountability and that is the first step towards getting change.