One 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.