'Responsible choices': the Jackson Hole Group plan for health reform.

"Responsible Choices" identifies the actions that the private sector and government should take to improve the U.S. health care system and accelerate and expand the health care revolution that is already underway. Policy proposals are made for Medicare; Medicaid; reforming the tax treatment of health insurance; insurance reforms and expanding group purchasing opportunities; and improving the availability of comparative information on health benefit offerings, quality accountability, and cost and coverage data. The recommendations refocus the Jackson Hole Group's original managed competition proposals contained in The 21st Century American Health System (1991).

VIP interview: Paul M. Ellwood, Jr., M.D.

Paul Ellwood, Jr., M.D., is president of Health Outcomes Institute, a nonprofit health policy research organization, and President of the Jackson Hole Group in Teton Village, Wyoming, a health care reform policy think tank. He has been called one of the most important figures in American health care in the last half century. Dr. Ellwood has been a leader in introducing competition into the marketplace through health maintenance organizations (HMOs) and preferred provider organizations (PPOs); encouraging the business coalition movement; developing medical staff-hospital joint venture approaches to integrating health delivery, and installing the Outcomes Management System for payors, patients, and providers. He is now concentrating on working with health care leaders of the Jackson Hole Group to devise and implement The 21st Century American Health System, a comprehensive proposal for health care policy reform in the private and public sectors. Their objective is to ensure universal insurance coverage, managed competition, and health outcomes accountability.

Health care delivery update: Part 2. Banking on quality: the call for a quality reserve system.

In the health policy arena, policy-makers listen when physicians use quality as their battle cry in promoting or opposing health care innovations. Physician-managers are being challenged to measure quality and determine whether it is appropriate to deviate from community standards or expert opinion in providing care. Their responsibility extends to shaping their organization's culture and values, strategic planning, technology acquisition, and clinical performance. The effort to ascertain what constitutes genuinely effective medicine would be furthered by construction of a national Quality Reserve System. Designed to help--not police--individuals and organizations, it could accept data on diagnoses, processes of care, and functional outcomes and then provide "depositors" with evaluations of the effectiveness of various diagnostic and therapeutic approaches, suggest improved processes, and report on the clinical performance of each organization.

Health care delivery update: Part 1. Trends: less and more integration, bundled services, rethinking IPAs.

Vertical integration of national medical firms that contract with physicians has slowed dramatically. At the same time, several top-level group practices, taking advantage of reputations for excellence, are integrating vertically on a national or regional scale. A shift from buying well to actually managing medical care will separate the "prospective supermeds" that learned to collaborate with physicians from those that are attempting to manipulate them. In view of the budget deficit and the needs for long-term care, Congress is likely to espouse more drastic Part B cost-cutting measures such as a physician PPO or an indexed relative-value scale. An emerging feature in health care is the growing variety of prospective payment arrangements in which the price for various combination services is set in advance. To be truly competitive, medical care organizations will have to be more selective, choosing physicians because they are cooperative and economical and because they are capable practitioners.