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Alain C. Enthoven
Journal Articles

Integrated delivery systems: the cure for fragmentation

Alain Enthoven
American Journal of Managed Care , 2009

Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs).

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Journal Articles

Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Kenneth J. Arrow, Auerbach A, Bertko J, Brownlee S, Casalino LP, Cooper J, Crosson J, Alain C. Enthoven, Falcone E, Feldman RC, Victor R. Fuchs, Alan M. Garber, Gold MR, Goldman D, Hadfield GK, Hall MA, Horwitz RI, Hooven M, Jacobson PD, Stoltzfus Jost T, Kotlikoff LJ, Levin J, Levine S, Levy R, Linscott K, Harold S. Luft, Marshal R, McFadden D, Mechanic D, Meltzer D, Newhouse JP, Noll RG, Pietzsch JB, Pizzo P, Reischauer RD, Rosenbaum S, Sage W, Schaeffer LD, Sheen E, Siilber BM, Skinner J, Stephen M. Shortell, Thier SO, Sean R. Tunis, Wulsin L, Yock P, Nun GB, Stirling Bryan, Luxenburg O, van de Ven PMM
Annals of Internal Medicine , 2009

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together.

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Books

Biomedical Informatics: Computer Applications in Health Care and Biomedicine, 3rd Edition

EH Shortliffe, JJ Cimino, Alan M. Garber, Douglas K. Owens, Sara J. Singer, Alain C. Enthoven
Springer , 2006

This book focuses on the role of computers in the provision of medical services. It provides both a conceptual framework and a practical approach for the implementation and management of IT used to improve the delivery of health care. Inspired by a Stanford University training program, it fills the need for a high quality text in computers and medicine. It meets the growing demand by practitioners, researchers, and students for a comprehensive introduction to key topics in the field. Completely revised and expanded, this work includes several new chapters filled with brand new material.

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Journal Articles

Employment-Based Health Insurance: Past, Present, and Future

Alain C. Enthoven, Victor R. Fuchs
Health Affairs , 2006

We review the rise, stabilization, and decline of employment-based insurance; discuss its transformation from quasi-social insurance to a system based on actuarial principles; and suggest that the presence of Medicare and Medicaid has weakened political pressure for universal coverage. We highlight employment-based insurances flaws: high administrative costs, inequitable sharing of costs, inability to cover large segments of the population, contribution to labor-management strife, and the inability of employers to act collectively to make health care more cost-effective.

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Journal Articles

New Directions for Public Health Care Purchasers? Responses to Looming Challenges

A McKethan, D Gitterman, A Feezor, Alain C. Enthoven
Health Affairs , 2006

State public employee health plans (PEHPs) provide health benefits for millions of state and local workers, retirees, and their dependents nationwide. This paper explores major issues and challenges that PEHP leaders and state policymakers are addressing. These include the perennial challenge of funding benefits for a diverse and aging workforce; new accounting standards affecting public employers; and the changing relationship between states, retired public employees, and the Medicare program.

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Journal Articles

Competition in Health Care: It Takes Systems to Pursue Quality and Efficiency

Alain C. Enthoven, Laura A. Tollen
Health Affairs , 2005

Many stakeholders agree that the current model of U.S. health care competition is not working. Costs continue to rise at double-digit rates, and quality is far from optimal. One proposal for fixing health care markets is to eliminate provider networks and encourage informed, financially responsible consumers to choose the best provider for each condition. We argue that this "solution" will lead our health care markets toward even greater fragmentation and lack of coordination in the delivery system.

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Journal Articles

Stanford University's experience with managed competition

Alain C. Enthoven, Talbott B
Health Affairs , 2004

Stanford University has a "managed competition" model of health insurance. Stanford contributes the cost of the low-cost plan, and employees are responsible for premium differences between this plan and other offerings. Each employee gets what he or she wants and is willing to pay for, and everyone has low-cost access to health insurance. Stanford risk-adjusts the premiums based on age and sex and plans soon to adjust including prescription drug data. In the past five years, premiums have risen rapidly, in line with the rest of the market.

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Journal Articles

Sustaining a market-based healthcare system

Alain C. Enthoven
Healthcare Financial Management Association , 2004

Purchasers of health care are not holding the healthcare system accountable for quality and cost. Employers need to: Offer their employees a wide range of choices in health coverage. Earmark for employees' purchase a fixed dollar amount for health care set at or below the price of the low-priced plan. Insist that carriers and providers report the quality of care delivered.

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Journal Articles

Market forces and efficient health care systems

Alain C. Enthoven
Health Affairs , 2004

The "market forces" to which economists ascribe the ability to motivate improvement in quality and efficiency are largely nonexistent in U.S. health care. One thus might ask, "Could market forces be made strong enough to deliver efficient health care systems?" There is some evidence to suggest that the answer is "Yes." This paper offers a short list of some changes that would be needed to create such a health care economy.

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Books

Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice

Alain C. Enthoven, Laura Tollen
Jossey-Bass, San Francisco , 2004

Toward a 21st Century Health System is a collection of essays that explore a key element of the health care delivery system -- large multispecialty physician group practices. Edited by policy experts Alain Enthoven and Laura Tollen, and written by a panel of health policy scholars and leaders including Stephen Shortell, Hal Luft, Donald Berwick, James Robinson, and Helen Darling, this resource addresses a variety of topics, including:

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Journal Articles

Employment-Based Health Insurance Is Failing: Now What?

Alain C. Enthoven
Health Affairs , 2003

Employment-based health insurance is failing. Costs are out of control. Employers have no effective strategy to deal with this. They must think strategically about fundamental change. This analysis explains how employers' purchasing policies contribute to rising costs and block growth of economical care. Single-source managed care is ineffective, and effective managed care cannot be a single source.

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Commentary

Selecting a Health Plan: Is Definity our Destiny?

Alain C Enthoven, Sara J Singer
Stanford Report , 2002
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Journal Articles

Fortune 500 Model for Health Care: Is Now the Time to Change?, The

Alain C. Enthoven
Journal of Health Politics, Policy and Law , 2002
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Journal Articles

Structural Problems in Managed Care in California and Some Options for Ameliorating Them

Sara J Singer, Alain C. Enthoven
California Management Review , 2001
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Journal Articles

New Prescription for Managed Care in California, A

Alain C. Enthoven, Sara J Singer
California Management Review , 2001
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Books

Near-Universal Coverage Through Health Plan Competition: An Insurance Exchange Approach

Sara J Singer, Alan M Garber, Alain C Enthoven
Washington DC: Economic and Social Research Institute in "Covering America: Real Remedies for the Uninsured", JA Meyer and EK Wicks, ed. , 2001

Sara J. Singer, Alan M. Garber,and Alain C. Enthoven have designed a comprehensive, new approach for expanding access to health insurance. The proposal is built on the following key elements:

THE PLAN WOULD PROVIDE near-universal coverage by making private plans more affordable and helping low- and middle-income people buy coverage. This would be accomplished though tax credits and by creating “insurance exchanges” that would provide health insurance choices and promote competition among health plans.

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Books

Health Care and Information Technology: Growing Up Together

Sara J. Singer, Alain C. Enthoven, Alan M. Garber
Springer-Verlag (New York) in "Medical Informatics, Computer Application in Health Care, Second Edition", Shortliffe, et al, editors. , 2000
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Working Papers

U.S. Experience with Managed Care and Managed Competition, The

Alain C. Enthoven
Presented at the Federal Reserve Bank of Boston's 50th economic conference , 2000

To understand "managed care," one needs to understand the traditional model of health care organization and finance that managed care was intended to replace. That model was aptly characterized "Guild Free Choice" by Charles Weller to indicate that "free choice" was being used as a restraint of trade to block the emergence of any form of economic competition among doctors. Its principles were: "Free choice of doctor at all times;" "free choice of treatment, i.e.

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Books

California's Struggle with Regulation

Sara J. Singer, Alain C. Enthoven
Jossey-Bass (Menlo Park, CA) in "Regulating Managed Care: Theory, Practice, and Future Options", Altman, Reinhardt, and Schactman, editors. , 1999

What should be government's role in a market-oriented health care system?

What's the appropriate amount of regulation?

Who should regulate-states, federal government, or market forces?

What role do the courts play in this regulation?

Are there existing models that might guide leaders in designing an effective regulatory structure?

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Journal Articles

Managed Care Backlash: Unrealistic Expectations Born of Defective Institutions, The

Alain C. Enthoven, Sara J Singer
Journal of Health Politics, Policy and Law , 1999
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Working Papers

Decreasing Variation in Medical Necessity Decision Making

Sara J. Singer, Linda A. Bergthold, C Vorhaus, S Olson, I Mutchnick, YY Goh, S Zimmerman, Alain C. Enthoven
California Health Care Foundation , 1999

Medical Necessity was not a problematic issue when remote third party payers rarely challenged physicians' decisions and reimbursed physicians for whatever procedures they chose to order and perform. Over the past several decades, the term medical necessity has served as an innocuous placeholder, enabling insurance plans and physicians to make judgments about coverage that were usually unchallenged.

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Journal Articles

Expanding Consumer Choice of Health Plans

Sara J Singer, Alain C. Enthoven
Managing Employee Health Benefits , 1998
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Journal Articles

Managed Care Backlash and the Task Force in California, The

Alain C. Enthoven, Sara J Singer
Health Affairs , 1998

Signs of a managed care backlash in California are increasing. This paper reports and interprets the recently completed work of the California Managed Health Care Improvement Task Force, focusing on the managed care backlash and the state's regulatory response. Although cost containment was a contributing factor, the causes of and solutions to the backlash differ among consumers, physicians, health care workers, politicians, and health plans. The recommendations of the task force could improve the market for health insurance.

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