Here is the text from the draft of Senate health care reform legislation.
There is nothing new here, most health benefit plans already include such programs which are frequently a source of contention between the patient, their doctor and the plan. Whenever you have case management, there is frequently a course of action suggested that differs from what the doctor orders. That is not to say the alternative is bad, it may be very appropriate, but it is direct intervention between the patient and doctor and may result in a higher cost or less convenient care.
In the draft legislation preceding the above section we find the following words:
Do you see the potential for conflict? Do you think the average person will understand what is happening here? The above words sound great and what we all want to hear, but they are not always consistent with providing “affordable” health care. In reality the case management process will determine what is best for the patient (and the health care plan) and not necessarily the doctor…and that is nothing new.