Different health care delivery systems offer differing visions of efficiency

One California partnership that involved a large insurance company, a major hospital chain and a group of doctors has reduced health care costs. But a new report shows that the growing number of hospital-based physicians may ultimately be taxing Medicare resources. Meanwhile, a public hospital's attempt to redesign its care delivery model offers "a mircrocosm of reform goals."

Los Angeles Times: Health Care Partnership Pays Big Dividends
A rare alliance of health care rivals — a giant insurance company, a major hospital chain and a large doctors group — has managed to reduce health care costs through a radical new strategy: working together. The collaboration among Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group shaved more than $20 million in costs last year and prevented an insurance rate hike for public sector workers in Northern California (Helfand, 8/1).

Reuters: Are Hospital-Based Doctors Fueling Health Spending?
The growing number of hospital-based physicians in the U.S. could be taxing Medicare resources, government-funded researchers suggest in a new report. They found hospitalized Medicare patients checked out sooner when they were cared for by a hospital doctor than when their primary care physician followed them. Yet they were also more likely to bounce back into the hospital over the next month. As a consequence, the savings from the shorter original stay were offset by a higher bill for health services later — potentially adding up to an extra $1.1 billion across all Medicare patients. Hospital-based doctors, also called hospitalists, have become increasingly common in recent decades, and now tally some 30,000 in the U.S., according to the Society of Hospital Medicine (Joelving, 8/1).

California Healthline: Incentives For Public Hospitals A Microcosm Of Reform Goals
[Arrowhead Regional Medical Center in San Bernardino] has been adding internal medicine residency slots, building a new clinic, updating its disease registry, expanding specialty care capacity, launching the medical home concept, creating new stroke and diabetes care management programs, starting a redesign of the primary care system, and establishing baseline data for a plan to reduce hospital-acquired ulcers and infections. All of that is part of laying the groundwork for a total redesign of the medical center's care delivery model (Gorn, 8/1).