Boston Globe 6/21/2022

Dr. Paul M. Ellwood Jr., who changed the way millions of Americans receive private medical services by developing — and naming — the model for managed care known as the health maintenance organization, died on Monday in Bellingham, Wash. He was 95.

• Dr. Ellwood envisioned large nonprofit organizations that would compete for patients by providing the best care at the lowest price and that would contain costs by keeping patients healthy to begin with, through an emphasis on preventive medicine, including regular physical exams, well-baby checkups, mammograms, and immunizations.
• Dr. Ellwood, too, worried about the effects of cost controls on quality of care, especially after federal and state policy changes encouraged the growth of for-profit HMOs. As HMOs grew, merged, and became enormously profitable, he repeatedly voiced disappointment with the way his original ideas had worked out in practice.
• In later years he championed what he called “outcomes management” — a national database to show how the treatment of patients actually works out. Without such measures, he argued, health care providers and policy makers had no way of knowing whether care was being compromised to cut costs, and no way to evaluate proposals for reforms.  We have to create an agency to collect health outcomes data, isolate it from the rest of the government and the rest of the health system, and then use its findings to determine what it is that’s worth spending public or private money on for health care,” he said.

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