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Journal Article


Lost in Translation: Physicians' Struggle with Cost-Reduction Programs

The Issue

Relationships among health plans, the business community, and physicians are often strained—particularly when it comes to discussions about redesigning health care delivery. Fears of reduced income and limits on personal autonomy often lead the medical community to resist reforms proposed by payers or health plans. In this article, the author identifies another, largely unrecognized, factor: the lack of a common language that engages each group.

What the Study Found

In industry meetings, the author observed physicians withdrawing from cost-control conversations because of business language that evoked distrust and anger. As payers describe the need for reducing health care costs, physicians may hear an indiscriminate call for reducing services and the prioritization of dollars over patients. Focusing instead on identifying overuse and underuse of services can raise practitioners' comfort level, the author says.


Based on his observations, the author recommends the following steps for broaching the subject of cost reductions:

  • Define the intent of the project in language that practitioners respect. Promote affordable health care by encouraging the delivery of clinically appropriate services.
  • Anchor physician engagement programs in a statement of core values; honesty, transparency, and respect, for example, resonate with physicians.
  • Engage physicians early in the process of vetting areas of overuse, misuse, and underuse.
  • Develop and share accurate variation data on the measures selected.
  • Present the data without judgment during data visits.
  • Discuss the evidence behind use recommendations and view physician engagement in change as a process, not a one-visit objective.
  • Practice "bilingualism" when bringing stakeholders together: describe results in terms of both appropriateness and cost reduction.

Publication Details



H. B. Beckman, "Lost in Translation: Physicians' Struggle with Cost-Reduction Programs," Annals of Internal Medicine, March 15, 2011 154(6):430–33.