Will external review undermine the ability of health plans to steer patients to cost-effective care?

Some health maintenance organizations use even stronger incentives to steer patients toward drugs they deem to be the best value for the money.

Perhaps physicians steer patients away from the hard stuff because they are concerned about the growing culture of megacocktails.

Without the ability to steer patients to particular drugs, the budget office said, Medicare would not have the leverage to obtain significant discounts.

Research suggests that counselors may steer patients toward, as one counselor said to me, "starting again with a clean slate."

These plans, hybrids of managed care and fee-for-service medicine, steer patients to certain providers.

But many experts say the way to get big savings is to steer patients to preferred drugs.

The alliance's goal: steer patients to the hospitals with the best records for each treatment.

The groups can then bargain with drug makers and steer patients to products that cost less.

The only way to get big savings and discounts, they say, is to steer patients to certain preferred drugs.