Pricing specialty carve-outs and disease management programs under managed care.

Continuous quality improvement stands at a crossroads. One road is dominated by the frenzied competition in the current health care marketplace. Another road is traveled both by a desire to compete against disease and by vulnerable employees, many of whom are represented by a weakened union movement. This article reviews this history and lessons and its relationship to CQI. Employee involvement, not just from a psychologic, but also a decision-making and even ownership perspective is necessary for CQI to succeed in the long term. Only with this type of involvement in hand can the trust between employee and employer required for genuine CQI be created.