The story of aviation's re-invention of itself along the lines of strict quality control, sophisticated quality metrics, and dedicated use of checklists is one that is often told in health care circles. It is an object lesson, of course, in how health care might be or a study in contrasts, if you will.
And now we see the beginnings of even more aviation style performance rigor possible in Boeing's direct contracting with health systems. Boeing has moved — first in Seattle and now in Charleston, South Carolina and St. Louis, Missouri — to direct contracting.
Why do this? Have Intel's first direct contracts in New Mexico and Lowe's and Wal-Mart's limited direct contracts for certain specialties (orthopedic and cardiac surgeries) yielded such great returns that it has become a no brainer?
Actually, little public data is out there, though the cost savings must be substantial for Boeing to be able to reward employees who select health plans operating under the new direct contracts with free primary care, free generic prescriptions, reduced premiums, and more substantial health savings account contributions — an offer some 30 percent of eligible employees in Puget Sound accepted last year.
Boeing seems persuaded direct contracting can lower cost and improve quality. As Modern Healthcare so diplomatically quotes a Providence-Swedish Health Alliance executive: "Employers set demands for services that exceed typical expectations in the healthcare industry."
Missouri State of Mind 
Is an airplane, a fixed,known engineering construct, the same as a population of humans ?
Is an industrial model that works to ensure the quality of rivets and aluminum sheet a model that works when an MD examines a person ?
physicists boast about how they can predict the universe; as Feynman noted, ask a physicist what happens when you push water thru a pipe – he can’t tell you !
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