Saturday, October 27, 2012
To read the piece, visit the following link: http://www.nejm.org/doi/full/10.1056/NEJMp1204487
We hope you enjoy and would love to hear your feedback!
Tuesday, May 1, 2012
In a YouTube video presentation by Dr. Paul Grundy of IBM that can be found at the above link he describes 3 trends he is seeing:
1. Cost: good comprehensive coordinated patient-centered care saves money
2. Data: we can now help physicians make better clinical decisions because we now have the data needed to do so (how could he give a presentation without mentioning "Watson"?)
3. On-line asynchronous care: medical homes succeed because they allow for on-line and asynchronous care where you don't have to see your doctor to be treated and they don't have to see you to get paid. In this new information age our children will not put up with receiving care any other way.
In short, this is nothing new but it is all coming together across the country. The government, insurers, employers, providers, and patients are all recognizing that accessible, coordinated, patient-centered care really does save money and make people healthier.
You CAN have your cake and eat it too.
Monday, April 30, 2012
Much has been made of the problem of prices in our health care system. Uwe Reinhardt, back in May 2003, wrote an article in Health Affairs titled It's the Prices Stupid: Why the United States Is So Different From Other Countries. He's been writing about the issue ever since. In short, payers in the US system pay far more for the same services in absolute dollar amounts than payers in other health systems around the world.
- Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.
- Price variations are not correlated to (1) quality of care, (2) the sickness or complexity of the population being served, (3) the extent to which a provider is responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.
- Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers.
- Variation in total medical expenses on a per member per month basis is not correlated to the methodology used to pay for health care, with total medical expenses sometimes higher for globally paid providers than for providers paid on a fee-for- service basis.
- Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts.
- The commercial health care marketplace has been distorted by contracting practices that reinforce and perpetuate disparities in pricing."
Monday, March 26, 2012
Thursday, March 22, 2012
Wednesday, March 21, 2012
Friday, March 9, 2012
On February 22, 2012, President Obama signed legislation to cut funding from the Prevention and Public Health Fund. This fund was created by the Affordable Care Act (ACA) and invested $15 billion over 10 years to prevent disease and promote wellness in our society. This was a major advancement in U.S. health policy which shifted focus on creating a healthy and productive society rather than one that only reacts to disease once patients are already ill.
Prevention and public health are frequently the first place to start enacting cuts, but this is a huge mistake. Most diseases and causes of death in the U.S. are preventable, yet we continue to turn our backs on efforts to stop disease, illness, injury, and even death before they develop. When we have an unhealthy society, this affects many sectors of our economy as sick or injured workers are not as productive as they could be. Additionally, by continuing to only invest at the end of the line, care is reactionary and costly for the patients.
I think three primary reasons explain why investments in public health and prevention are often overlooked. First, people do not understand what public health is. It is more than just responding to infectious disease outbreaks or tracking influenza strains. Public health makes sure that the food we eat is sanitary, the air we breathe is clean, and that our roads are safe to drive on. Nearly every facet of our lives places us in danger, but public health professionals seek to minimize risks. Most public health interventions are inconspicuous and out of the public eye, so it is not surprising that political will for public health initiatives is minimal.
Second, prevention does not make anyone any money. Health care is big business these days and bottom lines for those in the health industry only decrease when people are healthy. Money comes at the end of the line: surgery for the diabetic with a foot ulcer, radiation for the cancer patient, and laser treatments for cervical pre-cancerous lesions are profitable interventions. Building a society that facilitates health and wellness reduces profits for many influential stakeholders.
Third, public health and prevention does not create the emotional appeal that many other political topics do. Take abortion, war, or even education. These issues are emotionally charged and can be divisive. Public health does not have the same appeal and as a result, it is often overlooked. Legislators are able to make cuts in this area without the political fallout or emotional reaction.
Cutting funds for the Prevention and Public Health Fund is unfortunate. Grassroots movements and public awareness campaigns are needed to highlight the necessity of public health interventions; I believe these campaigns should be led by primary care providers. Primary care providers are respected and are leaders in building a healthy society. Getting involved at the grassroots level is the best way to show communities, states, and the nation, how important investments in public health and prevention are to our country.
Health Affairs Policy Brief, “The Prevention and Public Health Fund,” Health Affairs, February 23, 2012
Schroeder, S., "We can do better -- Improving the Health of the American People," The New England Journal of Medicine; 2007; 357: 1221-28