How About Team-Based Care AND Experts

Jaan Sidorov

Posted 5/2/12 on the Disease Management Care Blog

Disease Management Care Blog readers may recall this snarky “It’s Team Based Care, Not More Experts” speechifying that challenged aJohn A Hartford Foundation report on the growing need for expert geriatric care.  The Foundation’s Program Director Christopher Langston responded and, rather than let it languish as a bottom-of-the-page-comment, the DMCB thought it warranted its own separate posting. Dr. Langston makes some good points:

The John A. Hartford Foundation has long recognized (here’s an example) that there are only 24 hours in the day and that teams are critical to delivering quality care in a cost-effective way.

So when we reported the results of our recent poll showing that despite the existence of the new Medicare Annual Wellness Visit benefit, older adults still aren’t getting important assessments (like fall risk, mood screening, or medication review) at adequate rates, we weren’t trying to doctor bash or even suggest that MDs should work harder. They just need to be sure that the work gets done by someone.

Continue reading “How About Team-Based Care AND Experts”

Should Health Insurers Cover Lung Cancer Screening with Low Dose CAT Scans?

Jaan Sidorov

Posted 4/9/12 on the Disease Management Care Blog

Remember this article on screening for lung cancer?

More than 54,000 former and current tobacco users who looked like they were free of cancer were randomly assigned to a yearly cheapo chest x-ray vs. a yearly pricey low-radiation-dose CAT scan. Over 5 to 7 years of follow-up, the CAT scan was better at picking up early lung cancer (119 cases) which translated into a small but statistically significant survival advantage of 62 lives saved per 100,000 patient years.

Does this mean that Medicare, Medicaid and all commercial insurers should “cover” a baseline and yearly follow-up screening CAT scan for tobacco smokers at risk for lung cancer?  According to actuary Bruce Pyenson and colleagues writing in the latest issue of Health Affairsthe answer may be yes.

The Disease Management Care Blog thinks the answer may still be no.

Is it being a heartless curmudgeon?  Read on and decide for yourself…….

Continue reading “Should Health Insurers Cover Lung Cancer Screening with Low Dose CAT Scans?”

Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record

Jaan Sidorov

Posted 4/04/12 on The Disease Management Care Blog

Every practicing physician using an electronic health record (EHR) has seen them.  Past diagnosis zombies that stumble endlessly through every encounter record.  “Coronary heart disease” that the patient never really had, “diabetes” that was only one possibility among many and a “fracture” that never appeared on any x-ray.

These undead conditions clutter the technology-enabled health system basically because of two EHR value propositions:

Continue reading “Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record”

A Thousand Dollars Says Dr. Ezekiel Emanuel Is Wrong About ACO’s Long Term Prospects

Jaan Sidorov

Posted 2/1/12 on the Disease Management Care Blog

Approximately 15 years ago, the Disease Management Care Blog was a speaker at a conference with an audience mostly made up of managed care leaders. It boldly argued the nation’s disease management vendors were going to help put the nation’s health insurers out of business by simultaneously assuming risk and lowering costs.

Hows that for chutzpah. The DMCB was never invited back, but not because it isn’t an outstanding conference speaker who deserves fat fees.

It was because it was utterly wrong.

And so is this online commentary on accountable care organizations (ACOs) courtesy of the The New York Times. In it, Dr. Ezekiel Emanuel boldly predicts that by 2020, ACOs will drive health insurance companies out of business. They’ll do that by assuming full risk, dropping patient barriers to care, coordinating services, fostering communication, promoting health, banning fee-for-service, increasing efficiency, relying on evidence-based care, being locally responsive and competing against other ACOs on cost and quality

Dr Emanuel is being astonishingly overconfident for four reasons.

Continue reading “A Thousand Dollars Says Dr. Ezekiel Emanuel Is Wrong About ACO’s Long Term Prospects”

More on the Death of Disease Management

Jaan Sidorov

Posted 1/30/12 on The Disease Management Blog

At the email prodding of several colleagues, the Disease Management Care Blog next turns its attention to a blog posting by Archell Georgiou MD provocatively titled “The Death Of Disease Management (Finally!).  The Archelle on Health Blog contrasts the industry’s early promises of evidence-based medicine plus patient self-care with the bitter fruits of non-existent savings, the disappointing Medicare Health Support (MHS) demo and a just-published anti-disease management New England Journal article.

Using that last Journal article as the final word, Dr. Georgiou provides her readers with a graveside eulogy of what went wrong:

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The Digitization of Health Information: Why Primary Care Is At A Moneyball Moment

Jaan Sidorov

Posted 1/17/11 on Disease Management Care Blog

In a yesterday’s post, the Disease Management Care Blog used Edie Weiner’s video presentation on digitization and commoditization to launch into its own version of health care futurism.  While it struggled with notions of “opportunity costs,” it concluded that a) highly evolved patient data bases, b) biometric monitoring systems, c) artifical intelligence-based decision support and d) growing consumer acceptance of informatics will make the need for many traditional outpatient visits obsolete.

Thanks to inspiration from the movie Moneyball, the DMCB explains why.  The movie chronicles the decision of the Oakland A’s General Manager (or “GM” played by Brad Pitt) to apply a more scientific approach to recruiting players. Eschewing the largely subjective evaluation process used by his veteran scouts, the GM decides to focus on a few key player statistics.  As a result, he recruits players with high “on base” metrics and comparatively low salary demands. Success follows, and not only does he build a championship team, but he is offered a job with the legendary Red Sox. There is a telling scene filmed at Fenway Park in which the Sox owner salutes the new revolutionary approach to baseball by giving a small soliloquy on the merits of adapting or dying. Building a winning team is no longer a highly tailored and subjective approach to individual players, but data, information and insights.

Lesson learned.

Continue reading “The Digitization of Health Information: Why Primary Care Is At A Moneyball Moment”

Why Medicare Access Is In Jeopardy In Both Salaried and Physician Owned Settings

Jaan Sidorov

Posted 12/21/11 on The Disease Management Care Blog

Don’t underestimate the physician dismay over the looming “Doc Fix” debacle. Unless some budget compromise gets hammered out, Medicare is about to stick it to a lot of docs.

Ever since the passage of the Balanced Budget Act of 1997, Congress has been repeatedly delaying a yearly mandated cut in Medicare’s physician fees. That statutory reduction has been slowly accumulating through no fault of the physician community and is now estimated to be more than 27%.  Assuming most physicians’ practices are made up by a majority of Medicare beneficiaries, that represents a huge hit to their cash flow. KHN has a good summary of the partisan mutual assured destruction that has led us to this crisis here.

Continue reading “Why Medicare Access Is In Jeopardy In Both Salaried and Physician Owned Settings”