Patient Engagement and Medical Homes – Core Drivers of a High-Performing Health System

Jane Sarasohn-Kahn

Posted 3/30/12 on Health Populi

It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world.

Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized inInternational Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey, published on The Commonwealth Fund’s website on March 29, 2012.

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Is North Carolina Medicaid the Healthcare Industry’s Solyndra?

Al Lewis

Posted 2/21/12 on The Health Care Blog

North Carolina Medicaid recently reported, for the third time, using a third consulting firm, the achievement of massive savings through its patient-centered medical home (PCMH) program, now called Community Care of North Carolina (CCNC). Among other things, CCNC pays the physicians more money in order to encourage and compensate behaviors and processes, including enhanced access to care and case management, to hopefully reduce the need for emergency and inpatient services. (A brief summary of this and past consulting reports appear in the current issue of Modern Health Care.

However, the third time is not a charm. Notwithstanding these consultants’ reports — which paradoxically support my contrary conclusions by choosing to ignore the overwhelming data contradicting their own claims – the program is a total failure as far as reductions in cost and inpatient utilization are concerned.

Continue reading “Is North Carolina Medicaid the Healthcare Industry’s Solyndra?”

The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System

Jane Sarasohn-Kahn

Posted 2/7/12 on Health Populi

U.S. health consumers’ purchase and use of over-the-counter medicines (OTCs) generate $102 billion worth of value to the health system every year. Half of this value accrues to employers who sponsor health insurance for their workforce; 25% goes to government payers (e.g., Medicare, Medicaid); and, 25% returns to self-insured and uninsured people.

For every $1 spent on OTCs, $6.50 is saved by the U.S. health system, shown by the chart.

For millions of health consumers, OTCs substitute for a visit to a doctor’s office: most cost-savings generated by OTC use are in saved costs of not visiting a clinician, as discussed inThe Value of OTC Medicine to the United States, published by the Consumer Healthcare Products Association in January 2012.

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Putting the Mouth Back Into the Body

Patricia Salber

First posted 9/29/11 on The Doctor Weighs In

Medicine has been great at creating body silos over the years.  The most obvious example is the disconnect between physical health and mental health.  Physical health providers often find it very difficult to get information about their patients’ mental condition from their patients’ mental health providers and mental health providers rarely connect with physical health providers to really understand the total health picture of the person they are treating.  Vision – mostly treated by optometrists is rarely integrated into general medical care and increasingly our feet are carved out to podiatrists practicing in a one-off fashion.

I could go on and on about body carve-outs, but won’t, as what I want to talk about today is oral health.  Unless you get a mouth cancer of some sort, oral health pretty much belongs to the dentists and the dentists are not really connected (or considered by most doctors to be a part of)  your medical care.

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Berwick on Incentivizing Health Care Value

Brian Klepper

AAFP (The American Academy of Family Physicians) News Now has an excellent interview with CMS Administrator Donald Berwick MD, in which Dr. Berwick describes his vision of more integrated and less fragmented health care delivery, and the changes in reimbursement incentives that will be required to get us there. An excerpt is below. Click the link above to read the entire piece. Worth your time.

Q. You also have talked about this being the era of health care delivery improvement. Can you explain that? 

A. Paying for value is an incentive. It is a motivation toward improvement. The underlying idea of improvement is that American health care, historically built in fragments, often cannot achieve for patients what it really wants to achieve. No one really wants that. Health delivery system reform refers to really reconfiguring care into much more seamless coordinated-care operations so that people, especially those with chronic illnesses, experience continuity of care over time and space.

So when patients come home from the hospital, there is a smooth handoff, and all the necessary information follows them. When they are seeing a specialist, that specialist is coordinating care with their primary care doctor.

In a fragmented payment system, it is so much harder to accomplish this. When payment is based on better integration, the result will be better integration of health care services. A delivery system redesign really means improving care for people when they are sick to ensure that they are safe and care is delivered according to science. And that includes improving seamless and coordinated care for patients — especially people with chronic illnesses. And then there is prevention, (including) a bigger investment in keeping people healthy, helping them to understand how to keep themselves healthy instead of waiting for illness to occur or reoccur, and educating people on how to prevent (illness). All of that involves design.

Q. You spoke briefly about the fee-for-service system. How do you feel about the AMA/Specialty Society Relative Value Scale Update Committee, or RUC?

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Average Annual Health Costs for a US Family of Four Approach $20,000, With Employees Bearing 40%

Jane Sarasohn-Kahn

First published 5/11/11 on Health Populi

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context,

  • The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350
  • The car buyer could purchase a Mini-Cooper with $20,000
  • The investor could invest $20K to yield $265,353 at a 9% return-on-investment.

Continue reading “Average Annual Health Costs for a US Family of Four Approach $20,000, With Employees Bearing 40%”