Tuesday, January 15, 2008

The Prospects for Health Reform and Disease Management

Fed up with the media primary frenzy, my wife has temporarily banished TV election coverage from our house. So, in response, the Disease Management Blog retreated to the office and nosed around some of the candidates' web sites, press releases and press reports and copied some telling quotes:

…will require that providers that participating in the new public plan, Medicare or the Federal Employee Health Benefits Program use proven disease management programs.

…will ensure higher quality and better coordination of care by using state of the art chronic care coordination models with federally funded programs to provid care for Americans afflicted with the costly multi-faceted illnesses.

...infuse incentives in insurance markets that promote wellness and better outcomes for chronic diseases. Health insurance must be redefined to cover wellness and well as sickness.

...give states more flexibility in how to use federal Medicaid dollars, making it easier for states to develop innovative programs - such as one in Utah that helps people managed chronic illness, keeping them healthier and reducing costs.

...any health care proposal must first focus on containing spending. To accomplish that, the emphasis should be on better treating chronic disease, like diabetes and heart disease....

('nuff said)

Issues of election rhetoric aside, it's remarkable how much apparent agreement there is across the political spectrum on the need to develop "programs" for persons with chronic illness. While the details have yet to be worked out and then there is the matter of Congressional buy-in, it seems that no health care reform proposal will be complete without some type of "disease management" in it. That's the good news.

Want some bad news? Check out Victor Fuch's Perspective piece in Health Affairs, where he points out that the coming Congress and administration will be hobbled by an inability to marshal enough of a reform-minded coalition, fear of change outweighing its attractiveness and the disproportionate political power of special interests. Then there is the distraction of some very important foreign policy issues, including withdrawal from Iraq & Afghanistan and dealing with the nuclear ambitions of North Korea and Iran. While the long term prospects are ultimately good, the chances of something happening in the next 5-10 years is "50-50" and "the executive and legislative branch will have little time or political capital to spend on major health care reform for the rest of this decade."


The Disease Management Blog will be on the road for the next 3 days. I hope to stay in a cheap hotel which means free internet access but doesn't mean a lot of time to post material. We'll see.

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