Thursday, June 26, 2008

NewTalk's 'Reforming Chronic Care' Postings

Well, even after yesterday’s logorrheic post and feeling like this, the Disease Management Care Blog couldn’t let the week come to an end without a…..

Hat Tip to David Harlow over at the HealthBlawg, who discovered what can best be described as a fascinating series of expert board posts on reforming chronic care over at Common Good’s NewTalk. Letting these healthcare luminaries loose on this meandering tour of law, politics and policy helps the naïve Disease Management Care Blog better understand why terribly earnest and incredibly bright beltway insiders just can’t seem to land on implementing solutions to low quality and high costs in chronic illness. Don a scop patch, take a seat on this bus and you’ll see first-hand the complex mind-numbing interplay of options, finite resources, skepticism, self-promotion, statutes, perspectives, stakeholders, need for an SSRI (for one person in particular), dismissal of disease management, good ideas, needs, cynics, history, notions, reality checks, bad ideas, biases, anecdotes, research findings, fawning over the chronic care model, assumptions, egos, models, costs, benefit language and verbiage. It makes for interesting reading, but it’s a good thing these guys aren’t in charge. The DMCB is reminded of a quote from John LeCarre’s “Tinker Tailor Soldier Spy”: a committee like this is an animal with four back legs.

If you don’t have a grande caffeinated beverage available and can’t read it all, the DMCB suggests you focus on the posts from Larry Casalino of the University of Chicago, who offers up a readable mix of primary care experience and academe. He astutely notes information technology alone is not up to the task of overcoming a fragmented health care system. He introduces us to the broader notion of ‘accountable care organizations’ that may be able to integrate otherwise independent hospitals and small physician groups. As the DMCB understands it, the idea is to harness the special advantages of independent small practices and still deploy larger economies of scale. He warns us to keep an eye out for an upcoming issue of JAMA, which will have an article on the topic. You read it here first.

Finally scroll through about half way and see what Susan Dentzer of Health Affairs has to offer in terms of a Big Bang Solution: Medicare Part E. She asks for comments. The DMCB offers this one: you go gurl!

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