Monday, August 4, 2008

What is Plan B?

The Disease Management Care Blog admits that it draws its inspiration from both good and bad cinema. Speaking of the latter, remember Harry Stamper (played by Bruce Willis), the ‘Armageddon’ driller-astronaut who is recruited to land on an errant killer asteroid and save the Earth? No, the DMCB doesn’t remember much of it either, but there is a scene where Harry asks the NASA administrator about the ‘Plan B’ should the landing not work. He is taken aback when he is informed that there is ‘no Plan B.’

While the fate of the earth is not at stake, there is a lot riding on the Patient Centered Medical Home (PCMH) pilots and the upcoming Medicare demo. And the DMCB doesn’t discern a Plan B. According to the Patient Centered Primary Care Collaborative’s Purchaser Guide (see page 9), there are a total of 18 studies on variations of the PCMH showing reduced care use/costs and 9 studies ‘negative for reduced care use/costs.’ That works out to 1:2 odds that a Plan B will be needed, or that 33% of the pilots will not show health care savings. If the Medicare Medical Home demo is one of the 33%, the PCMH - and the hope it offers for chronic illness - is in trouble.

Which reminds the DMCB of another movie: 'Terminator 2.' Arnold Schwarzenegger plays a good android defending the heroic John Connor and his mom Sarah from an evil liquid-metal android. Remember that one scene in which, while on the run, Arnold the Android describes to Sarah the series of events leading to the future (‘Skynet’) downfall of mankind?

With apologies to fans of the Terminator series:

The German Accented Patient Centered Medical Homeinator: ‘The Chronic Care Funding Bill is passed. The system goes on line August 4th, 2009. Demand for specialty care, hospitalizations and access to technology are not removed from highly variable human decision making and inevitable demographics. Chronic illness costs continue to grow at a geometric rate. Congress never develops self-awareness and repeatedly votes to suspend consideration of the Medicare funding warning trigger. It's clear that things will go belly up at 2:14 AM Eastern time August 29 2019. In a panic, they try to pull the plug on Medicare bankruptcy.’

Sarah Conner: [darkly depressed, sporting a firearm] 'The medical industrial complex fights back.... '

The Homeinator: 'Yes. Medicare gives up on the role of primary care and launches price controls, specifically targeting Miami, Phoenix and New York City.'

Sarah Conner: 'Why not vote them out of office in Washington DC? Aren’t they responsible for this?'

The Patient Centered Medical Homeinator: 'Because Medicare knows the medical-industrial counter-attack will eliminate any hope of compromise. There is no Plan B.'

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