Thursday, September 11, 2008

Impressions from the Health Affairs Briefing on Overhauling Health Care Delivery

Impressions and quotes from the Washington DC Health Affairs ‘release party’ min-lecture series over the September/October issue on ‘Overhauling Health Care Delivery’:

Large, high ceilinged room at the InterContinental stuffed with academics, policy makers and note-taking congressional staffers. It ended at 11 AM with the hotel staff noisily wheeling in the next function's lunch tables at 11:01 AM. The DMCB regrets not having the chance to meet the hard working editors.

Paraphrased quote from Mark Smith of the California HealthCare Foundation: ‘The solution to health care access and cost will not be mathematical linear rearrangement. The solution will be structural.’ The DMCB wonders if it will involve dynamite.

Challenges to the Patient Centered Medical Home identified by Bob Berenson: 1) lack of an operational definition, 2) it won’t cure the ‘tyranny of the urgent,’ 3) it will be a struggle for small practices, 4) it won’t cure the PCP shortage, 5) it’s unclear if this is for all patients or patients with chronic illness, 6) there are many local management challenges, 7) non-PCP specialists (endocrinologists) may warrant inclusion, 8) it’s unclear if patients should be locked-in to their primary care site and 9) becoming all things to all people may mean that this becomes another failed silver bullet. The DMCB adds that it has yet to leverage remote and efficient industrial strength telephony and monitoring as one ingredient in its suite of services.

A large integrated delivery system CEO saluted its EHR, large mass and adaptable primary care practices as the key ingredients in its version of the medical home. The DMCB disagrees and thinks it was parachuting in nurses into its primary care sites that are paid for by the managed care organization (or disease management function). They are the secret sauce.

The jargon used most stridenty to describe what health care consumers want: ‘personalized medicine.’ The DMCB recommends that DMOs alert their DC lobbyists to resurrect this term.

An unnecessarily complicated health care engineering term from Richard Bohmer: It will be impossible for primary care to diversify enough to meet all that is being asked of it. The answer is a new ‘care platform’ designed from the bottom up. All retail clinics are one type of care platform. Not all care platforms are retail clinics. And the DMCB’s running shoes are a type of aerobic exertion platform.

No comments: