Read In Airports and on Planes......

From 'Disease management for chronically ill beneficiaries in traditional medicare' by David Bott, Mary Kapp, Lorraine Johnson and Linda Magno, appearing in Health Affairs 2009; 28(1): 86-98.

Numerous CMS demonstrations - including, but not limited to, Medicare Health Support - have shed an unhappy light on the following premises about disease management for elderly, fee-for-service Medicare beneficiaries:

Acute exacerbations of chronic conditions could be avoided by better day-to-day self-management. This has been difficult to demonstrate and in retrospect, the evidence that exists is based on relatively small studies from academic settings.

High costs associated with chronic conditions stem from ED visits and inpatient hospital admissions for acute exacerbations. Yet, the majority of all hospital admissions have turned out to be for reasons other than the index condition.

Patients with chronic conditions are motivated and able to engage in improved self-management. There is little systematic evidence that this is true. Many patients apparently simply adjust to their condition and fail to see the benefit of additional change.

Periodic contact improves self-management and early recognition of symptoms will avoid hospitalization. Many programs turned out to have a poor rate of contact and there was little correlation between the contact frequency and outcomes anyway.

There is a health care provider who is prepared to respond to alerts by scheduling an urgent visit or coming to the telephone. Not so,unless there were standing orders or protocols. Docs won't come to the phone.

And this paraphrased quote from "Who Killed Health Care" by Harvard academic Regina Herzinger:

There are two 'distinctly differing approaches for reforming our health care system. Those who distrust markets and consumers prefer a single-payer system in which the federal government's excellent, centralized management would wring savings from billions now wasted on the hapless, competitive provate sector health insurance firms and inefficient doctors and use the savings to provide coverage for the uninsured. They would restrict insurance choices, much like an automobile market offering identical cars designed by a technocratic elite. Those who believe in consumers and entrpreneurs opt instead for private sector solutions. This small-is-beautiful camp would open insurance and health delivery market to innovators, ....where doctors are emowered to design better, cheaper care.....'

By the way, O'Hare was pretty empty for a weekday. The economy is definitely not doing well.