Monday, August 17, 2009

5 Ways to Improve Health Reform, Beating Germs, Health Co-Ops and the DMCB is on Twitter

So many things going on, so little blog. So, in the perfunctory style of KevinMD:

Can the Health Reform Legislation Currently Before Congress Do An Even Better Job With Chronic Illness?

The answer is yes, but by the time the Disease Management Care Blog began to think this through, the Partnership to Fight Chronic Disease was already on the case with this highly readable report. It's only seven pages, but important reading for anyone interested in advancing population-based care. Even if health reform gets scaled back to more modest levels, these five recommendations from the PFCD are worthy of urgent consideration at both the Federal and State levels:

1. Phase in evidence-based next generation care coordination models over the next three years. Emphasis on next generation. In other words, reducing re-admissions, piloting medical homes and experimenting with medication management programs are insufficient; no wonder that the CBO is unimpressed. More fruitful areas include increasing patient adherence and reducing barriers to chronic illness treatment options.

2. Expand on pay for value. Patient adherence to treatment recommendations needs to become a key outcome measure in any assessment of quality. And while we're at it, let's move the cost of care management and disease management programs out of the numerator of the health insurers' administrative cost ratios and recognize them for what the are. There are medical costs.

3. How about preventing chronic disease? That includes the work-place and the community with the right incentives, partnerships, community-based teaming, expansion of the public health infrastructure and getting the schools involved.

4. Reduce patients' out of pocket expenses for the prevention and treatment of chronic disease. It doesn't make any sense to charge a co-pay for the many services needed to manage chronic illness. The insurance benefit can be tweeked to reduce barriers and incent patients to do the right thing. Use co-pays when you want to reduce utilization, like in the case of multiple MRIs.

5. Better health information technology that includes telehealth, expecially in physician shortage areas. This includes remote monitoring, telephony and self-management support.

It's spelled 'a-m-e-n-d-m-e-n-t-s.'

Singing Happy Birthday Beats Germs?

So said HHS Secretary Sebelius on the Sunday news show This Week when she was not only ratcheting down the Administration's cleaving to the public plan option, but helping the public steel itself against the coming H1N1 epidemic:

'Because this virus spreads quickly child to child. Schools are taking preparation to get ready with hand sanitizers and frequent hand-washing, teaching your children to wash their hands, singing "Happy Birthday" to themselves as they wash their hands is good strategy.'


The DMCB tried to look that one up and ironically could find no comparative effectiveness research in the peer-review literature to back that assertion. It appears that the CDC's Clean Hands Save Lives! 'Happy Birthday' approach was developed as a timer. Singing the song twice through while soaping up makes the wash last at least 15-20 seconds. Fifteen seconds is at the limits of what health care workers will tolerate when it comes to hand-washing, even though going for 30 seconds reduces bacterial skin counts even further. If you decide to include this tactic in the battle against H1N1, this video is quite instructional.

Unfortunately, disease management organizations may decide that this doesn't quite meet evidence-based muster.

A Member of the U.S. House of Representatives That Doesn't Know What a Health Care Cooperative Is?

Representative Phil Gingrey (R-GA) appeared on today's MSNBC 'Hardball' to be interviewed about health reform and, now that the public option is on ropes, was asked about health insurance cooperatives. His disingenuous reply was that he didn't know what a cooperative exactly is. The DMCB hopes he just being cagey, but if he really doesn't know, he or his staff can simply 'Google' health insurance cooperative and look for the number one listing that has been used by thousands: that's right, the DMCB is at your service with an unbaised literature-based discussion of the topic.

and finally.....

The Disease Management Care Blog Is On Twitter?

Good news! Yes, even if the DMCB doesn't really understand Twitter either. Gosh darn it all, it decided it was going to find out. If you Twitter and are into Tweets, you can look for the DisMgtCareBlog and follow or whatever is done to twitterers. More to follow in this interesting journey.

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