Monday, September 14, 2009

The Irony of Adapting to Local Care Resources to Reduce Variation and Increase Quality

Writing in the American Journal of Managed Care, the Disease Management Care Blog points out that another looming danger of Health-Reform-As-We-Know-It is the lack of flexibility over local care patterns.

What, you say, isn't that precisely the problem?

Yes and no says the DMCB. It is a problem when variations in the rates of flu shots, diabetes blood glucose control and high blood pressure treatment occur across adjacent counties and from State to State. And the good news is that there are 'remedies' including provider feedback, information infrastructure, right-sizing the delivery system, economic incentives and shared decision making. However, in AJMC editorial, the DMCB points out that key ingredient of just how a network of providers implements the mutually supportive feedback, IT, system capacity, profit sharing and the other countless details involved in delivering flu shots and diabetes care is very much a local phenomenon. It describes the M-CARE system in Michigan that launched a successful and adapting diabetes care management program that evolved over time, shifting its resources in response to a changing population.

Nowhere is this phenomenon more obvious than in disease management. Talk to any of the leaders in the industry and you'll find that their success has been built on accomodating the local biases, cultures, resources, insurance types and numerous other quirks to drive care management standards in rural Florida, inner city Boston and the suburbs of Philadelphia.

Can the type of health care reform being contemplated in Congress be nimble and flexible enough to accomodate the success of the M-CAREs of this world and account for the key ingredient of locality? The DMCB has read a lot about the bills currently before Congress and hasn't seen it.

It hopes it is wrong.

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