Tuesday, October 6, 2009

Disruptive Innovations in Health Care From JAMA: Worthy of Consideration in Future Health Care Reform?

Much like the non-excitement over the winners of the Academy Awards' 'Performance by an Actor in a Supporting Role,' the Disease Management Care Blog's interest over the current bevvy of health reform legislation that will need to be reconciled in Congress is rapidly dissipating. While following the ups and downs of the various Senate and House bills makes for great bloggery, who really cares? It's all entering that opaque arena of legislating that Ronald Reagan described as the combining of an apple and an orange to make a pear. The DMCB will wait to see what unpredictable fruit of Best Picture ultimately emerges.

Yet, whatever happens, it is delighted by the NY Times' columnist David Brooks' analogy of Mr. Bentham vs. Mr. Hume and agrees the former will prevail in the final legislation, even if the latter is ultimately right.

When the DMCB isn't reading the Times, it would rather think about the future, especially because additional reforms are certainly going to be unavoidable. So, check out this commentary piece in the latest issue of JAMA titled 'Disruption and Innovation in Health Care' by RAND scientist Robert Brook (no relationship to David). He makes even Clayton Christensen look behind the times.

Here are eight important disruptions that Dr. Brook believes are within reach, are not being adequately addressed in Congress by either Mr. Bentham or Mr. Hume and could save us a ton of money.

1. The Carbon Footprint: Assessing the carbon dioxide load being emitted by the health care industrial complex is just as important a dimension of overall value as measuring cost, savings and quality.

2. Social Impacts: Where you live and what your race is is turning out to be more important that your cholesterol level or how much you exercise. A child's report card is no less vital to well being than screening for scoliosis or annual check ups. It's time to think about the role of physicians in increasing social determinants of health and whether the current pay for performance for narrowly defined health care measures is giving us our money's worth.

3. Competency, not Training: Nurse midwives, physician assistants, nurses may buy into the notion, but why stop there when it comes to down-jobbing? New training programs combined with the right kind of support may enable even high school grads to safely read mammograms, perform colonoscopies or inject botox.

4. Inefficient Use of Capital: Why build another MRI when the existing one is down six out of 24 hours a day. 24-7 health care would be a better use of existing pricey resources like physician offices, outpatient surgi-centers than building new physician offices or oupatient surgi-centers. If persons can't get a vaccine on a timely basis, why not enable it in the name of public health so that consumers can get it as easily as some motrin at an all-night pharmacy?

5. Waste Reduction: Every other business outside of government relentlessly roots out waste. What will it take to make health care CEOs and their Boards worry about this before, during and after their quarterly meetings?

6. Globalization: High quality and low cost care is turning out to be a plane ride away. If the U.S. can't create a market, maybe the globe can.

7. 'Applied' Public Health as a Skill: Medical schools, post-graduate training programs, medical certification and professional organizations will grow increasingly attentive to promoting the skills necessary to manage quality and cost on a population basis. Bravo! says the DMCB and it's sure the DMAA Care Continuum Alliance not only concurs but is doing its share to make that a reality.

8. Rights and/vs. Responsibilities: Sure, citizens have a right to smoke, forego screening tests or not see a physician. Physicians have just as much a responsbility to remind patients to not smoke, to get tested and to come in and get an appointment. Patients also have the right to have this done at their convenience. Patients who take advantage of the testing may also have a right to be moved to the front of the line if they come down with cancer anyway. That's all debatable, but it may be time to have that debate.

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