Wednesday, March 16, 2011

Quotes, Insights and Impressions From The Population Health & Care Coordination Colloquium: Health Reform, "Broken" FFS, Retail Clinics & The Truth

The Disease Management Care Blog scribbled notes while it was at the just concluded Population Health and Care Management Colloquium in Philadelphia. Some are paraphrased quotes, others are insights and others are opinionated impressions. With that caveat, here are some of the better ones in no particular order:

Attendance was high (enough to fill a large hotel ball room), jargon ("engaged patients!" "accountable care!") abounded and enthusiasm was high (makes no difference if health reform is upended by the Supreme Court or an implacably opposed Republican party, there is no going back).

While many speakers prized the intimacy of a primary care doctor-patient relationship, they had little problem with the intrusion of other non-physician "team" members at the local clinic level. While they seemed to think its purpose is to "help" PCPs, the DMCB suspects many of its primary care physician colleagues have a different perspective. They secretly welcome the prospect of the involvement of non-physicians so that they can "outsource" that intimacy. That means that they'll be able to focus on the more interesting complicated medical stuff.

Think retail, convenient care walk-in and strip mall style nurse-run clinics are going to take off? Maybe, but three veterans from different corners of the country all agreed that they're only profitable when a) their services are covered by an insurance benefit (this is not a cash business) and b) they're closely aligned with a provider network and can refer patients. Otherwise, they're a loss leader. Primary care physicians seem to have little to fear from these bad boys.

Other speakers tut-tutted a "broken" fee-for-service system that "pays" for medical errors. What's wrong with that says the DMCB? When it buys a defective consumer product, it generally pays for a repair unless there is a guarantee (and that's built into the purchase price) or buys up to a warranty that's available for an extra fee.

Business owners are skeptical that health reform will work. The promises are old and there's no new money. Maybe that's because some of them read the DMCB.

Long term "central" intravenous access has been the subject of considerable research. Ask women who've been through it, however, and many will tell you that a major patient concern is its annoying proximity to their bra straps. The problem is that they haven't been asked. What else haven't we asked, and why not?

Speaking of which, one speaker from a national quality standards setting organization agreed with the DMCB that classic "evidence-based" medicine is just one of many windows onto the "truth." Others include observational data bases, effectiveness studies and qualitative patient surveys. Just like "disease management," or the "medical home" or the "electronic health record are not individually "the" solution to achieving high value health care.

Apple products have a high penetration among patients, but a downside is that it also doesn't use Adobe "flash" to support on-line movie viewing. One consumer health education company described how hundreds of Mac and "i"patients under contract were unable to access an interactive patient education video.

Talk to the average doc about the active participation of patients in developing their care plans, and they'll think this is all about "informed consent," in which patients sign all the necessary forms giving permission for surgery. They don't know there's a difference between informed consent and informed choice.

Those repugnant "death panel" scares may have prompted some patients to question the big deal over Dartmouth Atlas-style health care variation. They believe "more" is truly "better."

It is possible to roll publicly available demographic, health and income data up by zip code and assign a local "needs" score that can assist in population-based care planning. The DMCB has always been tempted to define "disease management" as "applied public health." Maybe that is more accurate than it appreciated.

1 comment:

Bradley Dean Stephan said...

Thank you - a great 'teaser' for those readers unable to attend the conference. I'm heartened by the 'sally forth' trend, relative to the ACA. So much of the Act is about clinical quality, efficiency and safety, as well as population health management. Indeed, the terms "prevention/prevent/preventive" are mentioned 444 times. It's as if it was written by an ivory tower clinical strategy committee. I would think innovation (or, at least planning) is currently at a watershed point in our industry.