Tuesday, March 8, 2011

The Rocket Science Double Standard, Medical Home Induced "Change Fatigue" & If Universal Coverage Doesn't Reduce Bankruptcies, We Need "More" Of It

In a quick "walkabout" of the web, the Disease Management Care Blog came across some interesting items:

Introducing the latest issue of Health Affairs on Innovation In Health Care Delivery, Editor-in-Chief Susan Dentzer writes that the March issue's descriptive profiles of fifteen organizations that have a) focused on the sickest people, b) keep chronically ill people as healthy as possible and c) rely on a team approach patients’ varied needs, amply demonstrate that innovation doesn't require "rocket science." Yet, that was precisely the level of rigor demanded by policy makers of the investor-owned for profit disease management industry years ago, when it was doing the same thing. But the DMCB is not bitter.

Neither, apparently, are the physicians who participated in American Academy of Family Practice's nationwide demonstration of the Patient Centered Medical Home. Rather, these physicians are tired. Very tired. Writing about lessons learned in the same Health Affairs "Innovation" issue mentioned above, Paul Nutting and colleagues describe how - despite the extensive support of a team of facilitators and experts - transforming motivated physician practices into medical homes takes more than two years, is often incomplete, intrudes into cherished notions about the doctor-patient relationship, is stymied by the EHR's shortcomings and often exhausts "adaptive reserve" which leads, in turn, to "change fatigue." The authors suggest a balm made up of "medical neighborhoods," which are supported by even less evidence than the medical home.

Speaking of a lack of "evidence," that isn't going to stop the Physicians for a National Health Program either. Co-founders David Himmelstein and Steffie Woolhandler have apparently (the on-line March issue of the Green Journal is not available yet) found (according to this press release) that Massachusetts's universal coverage law has not been associated with a statistically significant drop in "medical bankruptcies." This has apparently led the authors to counterintuitively conclude that even more health insurance coverage is necessary. The DMCB suggests that they address the concerns in this post instead. Just because there is an association (two things seem to happen at the same time) doesn't mean there is any causality (that one causes the other) or that we know directionality (or which causes which).

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