Happy Cinco de Mayo: A Time to Reflect on a Growing Opportunity for Population Based Care Management

Cinco de Mayo is upon us. This is a day when millions celebrate Mexican heritage and pride. The Disease Management Care Blog's first real exposure to the significance of the day came from its Spanish-learning spawns' high school celebracións. Given the growing importance of our southern neighbor, it's a pity that the DMCB took so long. It should have gotten a better appreciation of Hispanic culture much earlier in its education and career.

For example, the DMCB learned, thanks to George Friedman's book The Next 100 Years, that Mexico will likely be an important and ultimately welcome source of population growth for the United States. As the rising age of persons in China, Japan and many countries in Europe stress economic vitality, the U.S. can look forward to many decades of economic growth thanks to a young and vibrant population seeking the opportunity of the American dream. It's not too late for the DMCB to appreciate that: it is the child of immigrants.

However, Mr. Friedman also points out that in contrast to other immigrant groups who have fallen into America's melting pot, it's unlikely that that persons of Mexican heritage will be culturally assimilated. Thanks to lingering social and economic links to a homeland right next door, Mexicans and other persons of Hispanic heritage will remain a distinct group: cultures and language will intermingle, much like they do in other border zones around the world. As Arizona's travails amply demonstrate, it won't necessarily be a trouble-free process. However, the DMCB is confident that Americans, after choosing every other alternative, will finally make the right decisions when it comes to immigration reform.

The implications for population-based care management are significant. Almost 20 years ago, the AMA recognized the special challenges of providing health care for the Hispanic population, which, sadly, still seem to be with us today. The good news is that there is a growing body of science to help guide the way in (for example) promoting exercise and reducing hospitalizations in this group. Given the growth of this segment of society, its special circumstances, the burden of disease and the lingering health disparities, the DMCB views this is as a huge opportunity for the growth of care management organizations. Companies that learn how to serve this population should do very well in the future.

Cinco de Mayo is not only a time of celebration, it's a time to remind ourselves of the work to be done and rewards that await.

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Martin Luther King Day and Health Care Disparities - Much Work Remains

Martin Luther King Day is upon us. The Disease Management Care Blog is using this time to reflect on Dr. King's remarkable achievements on behalf of the disenfranchised. Yet, while his civil rights legacy is indeed a cause for celebration, it's also a reminder that, when it comes to healthcare, much work remains to be done:

Of course we know that socioeconomic status and race are linked. The good news is that it's possible to tease that out and discern when barriers to care are predominantly economic and when they are a function of skin color. Sadly, the science confirms that what Dr. King told us decades ago is till true today: we still have a problem. No, make that a really BIG problem.

While we're all looking for reasons to leave no corner of the health care system unexposed to electronic medical or health records, the Department of Health and Human Services has released a long awaited Interim Rule on the 'meaning' of meaningful use for health information technology. The good news is that it includes a requirement that it be used to reduce health care disparities. The bad news is that that particular issue is being treated as a 'quality of care issue,' along with other care domains such as continuity of care, error reduction and research. If Dr. King were alive today, he'd probably wonder about linking fundamental human rights issue to 'quality'; the Disease Management Care Blog would not only agree, it'd also worry about the prognosis of that approach.

Of course, having an electronic health or medical record is not the same as having a workable registry. Despite the little real world knowledge of just how electronic records address disparities, there is this report on how registries can help define the patterns of care associated with race. The first step to doing something is to measure it, and this sure looks like a good first step, assuming this is built into registries and we are prepared to act on it.

Many may not be are aware that managed care insurers have a long legacy of working to reduce disparities among their enrollees. They're making some progress (see here, here and here), but the flight of employers to self-insured plans could possibly undo things. Going forward, the DMCB thinks Rev. King would suggest this deserves greater measurement and scrutiny.

Last but not least, patient centered medical homes and disease management can reduce disparities. In working with many organizations, the Disease Management Care Blog is proud to report that many take that mission very seriously. It just wishes they'd do a better job of taking their data on this and moving it into the public domain.

The Fat Lady is a fan of Reverend King and brings up this quote from the 25th Chapter of Matthew.

.....Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me....I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.'

While some readers may think the Bible shouldn't have any role in health care policy and planning, the DMCB knows Reverend King would disagree. Even then, we can still be guided by its powerful insights about the human condition and the way forward.

These 'least' are our equals. The sick await. The work remains. We can do better. And the stakes are high.