Friday, February 13, 2009

Medicare and Applied Health Services Research. It's Time.

The Disease Management Care Blog found two suggestions from its buddy, Sandra Foote, to be interesting options as the U.S. continues to think about healthcare reform. While we know what works, there is a lot we don't know. The evidence-based medical literature only helps us with approximately 30% of clinical practice. While we continue to struggle with financing and shaping the other 70%, Sandy recommends that Medicare develop "a powerful continuous innovation strategy" that draws on the lessons of the private sector. The idea would be to develop "goals, leadership, organizational structures, incentives and processes" that would constantly test innovations. The DMCB thinks of this as "demos" but multiplied on a log scale and placed on steroids.

Paired with this idea is a mandate that's been given to MedPAC to "conduct a study of the feasibility.... of establishing a Medicare Chronic Care Practice Research Network." Sandy reports this would involve creating a standing network of providers that test new approaches to care.

The DMCB thinks of this as "tithing," i.e., giving a portion of your income for service to a greater good. All healthcare organizations, from individual physicians up to large integrated delivery systems have an obligation to assess the content of the care they are providing. The DMCB thinks that in order to do this right, it generally takes about 10% of the operating budget: that's how much time it devoted to data management and reporting in its former life as a medical director.

Think that sounds like a lot? The DMCB argues that one reason the Federal Government is creating a national center for effectiveness research is because mainstream healthcare - outside of academic medicine - has not stepped up to this plate. The good news is that other healthcare organizations, including disease management providers, are also beginning to embrace the value of "applied" health services research. They'd welcome Medicare to this party. Hopefully, Medicare would be prepared to commit sufficient resources to doing this right.

Heads up: the DMCB will have a print editorial on the topic appearing in the not too distant future.

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