Political Jockeying In Anticipation Of Supreme Court Ruling – Kaiser Health News

Political Jockeying In Anticipation Of Supreme Court Ruling

Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to talk about the permutations of the impending Supreme Court decision on the constitutionality of the health care law. Carey says much is at stake for all people who touch the health care system while Werber Serafini outlines some of the Republican alternatives to the law.

via Political Jockeying In Anticipation Of Supreme Court Ruling – Kaiser Health News.


Notes on Prevention, Disease Care and Delivery Systems

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May_30_Health_Care_Rally_NP (641) (Photo credit: seiuhealthcare775nw)

I have, for some years now, said that, for all our talk as a nation about our “health care delivery system,” we do not actually HAVE one!  Rather, I believe that we have a “disease care industry” that thrives as a market-driven economic engine to the tune of over $2 trillion and approaches one-fifth of our national economy.   And that is a good thing, as far as it goes.  It just doesn’t help us get healthier!  Today’s Health Affairs Blog entry, “It’s Too Late to Turn Back Now – A Transformation to Wellcare is Underway,” got me started thinking.

What would a true “health care delivery system” look like?  Here’s my take:

  • It would focus on primary care, providing a more robust and better-paid primary care workforce, including interprofessional teams of nurses, physicians, pharmacists,  dentists, psychologists, nutritionists and social workers
  • There would be a single-payer reimbursement system (could be public or private), where a basic level of care would be covered for everyone.  Basic coverage must include preventive services, and the full services of a Patient-Centered Medical Home (PCMH)
  • A PCMH would be defined as a clinical practice in which
    • Every patient has a designated primary care provider (doctoral-trained physician or nurse – we can’t train enough physicians for this to only be a role for physicians – the need is too great, and our nursing colleagues bring a lot to the table for this role)
    • Every patient has a documented care plan with benchmarking and accountability, both for the patient and the practice team
    • All patients in the practice have access to the full-scope interprofessional team as needed
    • The practice manages the health of its patients as a population
    • The practice has a fully functional electronic health record (EHR) that includes robust capacity for patient registry functions and data mining
    • The practice commits to regular practice quality improvement and patient safety as a hallmark
    • Each patient undergoes a formal health risk appraisal, and all risks get managed through evidence-based primary, secondary or tertiary prevention efforts as part of the patient’s documented care plan
    • All patients have access to a smart-phone, tablet computer or similar technology to interact with the practice electronically
    • The practice gets reimbursed to interact with patients by telephone, electronically, and using telemedicine technology.
  • A local mechanism for accountability, through regional planning boards, report cards, or other similar mechanisms would give public feedback about performance of each PCMH, and about the health outcomes of the populations they serve.  To read an interesting piece about the current status of such accountability options, take a look at the following articles:  Consumer Reports Starts Rating Primary Care Practices (American Medical News) and Evidence-Based Policy Making (Health Affairs).

I know that some elements of what I propose are controversial, including the provision that not all PCMH practices are led by physicians.  I actually believe that the “work” of primary care physicians will be something different from anything we have ever seen, but I will save that content for another post.

What would YOUR definition of a “true health care delivery system” look like?  Post your comments, and let’s begin a conversation!

About This Blog

The health care industry in the United States in the early 21st century is undergoing tumultuous change.  Care delivery models are changing, the nature of work for health professionals is changing, and the social contract about how this country finances health care is being rewritten.  This blog will provide current analysis of these changes, and discussion about the way these changes are impacting the work life and well-being of health professions from all disciplines.  Particularly welcome are public health professionals, physicians, nurses, dentists, pharmacists, social workers, psychologists, and those interested in the wellbeing of people working in these fields.  

This post launches my effort to contribute to the healthy work life of those in the health care industry in the United States at a time of tremendous change.  No matter what your field, work in this arena is challenging, rewarding, and at times very frustrating.  As a practicing physician, I know that caring for ourselves while we care for others is a tremendous task, and one we are not always very good at doing.

Through these pages, I hope to share at least four kinds of information:

  • Tips on managing a life and career in health care
  • Analysis of the changing work environment for health professionals
  • Practices and resources supporting physical, emotional and spiritual well-being
  • Commentary on the health care industry as we go through this period of change

If you like what you see, please comment, and share our blog with others.

Please join the conversation, and please check out our website at www.mettasolutions.com.