BS: What a healthcare concept!

Subject: BS: What a healthcare concept!
From: katlaughing
Date: 19 Jan 11 - 03:54 PM

Heard on NPR, today, this guy made a lot of sense:

Lowering Medical Costs by Providing Better Care

One of the criticisms of the health care reform bill enacted last year is that it expanded coverage without doing enough to control rising health care costs. Surgeon and journalist Atul Gawande says there are hopeful signs that costs can be contained — not by cutting back, but by providing more intensive services to chronically ill patients who incur huge costs with long stays in hospital rooms and intensive care units.

Gawande's piece in the current issue of the New Yorker about those who focus on patients with the highest medical costs is called "The Hot Spotters."

One of the physicians he profiles, Jeff Brenner, is a family practitioner working in Camden, N.J. In 2007, Brenner started treating chronically sick people who accounted for a significant percentage of the health care costs in Camden.

Brenner was operating under a hypothesis: He figured that the people who had the highest costs in the health care system were also getting the worst care. By helping them, he could also lower the health care costs — not just for them but for the entire city of Camden.

After three years, Brenner and his team appear to be having a major impact. Gawande writes that his patients "averaged 62 hospital and E.R. visits per month before joining the program and 37 visits afterwards — a 40 percent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after — a 56 percent reduction."

That net savings, Gawande tells Fresh Air's Dave Davies, is absolutely "revolutionary."

"Jeff Brenner is something of a saint," he says. "He ended up taking patient after patient [and] being very successful — lowering their cost by double-digit percentages while improving the quality of care to the point where he had more than 300 patients enrolled."

But Brenner didn't work alone. He also employed a nurse practitioner and a social worker to follow patients — using a team approach to make sure patients had access to health care professionals.

"Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care," says Gawande. "In the current health care system, you're not paid to keep people healthy. If you're a complex patient with a range of problems, it doesn't fit into the world [of primary care visits]. You need a project manager — a whole team to take you under their wing and see you through this course of illness. What [Brenner's] creating is the system as it should be."

Atul Gawande is a staff member of Brigham and Women's Hospital, an associate professor of surgery at Harvard Medical School and an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health. He was a senior health policy adviser for President Clinton. He is a staff writer for The New Yorker magazine and also the author of several books, including The Checklist Manifesto and Better.

Subject: RE: BS: What a healthcare concept!
From: Dorothy Parshall
Date: 19 Jan 11 - 05:49 PM

What a monumentally intelligent concept!! Now if others were intelligent enough to follow suit...

Subject: RE: BS: What a healthcare concept!
From: SINSULL
Date: 19 Jan 11 - 06:12 PM

Patient Advocates handles our health care. If I have a question I go to them. If I ask a question that sets off alarms they are back to me immediately to clarify and offer options. Some of you may remember when their intervention saved both my thyroid and my voice. Recently I had a health screening at work showing high tryglicerides. They were on the phone with me to see if I had followed up with my primary care (I had) and sorted it out (we had). Prevention, first calss care and someone who listens. Can't ask for more.
SINS

Subject: RE: BS: What a healthcare concept!
From: SINSULL
Date: 19 Jan 11 - 06:13 PM

class - OOPS

And all this saves the company on our health care costs. Go figure.

Subject: RE: BS: What a healthcare concept!
From: Bill D
Date: 19 Jan 11 - 06:16 PM

What is the old saw? "An ounce or prevention is worth a pound of cure."

If folks don't GET so sick and are treated early, they don't drag down the system with emergency and long-term care.

Subject: RE: BS: What a healthcare concept!
From: Janie
Date: 19 Jan 11 - 07:35 PM

I've noticed quite recently, within the last 6 months, more insurers employing clinical care case managers for some patients with chronic, complex medical or mental health issues. I've been pleasantly surprised in the few dealings I have had with these case managers. They work with patients to improve compliance with treatment, insure that conditions are being closely monitored so that interventions can occur before hospitalization is needed, etc. Keeping up with doctor appointments, medications, physical therapy, occupational therapy, etc., is a complex and energy consuming endeaver, and people need support and advocacy to manage their health when they have significant chronic illness.

A community health facility in my area is participating in a grant-funded research project in which I know a couple of people who are involved. (both have congestive heart failure.) Every morning they weigh themselves, and check pulse, temperature and blood pressure on equipment that transmits the data to the physician's office. If the physician's office does not receive the data for a couple of days, they call the patient to remind them and to check in. If the physician is concerned about the readings, they contact the patient. There may be medication adjustments that can be made based on the phone call, or the patient may be asked to come into the office, immediately if the readings indicate the need, or at least within 2 days. Or, if readings are very critical, they can direct the patient to go to the ER, or even summons an ambulance. For both people I know involved with the project, the quick feedback has kept them much more stable over the past year, probably prevented visits to the ER and hospitalization on occasion, and resulted in rapid hospitalization and stabilization in one instance that very likely would have resulted in death otherwise.

Subject: RE: BS: What a healthcare concept!
From: Rapparee
Date: 19 Jan 11 - 07:57 PM

Read the book "The Best Care Anywhere" by Phillip Longman (I think that's the author). It's a real revelation, it truly is.

Subject: RE: BS: What a healthcare concept!
From: Richard Bridge
Date: 20 Jan 11 - 06:55 PM

The purpose of capitalism is to create serfs.

Subject: RE: BS: What a healthcare concept!
From: Bill D
Date: 20 Jan 11 - 07:12 PM

Oh? We wouldn't want to be making any vague, unsupported generalizations, would we, Richard.

Subject: RE: BS: What a healthcare concept!
From: Bobert
Date: 20 Jan 11 - 07:49 PM

Well, it will take looking at a number of pilot programs to see what works and what doesn't... The idea of health management sounds good...

This is one of the strongest arguments for the federal government, rather than state and local governments, to be the leader in figuring out what works...

Piece meal systems which are subjected to the local politics end up ineffective...

Thanks kat for the heads up...

B~

Subject: RE: BS: What a healthcare concept!
From: Rapparee
Date: 21 Jan 11 - 12:36 AM

Bobert, read the damned book I recommended!