Archive - Jan 18, 2011

"Meaningful steps to curb runaway health care costs"

If you’re involved in politics or in healthcare, the big news this week may be the vote scheduled for Wednesday about repealing the Affordable Care Act, sometimes called Obamacare by its detractors. I’ve spent a bit of time in politics and now work for a community health center, so it seems like this ought be be big news for me. However, it really isn’t.

Yes, the new Republican majority in the House will most likely vote to real health care reform tomorrow, fulfilling campaign promises. Then, it will die in the Senate and that’s about it.

Perhaps even more significant, it may not make a lot of difference to most people. Yeah, doing away with pre-existing conditions and lifetime caps, and allowing children to stay on their parents health care plans until they are 26 are good things, which will make things better for some people. It will be good when people can more easily get affordable health insurance, but does it really improve health care?

It seems like the parts of health care reform that are going to make the most difference are things that people don’t hear about, and perhaps don’t even understand. Electronic Medical Records are likely to eliminate some mistakes, especially in terms of patients getting proper medications from their pharmacists, and in the long run might start changing the relationship between a patient and their doctor, but that points to perhaps the bigger change that we need to spend more time thinking about. What sort of relationship should there be between a patient and their doctor?

Many, it seems, have a mixed relationship with their doctors. They say they don’t trust their doctors and only go if they absolutely have to, but when they go, they may not give complete information to their doctors, but then don’t question what their doctors tell them, other than perhaps not taking the medication that has been prescribed to them, or making other changes that would improve their health.

One of the big phrases these days is Patient Centered medicine. Buried in the Affordable Care Act are incentives to move towards patient centered medicine. Already, there are interesting reports out about this. Last November, the Patient-Centered Primary Care Collaborative issued a paper exploring this. In the first part of “Summary of Data on Cost Outcomes from Patient Centered Medical Home Interventions”, “Integrated Delivery System PCMH Models”, they note a study that found:

$10 PMPM reduction in total costs; total PMPM cost $488 for PCMH patients vs. $498 for control patients (p=.076).

Unfortunately, this doesn’t make a good sound bite. It needs translating from the jargon. PMPM is an abbreviation for Per Member Per month. PCMH is a Patient Centered Medical Home. For this sample, it costs $10 more per month to treat a patient in the current manner than it does with a patient centered medical home.

They cite study after study showing how moving towards a patient centered medical home saves money. I’m still trying to get my mind around what a PCMH really is. The National Committee for Quality Assurance describes it this way:

The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

How is this really different than existing models? I’m not completely sure, but as I understand it, it is based on having a regular primary care doctor that you trust and work closely with. Having a doctor that knows who you are and what has been going on in your life and medical history would seem to make a big difference in avoiding medical mistakes or unnecessarily hospitalizations or other treatments.

So, the politicians can spend their time arguing about who gets paid when for what services, which seems to be a lot of the current debate in Washington, or they can focus on re-evaluating which services really are the most important in providing quality health care. Personally, I’m looking forward to the current charade ending in Washington and moving on to a more meaningful discussion that will curb runaway health care costs and improve patient outcomes.

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