Saturday, July 26, 2008

Is an Entirely New Model of Care Needed for Chronic Conditions?

There was a very interesting conversation last month at New Talk, in which national healthcare leaders from across the country discussed whether an entirely new model of care is needed for managing chronic health problems. It was summarized this way:

Why overhaul chronic care delivery? For starters, about 75% of health care spending goes toward chronic conditions, and our panelists agreed that the current system is plagued by waste and poor quality.

What can America do about it? Panelists suggested eliminating one primary villain-the fee-for-service approach-in favor of the medical home or other new models that offer coordinated care and continuity of providers. This new paradigm opens the door to a patient-provider relationship marked by a two-way sense of responsibility.

Everyone recognized the potential barriers to implementation: …[including] a "multi-stakeholder approach" as an antidote to the stifling influence of interest groups; [and] regulatory waivers … essential to clearing the way for innovation.

Other challenges brought to the table include: creating incentives for engaging patients in their own health, developing a nationwide system of health care IT, and insuring that new programs dovetail into the larger system of acute and preventative care.

Other tactics proposed by the participants include:

  • Rewarding providers for delivering high quality care with minimal waste
  • Making tough choices about reducing spending on end-of-life care
  • Promoting the use of electronic health records
  • Establishing a national center for effectiveness research
  • Focusing on improving population health
  • Getting patients more involved in managing their own health, including focusing on prevention
  • Providing some form of case management.

While their recommendations are consistent with the Wellness-Plus Solution presented on our Wellness Wiki, several key elements were missing, including the promotion of:

  • Personalized care [see this link]
  • Next generation Personal Health Records [see this link]
  • Home care and Telemedicine [see this link]
  • Diagnostic decision support systems [see this link]
  • Research and delivery of cost-effective complementary and alternative care [see this link]
  • Biopsychosocial healthcare that focuses on the whole person and the mind-body interaction [see this link]

I applaud conversations like this because they bring to light how bad our current healthcare system is and how much has to be done to fix it. Yes, we do need radical reform and it's good to hear people talking about it!

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