Bacon's Rebellion

Democracy Thrives in Sunlight

Another Private-Sector Initiative to Salvage Health Care

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by

James A. Bacon
in

Back in 2006 an estimated 2.2 million Virginians were living with chronic diseases, running up $24.6 billion in health care costs. The numbers are far higher today. One reason costs are so high is that care is so fragmented. Patients often have multiple providers, treatment plans and prescriptions. Physicians, hospitals and other providers operate in silos, providing care without complete information about what others are doing. The lack of communication leads to unnecessary emergency room and hospital admissions.

The au current idea for dealing with this mess is the Patient Centered Medical Home (PCMH), in which the “home” is not a physical place but a personal physician who leads a team of providers to plan and deliver ongoing care for the “whole person.” The idea is catching on, and a General Assembly report, “Chronic Health Care Homes,” describes what’s happening in Virginia.

The Family Medicine Group in Vinton was the first practice in Virginia to be certified as a PCMH. Now, 18 Carillion physician practices in the Roanoke and New River Valley areas are recognized as NCQA Level-3 (highest) PCMHs. Additionally, an increasing number of practices in the Hampton Roads area are transforming themselves into PCMHs. Physicians and faculty of Eastern Virginia Medical School and several Sentara practices are in the application process for recognition as a medical home.

In the meantime, a Virginia Innovation Center, established as a nonprofit center hosted by the Virginia Chamber of Commerce, “will serve as a resource” in Virginia by (1) researching and disseminating knowledge about innovative models of health promotion and health care; (2)  developing demonstration projects to test innovative delivery models; and (3) helping Virginia employers, providers, purchasers, health plans, and communities accelerate their pace of innovation. (That information was based upon a 2010 communication to JCHC staff but I can find no indication from a Google search or a search of the Chamber website that this center exists yet.)

Based on the study findings, the Joint Commission on Health Care resolved to continue monitoring the progress of the concept.

— JAB

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  1. larryg Avatar
    larryg

    The health care system is explicitly designed to SELL health care.

    In theory, if you have a Primary Care physician, and he/she gets copies of referral providers actions you have the basis of PCMHs but your primary care physician (if I understand correctly) cannot look over the shoulder of other providers and nix what he/she thinks is an inappropriate or even duplicative test or therapy or drug prescription.

    I have enough trouble “encouraging” referral providers to “copy” my primary care provider on tests and drugs.

    My insurance companies and my prescription drug company do a better job of coordinating providers by denying multiple/redundant therapies and drugs…etc…

  2. DJRippert Avatar
    DJRippert

    The flow of information through the health care system in the United States is an embarrassment. Consumers don’t really have a choice because they don’t have the information required to make choices. Meanwhile, moving paper based medical records from one doctor to the next is a slow and painful process. Therefore, people tend to stick with providers regardless of how well that provider is performing.

    The government mandated telephone number portability for cellular companies so that consumers would have greater choice in picking a cell phone company. However, there is no such regulation when it comes to the infinitely more important question of health care.

    If I want to make a tee time at my local country club, I go online and pick a tee time on the web site of a tee time service linked to my local club’s web site. How many doctors let you schedule your next appointment online?

    If I need to talk to my company’s lawyer I can visit him, call him or get on a video-conference with him. He’ll bill me for the time no matter what venue I use. Insurance companies don’t let doctors bill patients for remote medicine. No, I have to trudge into the doctor’s office for the simplest of things. Why?

    Health care in the United States is a mess. Obama, et al have tried to reform it. Perhaps their reform needs reform. However, the present system cannot stand.

    Bacon hopes that primary care physicians will support patients as “case managers”. Why not? This is what stockbrokers do. They coordinate a number of investments and are accountable for the overall health of your portfolio. So, why hasn’t the vaunted free market come together to guide doctors to give the people what they want? Because the market isn’t free. The supply of doctors is artificially limited by small medical school admissions and regulation. Information flow is hindered through an absurd theory of perfect privacy. Have you ever wondered why so many banks let you do essentially everything online but medical providers claim “privacy laws” restrict you from doing almost anything online? What would a thief rather have – access to your bank account or your medical records?

    This whole area is crazy.

  3. larryg Avatar
    larryg

    I do not find a single thing that DJ has said that I disagree with. We are essentially held hostage by the profit-seeking folks in the Medical Field. They all in it to make money and few of them are interested in saving consumers money if it affects their bottom line. I.e. if they are making money selling duplicative tests.. stay out of their nickers.

  4. Peter Galuszka Avatar
    Peter Galuszka

    What kind of nonsense is this? The Virginia Chamber of Commerce is doing some fast-talk with “Innovation.”

    Just had to switch medical insurance. Before, I paid a small co-pay for a blood pressure medicine.

    Under the new plan (just me and am in the “they get screwed category”), I was initially charged about $165 (all on my) for the supply. Then my primary care doc gave me a little discount card. My costs went down to $25.
    I asked am MD friend about this and he just laughed.

    Don the Ripper is absolutely right. There is no way you can know what they are charging. If you can’t know, you can’t operate in a “free market” and “private” way that James A. Bacon Jr, so dearly loves.

    We need a one carrier system — socialized care. Call it what you want.
    But pluuuzleez. No Va. Chamber of Commerce initiatives. Don’t insult us.Especially when no one will tell you what anything costs.

  5. James A. Bacon Avatar
    James A. Bacon

    Peter, unless we can figure out how to deliver health care more efficiently, nationalized medicine will bankrupt the country. Once government can’t borrow anymore to support lavish spending, you might not like your socialized health plan so much. Just ask the English — and they’re not even broke yet.

  6. Peter Galuszka Avatar
    Peter Galuszka

    Jim,
    We are the only advanced civilized nation that sticks so stubbornly to for-profit care that has given us this completely unworkable, extremely expensive, totally non transparent and unethical system that gives us bad infant mortality rates yet lets the wealthy have access to lots of advanced technology.
    I haven’t seen one thing in your file that moves the ball forward. All it does is changes what a doctor is called.
    Once again, there’s this big discrepancy between your bookish analysis and what is really going on. I’ve been through a lot of medical care in reality recently, mostly with the elderly, and very little what I read on this Blogsite rings true.
    And I don’t give a damn how the Brits do it. I assume you have hands-on experience there as well? Why don’t you spend a day in an ER?

  7. James A. Bacon Avatar
    James A. Bacon

    Peter, you may have experience dealing with the insurance side of the equation but that doesn’t make you an expert in health care delivery. You can change the who-pays question but if you don’t reform the how-we-deliver-the-service piece, you’re not addressing the problem of runaway inflation in health care costs.

    Rather than visiting an ER to see how things work in the U.S., time would be better spent in one of those “medical factories” in India to see how heart bypass surgery can be performed at a fraction of the cost with equal or superior medical outcomes. Unfortunately, that’s a trip I can afford right now.

  8. Peter Galuszka Avatar
    Peter Galuszka

    Jim,
    Reading a Cato Institute study or a press release from the Virginia Chamber of Commerce does not make you an expert, either. My personal experience goes beyond what you characterize as the “insurance” side of the equation, as you know well.
    Your example of heart transplant factories in India shows, once again, how little you really know about the subject. How many people around the globe need heart transplants as opposed to basic or intermediate care? The No. 1 medical challenge facing the world today is not getting a heart transplant. What’s next on your list, “medical concierge?”
    You might want to take a look at T.R. Reid’s 2009 book that disassembles the myth that “socialized” medicine is a monster. By actually going into hospitals and operating rooms (which you seem unwilling to do), he finds that advanced countries all except the U.S.) do have decent and affordable health care even if they are one payer systems.
    With them, the focus is the patient, not making a buck and not erecting and maintaining a highly inefficient but dogmatically-correct system that puts managed care companies in charge.
    I do hope you give me a call when you are turned down for coverage because of a “pre-existing condition” (a.k. a pushing 60 years old).

  9. larryg Avatar
    larryg

    how much do you have to know if every other industrialized country in the world pays 1/2 what we do and they live longer?

    The GOP is a collective bunch of feckless idiots.

    They essentially defend the status quo and insist that a “free market” with tort reform will “work” but where in hell is their legislation?

    The reason we pay twice as much is because the people who are not insured STILL get taxpayer-funded health care – MedicAid at 500 billion and accelerating but they really don’t get care until they got something bad wrong with them and then we pay at the most expensive phase of the disease.

    Every single health care system in the world that covers everyone and lowers costs is a govt run system.

    There is not a single system in the world that is truly non-govt, private that comes anywhere close in terms of coverage, quality and life expectancy.

    I keep asking for the top 3 (best) countries in the world who do not have govt-mandated universal coverage and there is deafening silence.

    What the GOP wants is basically an experiment.. never been tried.. no examples of it in the world.

    My understanding is that Medicare now mandates electronic records.

    Hallelujah!

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