I was not at all surprised to read a piece in the Boston Globe: ER visits, cost in Mass. climb
High performing health system achieve better outcomes, improved experience of care and at lower per person cost than the non system we have in the US.
High performing health systems have comprehensive primary care as their foundation.
Comprehensive primary care is defined by a patient population who can say:
"I can get care when and how I need it"
"I have a PCP who knows me as a person"
"My PCP cares for the bulk of my needs"
"If I need care outside my PCP office I know who to turn to, my PCP coordinates my care"
Presence of these attributes has in published studies reduced hospitalization rates, emergency room use, improved presenteeism at work and school, improved rates of preventive care and the effectiveness of chronic disease management. Presence of these attributes results in improved experience of care and the aggregate effect on the population results in reduced per capita costs of health care.
The work of comprehensive primary care is blocked by payment policies that make primary care a repugnant career choice and punish PCPs for engaging in the full scope of work of comprehensive primary care. The solution to the problem is health reform.
Health reform requires three elements:
1: Everyone has access
2: The money flow inside health care supports the desired health outcomes and the work it takes to get us there
3: The work of health care is redesigned to support the desired health outcomes
MA provides false access and maintains a broken and dysfunctional delivery system. MA moved on #1 without making any substantive move on 2 & 3. That the current plan results in an angry disillusioned public and increased costs with no demonstrable improvement in health outcome was a foregone conclusion. Our nation is about to embark on the same path. If it continues on this trajectory I predict a disappointed and angry nation paying more for bad care in 2012. Woe to the party tagged with this disaster.
The nation need not follow the mistakes of MA. Invest in serious payment reform and simultaneous delivery system redesign - not the tepid incremental programs that provide marginal improvement, but truly innovative solutions that give us the breakthroughs in outcomes. Use the burning platform and your bully pulpit Mr. President and step boldly forward to embrace the true solutions you espouse.
L. Gordon Moore MD
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