Archive for the ‘care coordination/quality’ Category

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Are we speaking the same language? The problem with medical jargon

Wednesday, July 28th, 2010

Today, many families are struggling not only with the cost of and access to health care, but also with the quality of care they receive. A recent article in the Wall Street Journal, “Taking Medical Jargon Out of Doctor Visits”, articulates an incredibly important issue that sometimes gets swept under the rug in the talk about cost and quality of care: patient health literacy.

According to the Centers for Disease Control and Prevention, about nine out of 10 adults find it hard to follow routine medical advice, mostly because they don’t understand what their care providers are saying. The complex instructions and jargon that doctors use make patients more likely to skip necessary medical tests or not take their medication as prescribed. This confusion leads to poorer health outcomes and increased health care costs currently estimated at $238 billion a year.

There is a common assumption that lack of health literacy is limited to racial and ethnic minority populations. While these populations are disproportionately affected by low health literacy, according to a report from the National Patient Safety Foundation, Low Health Literacy: Implications for National Health Policy, the majority of people with low health literacy skills are white. Older people, recent immigrants and those with chronic conditions are likely to have low health literacy, as well.

Of particular note from the WSJ article is the federal strategy around health literacy entitled the National Action Plan to Improve Health Literacy. The plan seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multi-sector effort to improve health literacy

We are headed in the right direction. However, there is still a fundamental need for greater change in the health care system – particularly in the areas of how care is delivered and paid for – if we are truly to achieve better access to quality, affordable care.

As our population grows older and larger, the impact on the health outcomes of patients and the costs to the health care system will only increase. These problems are compounded by the lack of care coordination for those with multiple chronic illnesses. People with multiple chronic diseases have increased interaction with the health care system, leading to more opportunities for confusion surrounding their medical care – which is in turn influenced by the number of doctors they see and what they hear from their doctors.

An older person with five or more chronic conditions (e.g. diabetes, hypertension, heart disease, arthritis, obesity), has an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year. How incredibly confusing would it be for that person to manage his or her own health? Older adults and their caregivers should be full partners in their care, and they should be provided with the information and support to manage their conditions so they can make informed health care decisions.

With the advent of the Patient Protection and Affordable Care Act (PPACA), the Campaign for Better Care, led by the National Partnership for Women and Families, Community Catalyst and the National Health Law Program, is working to ensure the needs of older adults and their families are highlighted and addressed.

Helping patients and providers communicate effectively with each other will be a crucial component to the quality of care that patients receive. The Campaign’s national consumer coalition has developed a “Yardstick” for Better Care, which identifies key elements of patient-centered practice for inclusion in new models of care

The Campaign for Better Care hosted a public event today in Washington, D.C. – the “Building Better Care” forum – and the forum webcast will be available online Friday. Special guests included Senator Sheldon Whitehouse, award-winning author Gail Sheehy, UCLA Geriatrics Division Chief David Reuben, journalist and activist Jonathan Rauch, HHS Director of Delivery System Reform Peter Lee, and more.

To learn more about these issues and how the Campaign is tackling them please visit www.campaingforbettercare.org.

– Jenelle Holder Williams, Field Director, Integrated Care Advocacy Project

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Case study shows community health workers improve primary care and enrollment

Friday, July 9th, 2010

Policy changes in two states to expand and strengthen the workforce of community health workers provide a model for other states as they implement the Affordable Care Act, says a new case study, “Community Health Workers: Part of the Solution,” in the July Issue of Health Affairs (free abstract—subscription required). Coauthored by Community Catalyst’s Director of Health Equity Lisa Renee Holderby, who previously headed the Massachusetts Association of Community Health Workers, the paper looks at how Minnesota and Massachusetts turned to community health workers to address shortages in the health care workforce and improve enrollment and primary care.

The case studies found that policy changes that supported the use of community health workers (CHWs), who provide patients peer-to-peer assistance managing their health and navigating the health care system, helped increase enrollment and quality of care in their communities. The Institute of Medicine has recommended that CHWs be included in care teams to help improve the health of underserved communities.

“As members of the community,” the authors write, “these front-line workers are valued for their cultural competence and mediate between providers and other members of diverse communities. Evidence is accumulating that including community health workers in determining the appropriate use of services has a sizable positive return on investment.”

So what policy changes do the authors want to see in other states? First, sustainable funding for CHWs to participate in the system – including reimbursement by public programs like Medicaid, Medicare and CHIP. And they suggest states establish workforce education programs and occupational standards to train and credential CHWs like other health care workers. The authors also propose that states establish some uniform guidelines they can use to chart and evaluate CHWs and their participation in the health care workforce – something that is going to be happening in many corners of the health care system as part of the Affordable Care Act.

“Community health workers can be vital to efforts to restructure the delivery of primary health care. The patient-centered medical home has been described as providing ‘accessible, comprehensive, family-centered, coordinated, compassionate and culturally effective care.’ Although the workforce required for the medical home model has not been fully defined, close ties to the community and cultural competence are essential. Additionally, a successful medical home will require continuity of communication between provider and patient.

“Community health workers are uniquely qualified to meet these responsibilities and to complement other members of the health care delivery team. These workers’ valuable capacity to increase patient engagement will be important to consider in evaluations of quality improvement.”

“Community Health Workers: Part of the Solution” is part of a special issue of Health Affairs on the implementation on health care reform, and the whole thing’s worth a read (caveat: subscription required.)

–Kate Petersen, Health Policy Hub

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The Insider: A broken record

Tuesday, June 8th, 2010

Health Care Reform = Rationing has been a favorite theme of opponents throughout the debate.  While the circumstances and details change over time, this theme remains constant.  In the past week, opponents have stepped up their attacks on the nomination of Don Berwick to head CMS, citing again his positive statements about the British National Health Service. They also seized on a New York Times article that has largely taken the work of the “Dartmouth Atlas” out of context to continue their scare campaign.  (The Times feeds the Berwick/reform/rationing storyline by quoting Berwick as one of the defenders of the Dartmouth work.)

The Dartmouth researchers have shown that there is no necessary correlation–and at times a negative correlation–between high health care spending and high quality. And though the Times story attacks the Dartmouth work and researchers, it fails to refute their conclusion. The piece has generated vigorous pushback against the piece—not only by the Dartmouth researchers themselves, but by sources for the story who say their words were used out of context to criticize the project.

The problem isn’t that there aren’t limitations and ambiguities in the Dartmouth work. It’s that in the game of telephone from sources to the Times reporters to opportunists who picked up the Times story as another club to beat reform with on the airwaves, all of the nuance gets lost.

–Michael Miller, director of strategic policy

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The Insider: Proxy War

Monday, May 17th, 2010

LINK FIXED

Last week, we likened the low-visibility conflicts over regulatory measures to trench warfare. This week, the military metaphor of choice is proxy war. Republicans in the Senate are using the nomination of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services to resurrect many of the themes they sounded during the legislative debate–especially the fiction that health care reform will lead to rationing.

Yes, folks, the death panels are back–if not explicitly, then by (heavy) innuendo.

Why? Because Berwick, currently the head of the Institute for Healthcare Improvement, has made the near-treasonous observation the U.S. health care system is not, in every respect, the best in the world (World Health Organization rankings be darned).

And he had the temerity to express admiration for the British National Health Service. Admiration for the NHS means support for comparative effectiveness research, which is akin to endorsing rationing, which is achieved by death panels, which lead to socialism—get it?

But the GOP attack on Berwick is not motivated, at least exclusively, by wounded national pride, sour grapes over the party’s failure to kill health reform, or even by policy differences. Rather, it is a cold political calculation aimed especially at raising the fears of seniors, who (as we repeat almost weekly) will have a major say in which party controls Congress in 2011. Right now, that calculus appears to be working.

Life in Chicken Little Land

Chicken Little

If the election were held today, the picture would look pretty scary for Democrats. Although overall voters seem pretty evenly divided on who should control Congress, the enthusiasm gap definitely favors the Republicans. According to Cook Political Report, of the 30 “toss up” House races, 28 are currently held by Democrats, setting Republicans up for significant gains in the House. In the Senate, Republicans could pick up as many as six or seven seats.

What does this mean for health care reform? Well, we should be prepared to live in Chicken Little Land for quite a while to come, fielding Y2K-style warnings of impending doom until the sky fails to fall in 2014. (Of course, that’s only if we first get past the Mayan calendar end-of-the-world prediction in 2012.)

Of course, a lot could happen between now and then, and most of it is outside of the control of health care advocates. What we can do—and must do—is keep on telling the truth about reform, making special outreach efforts to those who are most vulnerable to misinformation.

Laugh-track

Watch Jimmy Kimmel and T-Pain’s musical spin on some of the President’s health care reform messaging.

–Michael Miller, director of strategic policy

photo credit: ffg on flickr

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As Boomers turn 65, better team-based care becomes a must

Wednesday, May 12th, 2010

cbcWhen Older Americans Month was established 47 years ago, only 17 million living Americans had reached their 65th birthdays.

Today, there are nearly 40 million adults age 65 and older. And when the first baby boomers turn age 65 in 2011 they will become eligible for Medicare. With the aging of the baby boom generation – the largest in our history – the U.S. older population is expected to grow to 71.5 million by 2030.   Will health reform translate into the comprehensive and coordinated care that older adults with multiple health problems need and deserve?

The Campaign for Better Care, a national initiative which launched this spring, is aimed at making sure the answer is yes.  Community Catalyst is proud to be a partner in this new campaign, which recognizes that older adults—those with multiple health problems, in particular—need doctors, nurses and other health providers who talk to each other and work together, along with the patient and their family caregivers, as a team.

This is exactly the kind of approach our friends at the Commonwealth Care Alliance use with their members, all of whom are either older adults or people with complex health needs.  At CCA, members are assigned to a team made up of the primary care doctor, a nurse practitioner, a nurse, and a behavioral health practitioner.  Working together with the member and her family, the team develops a care management plan aimed at enhancing the member’s quality of life.  This approach also serves to avoid medical errors, duplicative tests, and wasted time and costs.

The Campaign for Better Care is advocating at the federal and state levels to ensure that new models of delivering care are patient- and family-centered, team-based, and include important services like:

□    geriatric assessment
□    care planning
□    comprehensive care coordination
□    transition management between care settings
□    medication management
□    community support for older adults and their family caregivers

It supports payment strategies that support primary care practice and reward better quality, coordination and communication among health providers, patients and family caregivers.

Community Catalyst whole-heartedly supports that agenda, which puts into action many of the recommendations found in our care coordination (pdf) and payment reform (pdf) issue briefs.

So this May, as we celebrate older Americans, I hope that you’ll consider joining a month-long public education drive to spread the word in your networks about the need for better coordinated, patient- and family-centered care.  To learn more and become be an “ambassador” for better care, visit www.CampaignforBetterCare.org.

–Renee Markus Hodin, project director

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Academic detailing and the odds at Agincourt

Thursday, April 22nd, 2010

Today we share a post from Community Catalyst’s prescription drug blog, PostScript.

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We read with interest Merrill Goozner’s blog, “Putting Academic Detailing in Perspective.” See, the Agency for Healthcare Research and Quality recently distributed $30 million of stimulus funds to 9000 locations around the country to get doctors unbiased patient-centered outcome research through academic detailing, also sometimes called prescriber education. (Community Catalyst and the Pew Prescription Project have supported federal and state academic detailing efforts–more here and here.)  Goozner seems to suggest that, while nice,  such grants cannot hope to match “the combined might of the marketing arms of Big Pharma, Big Bio and Big Device.” With a little guess-timation, he says the number of academic detailers that such grants could deploy is a drop in the bucket compared to pharma sales reps: “Do the math,” Goozner writes. “50,000 for the drug industry; 300 for the truth squad. Henry V had better odds at Agincourt.”

Well, sort of. Yes, in numbers, the (shrinking) army of company detailers far outstrips the number of academic detailers currently in the field, or that would be deployed as part of AHRQ grants. But there are other questions of public policy and public health at work here, and it’s worth looking at what those are.

Academic detailing, to refresh, sends trained clinicians such as pharmacists and nurses into the field to talk to doctors. Versed in the body of research on a condition or drug class, the academic detailers talk with doctors about what the science shows to be the safest, most effective treatment out there. They are employed by a nonprofit or a public agency—and therefore not working on a sales commission or motivated by profit to promote one product over another.

Though some doctors may be looking for perks or samples, many say they talk to drug reps because they can’t always find the information they need elsewhere. But it’s more useful for a busy doctor to meet with one academic detailer who knows about all therapies for a given condition and how they’ve faired in trials, than to meet with several commercial detailers, who rarely have clinical backgrounds and are interested, in every case, in talking up one product: theirs.

And there’s the big difference: sales reps are there to sell drugs. Academic detailers are there to talk about what drugs and therapies are out there, and what the science shows works best.

Goozner’s shrug of a post also ignores the bigger picture: Academic detailing isn’t happening in a vacuum. The deployment of prescriber education at local, state and regional levels in the last five years—and now at the federal level—is part of a growing awareness that pharmaceutical marketing has the potential to interfere with safe prescribing and patient care—and a broader effort to make sure it doesn’t.  Medical schools, trade organizations, and a range of medical specialty societies have adopted policies to clarify the relationship between pharmaceutical companies and their members and faculty. Companies have begun to disclose their payments to doctors, and the Physician Payment Sunshine Act passed, establishing a new national transparency standard.

Goozner (and PhRMA President Ken Johnson, in recent comments), seem to suggest that academic detailing is a purely counter-industry tactic, designed to take on—or take down—Big Pharma.  But it isn’t, and to suggest so obscures academic detailing’s real, and very common, mission: to improve clinical care.

There are thousands of investments made daily at local and system-wide levels to improve patient care, and this is one of them. Academic detailing is, at bottom, an effort to improve patient outcomes through rational, evidence-based prescribing. Just as one hospital’s efforts to reduce its infection rates should not be dismissed for not reversing the national trend of hospital-acquired infections, so attempts to get the best science into the hands of doctors who want it should not be dismissed as insignificant or trifling. Good medicine matters, at every level.

–Kate Petersen, PostScript blogger

*if you want to get PostScript in your inbox, subscribe here.

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America needs better care!

Tuesday, April 13th, 2010

cbcHealth reform is law. The hard work of fixing our health system begins now. That’s the message of  Campaign for Better Care, a recently-launched effort to improve health care coordination and quality for people across the country. (Here’s the ad (pdf) that ran in Politico.)

The Campaign, a joint effort of the National Partnership for Women & Families, Community Catalyst and the National Health Law Program (NHeLP), is working to ensure that we realize the promise of health reform by improving health care quality, coordination and communication for older patients with multiple health problems and their family caregivers.

A newly released national survey of Americans 50+ tells the story.

  • Something to talk about. Nearly three-quarters have wished that their doctors would talk and share information with each other.
  • People who take the most meds need to hear more about medication interactions from their doctor. Forty percent of people who take five or more medications say their doctors do not talk to them about potential interactions with other drugs or over-the-counter medications when prescribing new medications.
  • Different info from different doctors. More than one third of people who use the health care system most say they’ve received conflicting information from different doctors.
  • Taking the test over—and not because they failed. One in eight (13 percent) has had to redo a test or procedure because the doctor or hospital did not have the earlier results.
  • Do you have any questions? Yes. Three-quarters of those who use the health care system most have left a doctor’s office or hospital confused about what to do at home.

But the real story is told by people like Joann, whose life was turned upside down last summer when her 79-year-old mother fell and broke her hip. Because her mother also suffers from osteoporosis and dementia, Joann stayed overnight in the hospital for two weeks to help her navigate the system.  She was physically and emotionally exhausted in this solo effort to make sure her mother was safe and well-cared for once she returned home from the hospital.

The new health reform bill is full of programs that could help people like Joann and her mother by providing the comprehensive, coordinated, patient-centered care they need.  And, the Campaign is committed to taking the essential next step: ensuring that these programs are designed and implemented with the needs of patients and their family caregivers front and center.  Because if we can make the system work for people with the most challenging health care needs, we can make it work for everyone.

To support the national Campaign, Community Catalyst is also working in six states to build support for these kind of programs:

Maine (Consumers for Affordable Health Care)

Massachusetts (Health Care for All)

Ohio (UHCAN Ohio)

North Carolina (NC Justice Center)

Pennsylvania (Consumer Health Coalition)

Wisconsin (Coalition of WI Aging Groups)

Check out the state campaign websites to learn more about what they’re doing to promote better care in their states.  And be sure to visit the national campaign website www.CampaignforBetterCare.org to learn more about the campaign and how to get involved.

-Renee Markus Hodin, project director

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