Lots of experts are doing lots of things to try to make health care better. But how does a specific doctor or clinic or hospital or insurer know what innovations to adopt in a specific setting and when and how to adopt (or adapt) them?
The Agency for Healthcare Research and Quality held a webinar on that question based on a new paper titled "Will It Work Here? A Decisionmaker's Guide to Adopting Innovations." Readers of this blog know that diffusion of innovation is one of our passions. Delivery system reform is a vital element of improving health care for all Americans, but improvement is a slow and painful process. It can be very hard for champions of innovation to penetrate the culture of certain organizations.
Will It Work Here? isn't a treatise on how or why innovations spread, but rather a preliminary tool to be used when reviewing quality improvement methods that have worked in other settings. The HTML version is especially useful with tons of hyperlinks to supporting documents.
Long before the federal government began its big push to reform the U.S. health care system, states were feeling the strain of rising health care costs and increasing numbers of uninsured. Many states decided to take a crack at health reform in their own way. We've heard a lot about reforms in Massachusetts, but other states have also made progress.
One such state is Vermont. USA Today highlights some of the quality innovations in Vermont that have helped the state save money and improve efficiency. Rather than start with the goal of universal coverage like Massachusetts, Vermont started working towards two other aspects of health reform: lowering cost and improving quality of care. (It already had a -- relatively -- low rate of uninsured residents, and including when Howard Dean was governor, the state had taken steps to cover most children and pregnant women, and as we'll see in a moment, it is also working on covering more adults.)
Today the AARP hosted a tele-town hall meeting between President Obama and AARP members. The crowd got the opportunity to voice their hopes and fears about health care reform, and Obama got the opportunity to explain what health reform means for seniors, their families, and their children.
Obama addressed a few key concerns:
Medicare benefits. "No one is talking about reducing Medicare benefits," assured the president. Reformers just want to reduce waste and strengthen the system. Obama also wants to negotiate with pharmaceutical companies to close the doughnut hole in Part D. The doughnut hole is a coverage gap that requires some seniors to pay for the full price of their medications, up until they qualify for catastrophic coverage. One caller to the tele-town hall from Colorado, Sarah, said she was in the Part D doughnut hole, and would spend all of her savings within the next two years paying for her Parkinson's medication.
As anyone who's been to Schneider's of Capitol Hill knows, there are many ways to make a case. Last month the Council of Economic Advisers (who know a thing or two about animal spirits) released a 56-page report making the economic case for reform. On Saturday, the CEA brought the case for health reform to small businesses.
The 20-page report begins by noting the importance of small businesses to the economy in terms of job growth and innovation. Firms with fewer than 20 employees accounted for 25 percent of net employment growth from 1992 to 2005. (For those of you still thinking about Schneider's, net employment growth is the difference between jobs created and jobs lost in a given period.)
Despite their importance to the economy, small businesses are ill-served by the current health care system. Higher brokerage fees, larger administrative costs and a smaller risk pool that leads to more adverse selection, mean small businesses pay on average 18 percent more than large firms for the same policy. As result small businesses are much less likely to offer health insurance to their employees and workers at small firms are more likely to be uninsured.
We wrote about the high rate of hospital readmissions recently on the blog and for The Washington Post/Kaiser Health News. Today, both the Wall Street Journal and NPR examine the problem, both focusing (as we did) largely on older people with heart disease.
NPR's Joseph Shapiro told the story of Jessica MacLeod, a nurse with advanced training at the University of Pennsylvania Health System in Philadelphia. (We've written about Penn's Mary Naylor and their Transitional Care Model, too, here and here). MacLeod gets to know her patients in the hospital, and then follows them at home for two or three months, with particular attention to those first 48 hours when lots of things can go wrong.
One of her patients is Ken Rogers, 80, a retired superviser at a printing company. He recently spent a week in the hospital after experiencing chest pains.When he was hospitalized in the past, he recalled, "when I came out of the hospital, you go, 'Yeah? What do I do now?' It was, 'See ya,' " This time MacLeod was at his home within a day, and she returned often.
Kaiser Permanente chairman and CEO George Halvorson delivered his message about delivery system reform and integrated care model, reports GoozNews, to a national forum presented by Kaiser Permanente Health Care Institute and the National Labor College. We hope someone in Congress was listening.
We wrote the other day about a gathering in DC of 10 communities that had improved the quality of local health care while controlling costs. Here are a few quick links to what others had to say:
Julie Rovner at NPR included some great material about how quality and efficient care also makes demoralized doctors rediscover the joy of caring for patients. (It's not in the abbreviated online print version, listen to the story audio).
John Lumpkin at RWJF's Users' Guide to the Health Reform Galaxy wrote about what doctors see when they take a data-driven look at what they do:
You may have seen the latest message tirade from the right -- health reform equals rationing equals hospice equals euthanasia.
Give us a break.
The House bill would encourage advanced planning. It would not mean that "old people could be visited in their homes and essentially be told, 'all right, sweetie, you have had a good life.'" It would not send government bureaucrats into homes to counsel seniors about how to cut their life short. It would not "start us down a treacherous path toward government-encouraged euthanasia."
Republicans talk about choice, and about patient autonomy and decision-making. Advanced directives encourage, and enable, informed choices. They encourage, and enable, conversations between patients and doctors. They encourage and enable conversations in families. They make it more likely that choices are respected and carried out -- which is not always easy in a medical system where the default is usually to do more and more, and in a culture where the default is often to avoid thinking about or talking about death and dying.
The July 2009 Kaiser Health Tracking Poll shows that a majority of Americans continue to want health reform -- but that support has slipped as legislative debate heats up and some criticisms gain traction.
Despite the serious economic problems facing this country, 56 percent of respondents believe health reform is more important than ever (down from 61 percent in June). By a margin of two to one (51 percent versus 23 percent) the public believes the country will be better rather than worse off if health reform is enacted. A similar poll released by the Robert Wood Johnson Foundation on Tuesday shows that 85 percent of those surveyed believe reforming health care is an important step to solving the nation's economic woes.
President Obama in his news conference last night tried to demystify a bit of the complexity about health policy and financing, to show why we need health reform to return to long-term economic prosperity.
But the bottom line, Obama stressed, is simple. Health insurance reform is good for America. And it's good for Americans.
Obama talked about deficits and delivery systems but he also addressed the American people at a personal level. For those wondering, "what's in it for me," the answer is "a lot."
If somebody told you that there is a plan out there that is guaranteed to double your healthcare costs over the next 10 years, that's guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that. Well, that's the status quo. That's what we have right now. So if we don't change, we can't expect a different result.
Health reform, Obama said, is about Americans having one less thing to worry about if they ever lose their jobs.
Reform is about every American who has ever feared that they may lose their coverage, if they become too sick or lose their job or change their job....It will give you the security of knowing that if you lose your job, if you move, or if you change your job, you'll still be able to have coverage.