Chronic Disease

A lucky 13 top-notch health policy wonks outlined concrete and achievable stops to improve quality, reduce cost, and repair our health care system in the May/June issue of Health Affairs.

More bad news for those of us who plan on getting old some day. The Institute of Medicine just released Retooling for an Aging America: Building the Health Care Workforce which reminds us there are not going to be enough doctors and nurses to deal with the geriatric needs of the 78 million baby boomers who start reaching age 65 in 2011.

Earlier today we put up a guest post by Robert Berenson of the Urban Institute on the troubles with a Medicare pilot program on disease management. Here's another interesting take by Gooznews' Merrill Goozner.

When we saw Monday's New York Times report on how Medicare's experiment in disease management was not cutting costs, we asked Robert Berenson MD, Senior Fellow at The Urban Institute, to comment. Here's what he had to say:

In the last two years of life, patients at some top academic medical centers spent more time in the hospital, had more doctors' visits and cost Medicare way more money than patients at equally esteemed top medical centers. But the higher bills didn't bring them longer life. In fact, patients with the more intensive and expensive treatment tended to die slightly sooner, according to the latest research on chronic disease and end of life spending from the Dartmouth Atlas.

The Dartmouth Atlas now has published huge amounts of data pounding home the message that more isn't always better. Doctors and patients haven't yet gotten the message across the board, and the way our health care system (Medicare and much of the private sector) pays doctors and hospitals encourages more and more volume.

Tired of waiting for Washington to fix health care, doctors across America are doing it themselves. I just attended a conference in Dallas where hundreds of physicians exchanged ideas on how to improve the quality of care they deliver, make their clinics more efficient—and rediscover the joy of practicing medicine. In future posts, we'll touch base with some really smart and dedicated people we met there and highlight specific innovations that got our attention—new ways of reaching hard-to-serve populations, managing chronic diseases like diabetes, involving patients in their own care, new twists on "shared visits."

The terms "concierge medicine" "Palm Beach" "poverty" and "free medical care" don't necessarily go hand in hand but a group of Florida "VIP" physicians are starting an interesting initiative aimed at showing that close doctor-patient collaborations with an emphasis on wellness and good management of chronic disease can work for the poor and sick, not just the rich and healthy.