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Fixin' Healthcare

Thursday, February 22, 2007

Transformation Of Healthcare - Business As An Example

Corporate America is getting more active in health care. Health promotion as an extension of occupational medicine has been around for a while and it is becoming more organized and focused. Facilities for physical activity, nutritional counseling, weight management and other prevention programs often are part of the package. Disease management, health coaches and primary care clinics round out the picture of "corporate health care".

The incentive for business is to save money and make employees more productive. A captive audience (to some extent) allows for greater intensity of health promotion and prevention. Business can offer employees incentives that are more easily recognized as such.

Health promotion and prevention are moving into the forefront of health care. The efforts in the corporate world bear close scrutiny for what works and can be exported to society at large.

Academia would do well to follow this trend from a research and teaching perspective. The issue of well-trained health coaches is one example. The federal government is conducting a three-year coaching pilot program to examine the concept. Insurers and self-insured employers are creating programs that employ health coaches.

These are the things that over time will change (transform) health care.

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Wednesday, February 21, 2007

Transformation Of Healthcare - Life's Persistent Problems

The surge in American society to medical care and a diagnosis for life's problems is a search for solutions. More often than not this search yields medications or surgery. There is always a diagnosis and medications and surgery are tools of the trade.

Optimum health is not associated with medications and surgery. These are end-stage tools. Healthy lifestyle (avoiding toxic substances, physical activity, proper nutrition, adequate rest and management of stress), education and human relations are far better tools for optimum health.

A cup of respect and a lump of humility might be better solutions to life's persistent problems.

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Wednesday, February 14, 2007

Transformation Of Healthcare - Laying The Foundation

There are some advantages to the delayed application of a technology. Such might be the case with the electronic medical record. Now that the time is approaching, it offers the opportunity to think strategically about the potential.

Converting the current medical record to an electronic format provides opportunity for improvement of patient safety and efficiency of patient care in the medical setting. The potential for improved health status is greatly increased by expanding the format to a personal health record. Including health education, health promotion and preventive health care would be a giant step to realizing (w)holistic health care and rational self-directed health care.

The extra planning and effort would be small and inexpensive at this time and it would pay huge dividends in the future. Including it later would be costly for the time wasted. Health care is a participatory, not a spectator, activity and the American public needs to get with it.

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Tuesday, February 13, 2007

Transformation Of Healthcare- Try It, You'll Like It

Most large companies are self-insured. This gives them incentive and flexibility to initiate activities intended to decrease health care cost and improve health status. Many companies are achieving early success by designing health programs based upon prevention and disease management.

Two years ago the supermarket company, Safeway, Inc., recognized that 50 to 60 percent of health care costs are driven by behavior. They decided to design and implement a health care plan that rewards good behavior. The Safeway plan brings together most of the best practices for encouraging employees to pursue healthy behavior. Health coverage costs for employees enrolled in the new plan fell 11 percent in the first year of operation (2006).

Unions have resisted health plans with cost-sharing features but the international president of the United Food and Commericial credits Safeway with trying to do more than just shift costs to workers. "This is more about the way health care is delivered and particularly about the behavior of individuals. [It] might not be the solution, but it's a different look that has the possibility of working."

What needs to be done may not be rocket science, but implementation to achieve sustained success is more than rocket science. It would beeeeee transforming.

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Monday, February 12, 2007

Transformation Of Healthcare - Follow The Goal

Political expediency and short-term solutions for critical problems are expensive. But, more than the expense is the danger that optimal solutions may become unreachable. Cultures have failed and disappeared because they could not accept or recognize optimal solutions to critical problems.

For example, growing corn to produce ethanol for fuel may be a good idea for small midwestern towns but it remains to be seen if that will be good for the country. There is no conceivable way ethanol is more than a stop-gap measure for energy. Meanwhile, people are not prepared for the measures that need to be considered.

Can the federal government be expected to provide a solution for health care. There are some good programs supported by the federal government but grid lock has set in for anything other than more of the same. Health insurance is popular but that will not change outcomes. The states and communities can accomplish more in the way of elevating health status.

It all comes back to education, attitudes and behavior. When all is said and done, those are local issues. The best the federal government can do is support state initiatives and assist with maintaining effective programs.

Goal is more precious than gold.

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Sunday, February 11, 2007

Transformation Of Healthcare - Beware Conventional Wisdom

The New York Times today reported an amazing transformation that contradicts conventional wisdom and demonstrates the power of small changes in human behavior involving the entire community. Funny how transformations are like that more often than not.

Niger is in a part of Africa viewed as barren wasteland decaying into desert. The trees were disappearing, the wind was blowing away the topsoil, sand dunes were encroaching and wells ran dry.

Facing those conditions, the farmers took a small but radical step. They ceased clearing the saplings from their fields before planting. Plowing and planting of crops took care to protect and nurture the saplings. These were simple methods that cost little or nothing.

Now, millions of trees are flourishing largely without relying upon the large-scale planting of trees. Niger is far greener than it was 30 years ago. These changes have come at a time of rapid population growth in Niger, contrary to the conventional wisdom that population growth leads to the loss of trees and accelerates land degradation.

A forestry expert at the University of Niamey in Niger's capital, Dr Mahamane Larwanou, said the regrowth of trees had transformed rural life. "It requires the effort of the whole community. If farmers don't take action themselves and the community doesn't support it, farmer-managed regeneration cannot work."

"Today, the success in growing trees suggests that the harm to much of the region may not be permanent, but a temporary loss of fertility. The evidence, scientists say, demonstrates how relatively small changes in human behavior can transform the regional ecology, restoring its biodiversity and productivity."

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Saturday, February 10, 2007

Transformation Of Healthcare - Your Complaint Is My Command

A recent poll of 39,000 patients and 335 primary care physicians was conducted by Consumer Reports National Research Center. The patients were composed of subscribers to Consumer Reports magazine and the physicians came from a random sample drawn from a national list of doctors.

Most patients think their doctors treat them respectfully, listen to them patiently and care about their emotional well-being. However, there are some complaints from both sides and the survey confirms that miscommunication is common for patient and physician.

Comes the telling part, "nearly 80 percent of doctors reported being urged by patients to prescribe medications they saw advertised in TV ads". Who says medicine isn't a business and the business is sickness? Marketing and advertising may identify "presumed" solutions to need, but more often than not these activities are designed to create demand.

Demand for health care works when the objective is achieving and maintaining optimum health status. Demand for health care fails when the objective is temporary relief of symptoms and propagation of sickness.

If nothing else the report conjures an image of primary care physicians' offices as daily "sick call" (patient health complaints). Primary health care should deliver and patients deserve a higher order of thinking and better outcomes than is created by this situation. The root of the problem starts with the mind-set and the reinforcement of health care as sick care. Health care is sick care that but it can be much more.

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Monday, February 05, 2007

Transformation Of Healthcare - A Muscular Public Health

Transforming health care involves the creation of a system to achieve and maintain optimum health status for every individual and the community. The three primary elements of the system are health and safety promotion; risk management and prevention of disease and injury; rehabilitation. Furthermore, this system must be developed while retaining and refining the capability of medical care to diagnose and treat people who suffer with illness, disease and injury.

This task can be initiated by converting the medical record to a health record. The health record would be based upon identification and management of health risk with provision for identifying and managing health problems. Informing and educating would be another function of the health record applied to consumers and health professionals.

Another route for transformation would restructure health education to create a dedicated program for education of enhanced primary care practitioners. These practitioners would function in teams for extended care throughout the community. The program would encompass all of primary care and include public health. There would be crossover between health education and medical education but the emphasis would differ. Some institutions of higher education should consider merging their schools of medicine and public health.

Every individual would be enrolled in the health care system for their community with oversight at the state level. Each individual would participate in the development of an electronic health record with controlled access on the internet. A health plan would be created for each individual and administered throughout the community.

It is a dream, but not a bad one. Not impossible, either.

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