Nobody argues with the idea that the next big advance in cancer care or HIV vaccine development requires a significant commitment to research. Nor would anyone argue that the quality of that research needs to be excellent or that it must yield reliable information and insight about what actually works and what doesn't. Would anyone invest in a global immunization campaign with a vaccine not proven effective in rigorously conducted trials? Of course not.
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A recent NY Times Economix blog post by Professor Uwe E. Reinhardt, Comparing the Quality of Care in Medicare Options, notes the lack of good research available to evaluate whether there is a difference in the quality of care provided by Medicare Advantage (MA) plans vs. traditional Medicare. He goes on to say that given the evidence that is out there, he leans toward giving the MA plans the edge. HQP’s experience in this regard is still evolving, but may be instructive, and seems to be in accord with Dr. Reinhardt’s tentative conclusion.
HQP’s journey to develop an innovative new delivery model to improve the health of vulnerable populations began over 12 years ago. The basic idea was simple. Find a way to more effectively prevent complications among the chronically ill. How? Develop a robust bundle of preventive services matched to the needs of a target population then deliver it in a highly reliable, individually-customized way through a proactive, engaging, supportive, accessible, and ongoing service. We call the program developed using this disciplined approach to design and implementation, an Advanced Preventive ServiceSM model of care. The American health care system desperately needs a way to prevent complications of chronic disease that works. Aetna’s recent news of its 2-year experience offering HQP’s program to higher-risk Medicare Advantage members is the latest in a long line of evidence that HQP’s model of nurse care management works. [click here for Aetna’s press release] As compelling as the most recent Aetna data is (hospital admissions reduced 15%, outpatient services by 17%, and overall hospital expenditures 16%) it actually understates the effectiveness of the program – by a wide margin. Why?
The movie “Escape Fire: The Fight to Rescue American Healthcare” (@EscapeFire,http://www.escapefiremovie.com/) is a thoughtful and compelling explanation of; the primary threats to the health of Americans, the key flaws of the U.S. health care system, and the dramatic change in thinking required to improve it. What’s needed are more reliable and robust preventive services, especially targeting those at highest risk for avoidable complications of chronic disease. That is exactly what the advanced care management model developed by HQP offers. There is now overwhelming evidence that the HQP model can improve health and lower cost among those at higher risk for poor health (see http://hqp.org/index.php/results). Isn’t it time to strengthen our commitment to the continued R&D required to further enhance this model (and others like it having strong evidence of effectiveness) and promote its widespread use?
Visit our homepage. I have enormous respect for Dr. Don Berwick – a brilliant, clear, and articulate health care leader, committed to advancing affordable, quality health care for all. Apart from his insights and skills related to improving our health care system, he withstood the maelstrom of Washington politics with grace and professionalism. A brief Q&A style interview with Don is available through the Commonwealth Fund website – click HERE to watch (10 mins) “Don Berwick: Reflections on the Affordable Care Act.” Not only does Don describe aspects of the Affordable Care Act that he believes is helping to improve our health care system, but he offers further insights into how a future health care system should function differently and the changes in thinking required of health care leaders to bring it into reality.
The connection to the work of Health Quality Partners (HQP; http://www.hqp.org)? To achieve a more affordable, accessible, and higher quality health care system it will be necessary to aggressively develop and deploy effective preventive models like HQP’s nurse care management program – providing care that does not begin or end at some business unit boundary or operational or informational silo (e.g., hospital, physician office, community organization, family). A service that makes the whole system work better to avoid preventable human suffering and expenditures. We have one that’s already been proven through 11 years of intensive research. What are we waiting for? |
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