Dual Eligible – A Day in the Life
By George Martin, MD – Senior Medical Director for Health Integrated

Remember, a dual eligible is some who qualifies for both Medicare and Medicaid. Having Medicare implies that you are either old or disabled. Having Medicaid implies that you have limited income. So what does your life look like if you’re a dual? Your hopes and aspirations are likely not appreciably different than those of others but your ability to realize those goals is far more limited.

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The Right Infrastructure Will Facilitate Care for the Dual Eligibles
By George Martin, MD – Senior Medical Director for Health Integrated

Hopefully, based on last week’s post, you decided that we should treat the dual eligibles rather than leave them to the “left overs” of healthcare. Remember, these are people that have both Medicare coverage, either through age or disability, and Medicaid coverage. As such they have a set of characteristics that makes them vulnerable. First they are more likely to have either a significant medical condition or multiple medical conditions. Second, they are economically disadvantaged. This combination of characteristics implies that they need access to care more than the average person and that they are less likely to have access readily available.

Why?

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Who has the right to determine the value of a life?
By George Martin, MD – Senior Medical Director for Health Integrated

Dual eligible – If this is you, it means that you qualify for Medicare, usually by age but often by disability. You also meet criteria to be covered by Medicaid. It also means that you are most often sick, poor and vulnerable. You likely do not have many years left, and those years are likely to be less productive than your resource consumption.

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Will these solutions solve the evolving physician shortage crisis?
By George Martin, MD – Senior Medical Director for Health Integrated

The current prediction from the American Association of Medical Colleges (AAMC) is that the United States will need 130,000 more physicians than will be available in 2025. One-half of these will be primary care. They further predict that the lack of access will increase the cost of care by a combination of delayed care and inappropriate access. Much of that access will fall on already overburdened emergency departments.

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The Physician Shortage Crisis and My Generation
By George Martin, MD – Senior Medical Director for Health Integrated

Since World War II, the baby boom has driven the economics of the United States. We drove baby sales in furniture and then bicycles. We drove housing and cars. Now, we drive, and will continue to drive, health care demand for the next 20 years. We are aging and there are a lot of us so the needs for health care, from drugs to hospice, are a growth industry based on demand. Time to invest? Perhaps.

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Patients want access to care but what do the docs need?
By George Martin, MD – Senior Medical Director for Health Integrated

I am reminded of one late night at the emergency room. I was to provide care and admit a sick child to the hospital. While finishing the paperwork, the father of another patient appeared and recognized our presence. The comment was, “Well doc, have you got this shift?” My answer easily could have been “Yes and the shift before and the shift after and the shift …” You get the picture.

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Do Patients Need Disease Management?
By George Martin, MD – Senior Medical Director for Health Integrated

Disease Management (DM) programs, as currently structured, are focused on prevention of acute exacerbations of chronic conditions. NCQA has a list of the things that should be done for patients with specific diseases. Within this measurement structure it has been demonstrated that if these measurable outcomes are met, the population being treated will have better health and cost less. So far so good, but my question is “Have we improved the health of the patient?” Further, have we empowered the patient to remain well (by removing any barriers and by education, access to health resources, etc.) or are they dependent on a DM program to maintain their health?”

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The value of questions and second opinions for patients
By George Martin, MD – Senior Medical Director for Health Integrated

A common commercial or public service announcement now airing starts off with a customer questioning everyone from a car salesman to a computer repair guy. He has endless questions for these people. Cut to a scene of him finishing an examination at the doctor’s office. The physician asks “Any questions?” The customer turned patient sits mute.

The reasons for this are two fold – trust and fear.

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But who defines what “access” means?
By George Martin, MD – Senior Medical Director for Health Integrated

As doctor and Senator Bill Frist said, “America enjoys the best health care in the world, but the best is no good if folks can’t afford it, access it and doctors can’t provide it.

But while all patients want access, actually having access means different things under different circumstances. Let’s look at three possible scenarios:

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What will it take to make this a Happy New Year for healthcare users?
By George Martin, MD – Senior Medical Director for Health Integrated

In keeping with several comments from readers provided in December to this blog, I plan to begin this year with a focus on the patient. Making 2012 “the year of the patient” was a specific request and so we will try. In doing so, I would like to not only identify the patient’s needs but also their wants. They are, after all, the end user and ultimate customer of the health care system. Unfortunately, like most systems, healthcare would rather ignore the customer. As I have heard it said “This job would be easy if we didn’t have to deal with patients”.

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