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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Could 2012 be a breakthrough year for healthcare?
By George Martin, MD – Senior Medical Director for Health Integrated

Whew! We made it. The end of another year. And a new year about to begin. Last week, we paused to reflect on the events of 2011. This week, we begin to plan for 2012.

For the moment, we believe that we have covered care management and the PCMH concept fully. Surely issues will develop in the coming months that will allow us to return to the topic but, for now, we will move on.

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A Time for Reflection and Anticipation
By George Martin, MD – Senior Medical Director for Health Integrated

Welcome to years end, a time for reflection, and soon to the New Year and a time for planning. This week and next we will do both. First, the reflection:

For many of us, college is far too far in the past. Personally, mine started with physics as a major. In the midst of my junior year, there was a realization of two things:

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Care Coordination for Young Adults
By George Martin, MD – Senior Medical Director for Health Integrated

Last week, we got you through the challenges of care coordination up to age 18. Now we will look at the needs of the 18 to 35 year old group. The problem here, so to speak, is that this group needs little intervention but they can most certainly still benefit from it. After all, to quote the old adage, an ounce of prevention is worth a pound of cure.

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Remove barriers to health care to influence behavior positively
By George Martin, MD – Senior Medical Director for Health Integrated

Generally, the response to health care issues is that the system is broken. Out-of-control costs are often cited as the issue and short term solutions typically are proposed. Previously, we discussed end of life issues. Now, here is the other extreme. More than 50% of all children born in the United States are eligible for government assistance to meet their health care needs. Medicaid is the largest of the programs. It also includes programs for “Healthy Children” and for those with specific disabilities.

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Truly effective Care Coordination should follow us all the days of our lives.
By George Martin, MD – Senior Medical Director for Health Integrated

Care Coordination Summary

Based on the blogs of the past few weeks we have tried to rough out the functions that care coordination must accomplish. To be effective, it must be literally cradle to grave with special emphasis on life’s transitions. And it should be continuous, though not necessarily obvious.

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End of Life Discussions Should Consider More Than the Financial
By George Martin, MD – Senior Medical Director for Health Integrated

 “No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.”

 – Steve Jobs Stanford Commencement Address Spring 2005

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Restructuring the Primary Care Office
By George Martin, MD – Senior Medical Director for Health Integrated

Going forward, much of the care coordination function will, of necessity, be centered at the site where we receive the bulk of our care: at the office of our primary care doctor. Based on previous postings, this will exclude those patients with serious chronic disease as well as those patients transitioning from stable to serious chronic disease, both of which will be managed through their specialist or via a virtual function.

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Is this the same old song and dance, my friends?
By George Martin, MD – Senior Medical Director for Health Integrated

The ACA sets forth only broad guidance in defining essential health benefits, and that guidance is ambiguous—some would say contradictory. First, EHB “shall include at least” ten named categories of health services per Section 1302. Second, the scope of the EHB shall be “equal to the scope of benefits provided under a typical employer plan.” Third, there are a set of “required elements for consideration” in establishing the EHB, such as balance and nondiscrimination. Fourth, there are several specific requirements regarding cost sharing, preventive services, proscriptions on limitations on coverage, and the like. Taken together, these provisions complicate the task of designing an EHB package that will be affordable for its principal intended purchasers—individuals and small businesses. The Department of Health and Human Services (HHS) has been charged with designing the EHB plan and enlisted the Institute of Medicine (IOM) to assist.

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