After thinking about birthing care, pre-natal care, and pre-conception care last Sunday, I took the liberty of putting some thoughts together for the local paper. With the help of my wife and editor Danielle Juzan we were able to distill over 1200 rambling words into under 500 carefully selected words. The emphasis was changed to reflect less the lunacy of the current system and more of the promise of the future should system change be allowed to occur and these were published on Friday. In my now much more succinct voice:

Technology at delivery and pre-natal care are important, but we must work harder to facilitate preconception care. If chronic diseases such as diabetes, heart disease and high blood pressure are treated prior to conception, the rates of miscarriage and fetal death go down.

Fetal and/or maternal deaths caused by diseases such as rubella (German measles), hepatitis B, chicken pox, influenza and tetanus can be prevented through vaccination.

Other dangers to the fetus caused by diseases such as HIV/AIDS, syphilis, chlamydia, and other sexually transmitted diseases are mitigated by early detection and treatment.

Unplanned pregnancies can be reduced with access to adequate contraception. Preterm delivery can be reduced through pregnancy spacing.

I mention this because educating people regarding the failings of the current healthcare delivery system in the US and the promise that the Affordable Care Act holds regarding system change is very important. Don Berwick, the head of CMS, has outlined the Triple Aim of the care delivery system.  Dr Berwick describes it as his main focus and

As described in the Health Affairs article and by Berwick in his speech , the Triple Aim consists of (not surprisingly) three overarching goals:

  • Better care for individuals, described by the six dimensions of health care performance listed in the Institute of Medicine’s 2001 report “Crossing the Quality Chasm”: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
  • Better health for populations, though attacking “the upstream causes of so much of our ill health,” such poor nutrition, physical inactivity, and substance abuse.
  • Reducing per-capita costs.

Pre-conception care is a perfect example of where the Triple Aim is important. Well planned care will lead to improved patient outcomes, better health for the population, and reduced costs.

For us to hit this Triple Aim, it will take more than doctors working harder. The Patient Centered Primary Care Collaborative held another meeting this past week to educate stakeholders.  Entitled Exhibiting the Evidence, it offered a mix of policy makers discussing the future of care delivery and ground troops discussing successes and failures. I strongly recommend going through the presentations, available here. In it you will find Paul Grundy’s report that the change to a primary care focus at IBM has led to a 30% reduction in hospital utilization and a 10% reduction in total costs (after 1 year). You will find reports regarding decision support and health information technology (tools necessary to produced patient centered care). You will find information regarding the accreditation process and the creation of Accountable Care Organizations. You will find several success stories.

Karen Boudreau from IHI pointed out at the PCPCC meeting that if we are not careful we are seemingly still poised to spend more and accomplish less within our healthcare system. She points out a better plan is to reform the system (the Triple Aim). This is what Dr Berwick is working towards at CMS. She also points out the trail blazers such as Group Health and Community Care of North Carolina have already established methods to effect system change. Those of us not in Washington or north Carolina need to push our local and state policy makers to get on the bandwagon.

Write a letter to the editor of your local paper pointing out that we do not have the best health care system in the world BUT COULD. Maybe you’ll make a difference.

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