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Nielsen holds a Ph.D. in health policy management from Johns Hopkins School of Public Health and a master’s degree in public health from George Washington University. Her interest in public health began with work as a Peace Corps volunteer in Thailand and matured through a position as a Senate staffer for Bob Kerrey during the health care reform debate of the 1990s. She also served as assistant director of legislation for the AFL-CIO. She was appointed by then-Kansas Governor Kathleen Sebelius as the first board chair of the Kansas Health Policy Authority, later becoming the executive director, responsible for developing a policy agenda and overseeing administration of the medical portion of state health programs including Kansas Medicaid, the State Children’s Health Insurance Program and the State Employee Health Program.
We were lucky enough to have her speak last week at the ADFM conference. Her insights into the world of care transformation were both exciting and overwhelming. Exciting because she sees the benefits of our organization:
“Primary care transformation is the foundation for larger transformation we need to see across the entire health care delivery system, and population health is at the heart of such change. This is something departments of family medicine recognized long before Affordable Care Act. They helped lay the foundation, and they are essential to the success of health care reform efforts,” she said.
Overwhelming because now we have to put our money where our mouth is.
My friend Paul Grundy has begun a blog on the IBM website, found here. In his first installment, he details the events of why, in part, I am more optimistic about the future of American healthcare for having worked with him. In the first part of his entry, he identifies why IBM has more than an intellectual interest in health care:
With this information, [Watson, the IBM supercomputer] can suggest options targeted to a patient’s circumstances. This is an example of technology that can help physicians and nurses identify the most effective courses of treatment for their patients. And fast: in less than 3 seconds Watson can sift through the equivalent of about 200 million pages, evaluate the information, and provide precise responses. With medical information doubling every 5 years, advanced health analytic systems technologies can help improve patient care through the delivery of up- to-date, evidence-based health care.
The point he makes following this, though, is not that the computer will lead to a reduction in health costs by decreasing the need for human interaction. This data needs to be converted to actionable information. That is where IBM, the company that purchases health care, has taken the lead:
So, how to make sure this actionable information flows and is held accountable at the level of a healing relationship?With this question in mind, in 2006, IBM – as a buyer of care- hosted a meeting for 47 of the Fortune 100 buyers, TRICARE, the federal Office of Personnel Management (OPM), buyers and the whole house of primary care. They agreed to guidelines now known as the Joint Principles of the Patient Centered Medical Home (PCMH).
This is how the Patient Centered Primary Care Collaborative got its start.From this group came many of the elements of care transformation included in the Affordable Care Act.
As you can see, Paul and IBM have influenced healthcare for the better and will continue to do so. If you have an interest in policy, specifically where its going as opposed to where it has been, I would advise you to pay attention to his thoughts.
Blue Cross of Louisiana is following Dr Berwick’s advice to act locally. For years in Louisiana care was delivered by specialists in the usual disjointed, uncoordinated fashion driven by dominant hospitals and medical schools. On December 2 a summit was held at the Pennington Research Center in Baton Rouge to initiate a sea change in the way care is delivered. They announced the rapid deployment of a primary care based patient centered medical home delivery model. In their press release, they cite the following data as contributing to this change:
According to the review, in South Carolina, patients in the patient-centered medical home started by Blue Cross and Blue Shield had medical and pharmacy costs that were 6.5% lower than the control group. Patients in a similar Blue Cross program in North Dakota saw hospital admissions drop by 6% and emergency room visits fall by 24%. During that same period, in the control group, hospital admissions were up by 45% and emergency room visits rose by 3%.
They go on to say
“The healthcare industry is facing unprecedented change. Blue Cross and Blue Shield of Louisiana has answered the call for new and innovative delivery models by embracing the concept of the patient-centered medical home,” said Mike Reitz, Blue Cross President and CEO.
“Accountable, collaborative, coordinated care delivered through the patient-centered medical home will transform healthcare delivery,” said Dr Kenneth Phenow, Blue Cross Chief Medical Officer. “As an industry, we have evolved as far as we can using costly, fragmented, fee-for-service payment. As we transform, pay-for-value models like those embodied by the PCMH approach will help us achieve better health and better care at a better cost.”
Mike Reitz reiterates his support for the concept as well as the importance of primary care on a video captured by Bayou Buzz found here.
This was e-mailed to me by Paul Grundy under the headline “PCMH as seen explained in the deep red states by an enlightened plan.” Anyone from Alabama listening?