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My wife (and editor) is a columnist for a hyper-local start-up trying to compete with our local newspaper. She wrote a column, published today, on the trials of one of our (now deceased) “urban chickens.” The story takes the reader from the designer chicken coop to the vet who specializes in urban chickens, through the diagnostic testing (mostly physical exam), and the outcome (the chicken had to be “euthanized”). We have had several conversations about this event in our household, mostly around how a vet can charge so much money to diagnose a bird that one can get pre-cut up at Food World for 69 cents a pound with a coupon. Mostly, I filed this under people with extra money do odd stuff for their animals and vets are willing to work with us to facilitate this behavior. I couldn’t help but reflect that in the old days, the county agent would have provided the diagnosis (“That’s bad”) and offered a free solution (wringin’ its neck). Or so I learned from watching reruns of Green Acres while I was growing up.

In catching up on a backlog of New England Journal articles, I came across an article that points out the cost-effectiveness of environmental prevention (either through creating opportunities such as walking and bike paths or prohibiting bad behaviors such as driving without seat belts) when compared to individual focused efforts such as screening for colon cancer. I also read the review of the Insitute of Medicine report on childhood obesity in a subsequent issue. Disturbing was the breakdown of attribution of cause by political ideology, with “conservatives” more likely to blame children for their own obesity. Another Bloomberg article points out that physicians are at times willing accomplices in subverting any requirement for personal responsibility. The writer documents physicians self-referring into a surgery center that gives them a tremendous profit in exchange for only referring folks with the “right” insurance and looking the other way as the insurance companies were milked (or bilked, depending on the outcome of the lawsuit) for excess payments.

In short, to improve the health of the country we are going to have to make societal changes that lead to prevention, convince 30% of the population that this is not socialism, and find ways to keep physicians and others from gaming any new system. Paul Grundy, my friend with the Patient Centered Primary Care Collaborative, would see the chicken story as a metaphor for a broken system but would understand the need for a county agent approach. He sent me an advanced copy of  their newest report (to be released September 6) entitled “Benefits of Implementing the PCMH: A review of cost and quality results, 2012.” The Patient Centered Medical Home is a way to organize care delivery that combines the best of high value physician interaction, rewards for population health, and identification and elimination of waste. The new assessment of this method of care delivery is:

The PCMH improves health outcomes, enhances the patient experience of care and reduces expensive, unnecessary hospital and ED care.

It is being implemented across the country with the following consequences:

  • As medical home implementation increases, the Triple Aim outcomes of better health, better care and lower costs are being achieved.
  • Medical home expansion has reached the tipping point with broad private and public sector support.
  • Investment in the medical home offers both short- and long-term savings for patients, employers, health plans and policymakers.

Note that the outcome for human patients (better health) is different than the outcome for chickens (stewpot). I hope for the sake of all of us that we achieve these outcomes (for people). Now if only we can bring a County Agent to Mobile who knows about chickens.