organized care

[Guest guest]

Who can explain t o me exactly what this means organized delivery systems of care?What exactly does working at KAiser or Geisinger or Mayo feel like? Is this term, organized delivery of care, meaning where there are armies of people behind each doc for each disease( described that when we last heard from him after his first day at Kaiser) so that patietns do better and that is why costs are less? Patients have diabetic nurses and dietticians an d foot checkers and nurse -callers etc?

If this means organized by disease that I understandOr is there something having to do with how the physicians work together ? Do all these organizations have some agreed on easy access to guidelines that every doc agrees to use so that I can KNOW if I work there that orhto doc#1 or doc#2 or # 3 will not vary in how they treat djd of the knee?

We PCPS ferret that out on our own but have much variation Does Geisinger vary from Group Health from Mayo from Intermoutnain?So is working like that good or not?( a digession into is ebm cookbook? and how the job of docotr is changing but that is not where I wanted to go right now))

IF what intermountain and kaiser and geisinger and group health do and is so successful why isn't everyone doing it?Seems like there is something else to k now?I worked in a VA there is lots of good press about the VA achieving standards and getting Routine Health maintenance done

But was not at all pleasant to work there The aides did all that rhm stuff before a doc saw a patient. tT had only to do with checklists and a computer.When I sent people to say urology if they got too busy they-uro or whomever- made incredibley well applauded barriers-- you pcps fill out this worksheet before we will schedule the patient( check yes you did an IVP yes he has a complaint of X repetitive work that was already in our notes etc)

NO specialist EVER read the common record we were STILL doing complex referral forms. Uro would pat itself on t he back for reducing waits and delays becasue they shifted work to pcp sIn the beginning of viagra being new only uro could prescribe it SInce the VA is uhh primarily an old guy place everyone who walks in wants viagra .Uro catches on and says we will NOT prescribe only PCPS can and zip-- waits and delays go down in uro( way up in primary ca re)

Is this what organized care is? I did not mean to digress too much w ith the story but since I have heard about t hese geisinger kaiser group health places as if they are so great AND I hear all the time about how the VA is so great but the VA is NOT great for many reasons- I wonder what the real deal is why these places are not emulated every single place- does that have to do with recalcitrant docs not wanting to " conform " or do these places really not improve care in the ways WE would truly measure it?

who knows?

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