Re: Summary of thoughts on reforming health care

[Guest guest]

Thanks so much for this, Gordon. Yesterday, I completely overwhelmed the reporter for our local newspaper. He was very interested in what we are doing and had excellent questions, but we ended up on all kinds of tangents and this outline would have been very, very helpful.

I will contact the reporter again and help him organize his 1 hour's-worth of notes.

Thanks again!

Durango, CO

Here are thoughts that might help guide a discussion on how to reform the health care delivery system.

Summary

The current measurement approach won't achieve the desired effect. (Berenson)

Effective primary care is the core of a high performing health system. (Starfield)

Patients are exquisitely sensitive to the degree to which medical practices attain the fundamental attributes of effective primary care. (Safran)

Patient experience can be measured accurately and easily in practice. (Wasson)

Even solo and small practices can use patient experience data to improve their results. ()

With the primary care microsystem organized around fundamental attributes, integrated delivery systems or networks of practices can adopt the Chronic Care Model and infrastructure. (Wagner)

We should not have all of our eggs in one basket. At the very least we ought to invest in serious demonstrations of efforts more likely to address fundamental attributes of effective primary care as the means to a high performing health system. ()

An alternative measure set would:

Be accessible to solo and small practices as well as large integrated systems

Include patient experience measures reflecting the core attributes of effective primary care

Elimination of barriers to first point of contact

Demonstration of strength of relationship over time

Reflection of the broad array of services

Coordination of care across the complex health system

Reflect implementation of the CCM

Two levels of measures would be helpful.

1: At the practice level a manageably small set of indicators reflecting the broadest possible applications of effective care delivery. The core of this measure set should be the patient experience, a measure set that applies to all patients. With the foundation in place practices can then drill down into specific disease based indicators.

2: At the population level with large denominators one can measure important but less frequent events like hospitalization, emergency room visit, per capita costs. Networks of practices in a community can use population data to identify opportunities to better meet the needs of sub-populations with more unique risk.