Summary of thoughts on reforming health care

[Guest guest]

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.