Posts Tagged ‘medical homes’

HHS To Step Up Alzheimer’s Research

Monday, April 9th, 2012

Federal officials have taken another step toward their goal of better treatment for and even prevention of Alzheimer’s disease by 2025, according to Kaiser Health News. A more comprehensive, draft version of the Obama administration’s national plan to address Alzheimer’s is now available. Experts emphasized expanding and better coordinating disease research, primarily through public-private partnerships.  They also stressed improved preparation for the healthcare workforce, enhancing public outreach and providing Alzheimer’s families with financial and other support.  To achieve these goals, President Obama proposed an additional $106 million in federal funds as part of his 2013 budget.

The Alzheimer’s advisory council provides new specifics about how the money will be used.  For example, they propose creating registries to better direct Alzheimer’s patients into clinical trials, as well as establishing a national inventory of research investments.  On the healthcare side, the council proposes working with private partners to develop evidence-based guidelines for Alzheimer’s care and establishing a national clearinghouse to publicize those recommendations.  Additionally, the council advocates that new healthcare models – such as the medical homes and accountable care organizations promoted by the Patient Protection and Affordable Care Act (ACA) – be analyzed for outcomes among Alzheimer’s patients.

The draft plan, issued by the Department of Health and Human Services (HHS), places top priority on treatment, and focuses on the burden the disease places on families and caregivers.  “Alzheimer’s burdens an increasing number of our nation’s elders and their families, and it is essential that we confront the challenge it poses to our public health,” President Barack Obama said.  The White House plans to divert an additional $50 million this year from HHS projects to Alzheimer’s research, and seeks an extra $80 million in new research funding in fiscal 2013.  “These investments will open new opportunities in Alzheimer’s disease research and jumpstart efforts to reach the 2025 goal,” according to HHS.

Eric Hall, president and chief executive of the Alzheimer’s Foundation of America and a member of the advisory council that has been working with HHS, said the draft proposal addresses many of the panel’s concerns.  “Given the current economic environment that limits much-needed resources and the scientific unknowns of this disease, we believe that defeating Alzheimer’s disease will likely happen in a series of small victories,” Hall said.  He was particularly satisfied that the plan focuses on educating healthcare providers on detecting early signs of cognitive impairment and linking newly diagnosed families with support services.

A differing perspective was offered by George Vradenburg, chairman of USAgainstAlzheimer’s and an advisory panel member, who said the draft plan does not go far enough.  “This first draft fails to present a strategy aggressive enough to achieve the goal of preventing and treating Alzheimer’s within 13 years,” he said, noting that the plan lacks specific timelines and does not hold any high-level officials accountable for meeting the plan’s goals.

More than five million Americans already have Alzheimer’s or similar dementias, a number that is expected to rise to 16 million by 2050, along with skyrocketing medical and nursing home bills, because the population is aging so rapidly.  “They’ve covered the right topics.  What is needed now is more detail,” said Alzheimer’s Association President Harry Johns.  “There’s real recognition at this point that Alzheimer’s is devastating for not only the individual but for the families and caregivers.”

Who Has the Most Trouble Paying Medical Bills? The Sick.

Wednesday, November 16th, 2011

Americans with chronic illnesses or serious health problems are more likely to have difficulties paying their medical bills or problems getting needed care than adults with similar problems in other high-income countries.  The poll found that Americans were most likely to have problems getting needed care because of the high cost, or as a direct result of medical debt, according to the Commonwealth Fund“Despite spending far more on healthcare than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording healthcare and paying medical bills,” Commonwealth Fund president Karen Davis said.  “This is a clear indication of the urgent need for Affordable Care Act (ACA) reforms geared toward improving coverage and controlling healthcare costs.”

According to the researchers, the results underscore some of the biggest flaws in the American healthcare system.  The Commonwealth Fund surveyed 18,000 “sicker adults” in the United States and 10 other nations – including Australia, Canada, France, Germany, Switzerland and the United Kingdom – and asked about healthcare costs, access to care, coordination of care and medical errors.  Forty-two percent of Americans said the high costs of healthcare prevent them from seeing doctors, getting prescribed medications and avoiding treatments, an appreciably higher percentage than in the 10 other countries.

“Our system is the most disjointed in the developed world, which is the cause of many of our problems,” said Robert Field, professor of health management and policy at the Drexel University School of Public Health in Philadelphia.  “Doctors often don’t communicate with each other, so we are more likely to get duplicate tests, multiple drugs with dangerous interactions, and lost lab results.”

According to the survey, 51 percent of American adults with health problems who were 65 or younger went without care because of costs, compared with 19 percent of adults 65 and older, who were covered by Medicare.  The study found extensive gaps in access to healthcare.  More than 70 percent of  patients in Britain, Switzerland, France, New Zealand and the Netherlands were able to get same- or next-day appointments when needed.  Just half of patients in Sweden and Canada reported such rapid access.

More than 33 percent of American patients questioned paid more than $1,000 in medical costs in 2010, compared with less than 10 percent in France, Sweden and Great Britain – the nations reporting the lowest rates.

One reason why is that industrialized nations are more successful in giving patients easy access to primary care and to “medical homes” that are essentially centers for care and complex treatment.  A medical home is a single, familiar location where people receive care from accessible providers who know the patient’s medical history and the knowledge to optimally coordinate care.  The Commonwealth Fund study credits medical homes with fewer errors, poor information, coordination gaps, and emergency room visits.

“To varying degrees, care is often poorly coordinated,” said Cathy Schoen, the Commonwealth Fund’s senior vice president for policy, research and evaluation.  But the results also indicate that the use of medical homes reduced that lack of coordination and helped in other ways, said Commonwealth Fund researchers.  “Having a medical home makes a difference; it makes a difference in every country,” Schoen said.

HHS Designates $8 Million to Advance Community Health Centers

Monday, December 13th, 2010

The Department of Health and Human Services (HHS) has announced that approximately $8 million in federal funding will be made available to community health centers that have cooperative agreements to provide training and technical assistance to local organizations. The agency’s Health Resources and Services Administration (HRSA) noted that the funding is courtesy of the Patient Protection and Affordable Care Act.  The health centers will use the funding to promote community development, plan expansions, create patient-centered medical homes and support the adoption of electronic health records.  Additionally, the Affordable Care Act will invest $11 billion to fund the operation, expansion and construction of community health centers across the country.  Of that, $9.5 billion will be used to construct community health centers in regions that are medically underserved.

“These Health Center Cooperative Agreements help build on the Affordable Care Act’s investments in community health centers,” said HHS Secretary Kathleen Sebelius. “These funds will provide assistance to community health centers to help them improve access to healthcare services, especially for those who are uninsured, isolated or medically vulnerable.”

Community health centers serve nearly 19 million patients, approximately 40 percent of whom lack health insurance.  These centers deliver preventive and primary care services at more than 7,900 service delivery sites around the country to, regardless of patients’ ability to pay.  Charges for services are set according to income.

“The funding the Secretary announced will ensure that health centers who need it have the ability to plan for their futures,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N.  “Community health centers provide high quality health care to anyone who needs it, these funds make continuing that care possible.”

Healthcare Consumption Shows Systemic Waste

Monday, September 27th, 2010

More than half of America’s 354 million annual acute-care visits – for fevers, stomach aches or coughs – typically take place in a hospital emergency room rather than in a primary-care physician’s office. This statistic was revealed in a study of systemic waste published in the journal Health Affairs. According to the study’s authors, their findings underscore a valid question about the healthcare reform law – how can a system that is already overwhelmed provide care to an additional 32 million newly insured patients?

The study, led by Dr. Stephen R. Pitts, an associate professor of emergency medicine at Emory University, examined acute-care visit records from 2001 to 2004 and found that 28 percent were to the emergency room.  This was particularly true for weekend and after-hours visits.  More than 50 percent of acute-care visits by patients who lacked health insurance were to emergency rooms, which are required by federal law to threat anyone with a serious condition.  This places a heavy financial burden on hospitals, which are compelled to provide basic care in what is admittedly an expensive environment.  Often, there is little or no follow-up to determine progress or secure follow-up care.

“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” according to Dr. Pitts.  “And the reality is that the E.R. is frequently the only option.  Too often, patients can’t get the care they need, when they need it, from their family doctor.”  The Affordable Care and Patient Protection Act is anticipated to boost primary care by increasing reimbursements for physicians, attracting students to the field with incentives; expanding community health facilities; and encouraging accountable-care organizations and medical homes.  “If history is any guide, things might not go as planned,” Dr. Pitts wrote.  “If primary care lags behind rising demand, patients will seek care elsewhere.”

“Medical Home” – Closest Care to a House Call

Wednesday, December 30th, 2009

Medical home approach to healthcare can cut hospitalizations and ER visits.  It’s almost – but not quite – a house call.

A new healthcare concept called “medical home” is emerging across the country, especially in Illinois.  It is primary care devoted to prevention and to helping people with chronic conditions such as diabetes or arthritis manage their illness.  In a medical home, a physician oversees a team of nurses, physicians’ assistants and health coaches who make certain that their patients get the care, support and education they need.  Another benefit is that the plan frees up the doctor’s time to focus on the more serious medical issues.

Medicare recently announced a similar initiative, and healthcare reform legislation could champion medical homes.  One pioneer in the field is Group Health Cooperative, a Seattle-based HMO that plans to convert 26 clinics in Washington and Idaho to medical homes.  The pilot program, established two years ago, reduced ER visits by 29 percent and hospitalizations by 11 percent while improving the quality of care, according to a report in the September issue of the American Journal of Managed Care.

For medical homes to function properly, physician compensation will have to change, says Dr. David Swieskowski, chief executive of the Des Moines-based Mercy Clinics, Inc.  The model works optimally when physicians are full-time, salaried employees.  This payment arrangement is fairly rare, and insurance companies don’t reimburse physicians for taking extra time to talk to patients.

Medicaid introduced a version of medical homes in Illinois through Medicaid in 2006 and 2007.  During that time, Medicaid assigned 1.9 million people to physicians who agreed to coordinate care for an extra monthly fee.  As a result, immunizations, vision screenings and other types of basic care have improved, state officials say.