Monday, February 28, 2011

Care Coordination Experiments Deliver Hope, But Doubt Remains

In my daily search for health care news, there's a certain type of story that always draws me in—the tale of a crusading hospital or doctor who's hit upon a fresh way to treat patients with chronic conditions, and wants to replicate it nationally. Last week was no different—on Friday afternoon, I came across a Robert Wood Johnson Foundation report about Project ECHO, or Extension for Community Health Care Outcomes, that links primary and specialty care doctors in rural New Mexico with patients with chronic illnesses who have limited access to care and often must travel hundreds of miles to reach the nearest provider. Using telemedicine and videoconferencing—and leveraging resources in Albuquerque across rural New Mexico—Project ECHO has tackled 19 chronic conditions ranging from diabetes and substance abuse, and has since expanded to Washington State and Illinois.

Rural areas aren't unique in having patients with chronic diseases in need of coordinated primary and specialty care. In today's H&HN Daily podcast series, H&HN Contributing Editor Bob Kehoe sits down with Caroline Blaum, of University of Michigan Health System, to talk about her organization's groundbreaking work in the Medicare Physician Group Practice Demonstration, which included innovations for—you guessed it—ambulatory care coordination for geriatric patients with chronic conditions.

And in a recent New Yorker article, Atul Gawande profiled a Camden, N.J., physician who figured out through rigorous data analysis that 1 percent of that city's patients were accounting for 30 percent of cost and then set out on a door-to-door journey to meet and treat them.

My interest in these stories go beyond the obvious feel-good moments that tales of innovation for acutely ill folks in often underserved communities inspire—because it's precisely these patients whose spiraling costs threaten to devour the U.S. health care system as we know it.

According to the Partnership to Fight Chronic Disease, chronic disease accounts for 75 percent of U.S. health care spending, and roughly $6,032 is spent on each American with a chronic disease each year—roughly five times more than the cost of care for those without chronic conditions.

So it's evident—and has been, for some time—that the road to both improved health and lower costs lies on these patients and the innovations that both hospitals and docs are making to better serve them. I have a healthy degree of skepticism, though, given years of hearing about bending the cost curve and subsequent reality checks each fall, when you, me and everyone else receive notice from our employers that health care premiums are going up—again, because of increased utilization.

ACOs and other experiments around care coordination are designed to battle precisely this discouraging trend—the one where all too many Americans suffer from multiple debilitating conditions and the U.S. health care slice of GDP grows by a few percentage points each year. I'm holding out hope that the innovators driving real change in care coordination—like University of Michigan Health System and Project ECHO—will one day attain that almost-mythical bend in the cost curve, but I until then, I'll continue to dread that fall premium notice.


H&HN Daily

H&HN Daily extends the conversations that readers began in other health care management publications and media. Each daily e-newsletter contains at least two topics with exclusive insights from high-visibility, recognized names in health care. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length.


Haydn Bush
H&HN Senior Online Editor

Bill Santamour
H&HN Managing Editor

Matthew Weinstock
H&HN Senior Editor

H&HN Daily


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