Qliance Medical GroupUnder the ‘I didn’t see this one coming’ category, we find that Jeff Bezos, Michael Dell and Drew Carey (from the ‘one of these things is not like the others’ category) announced an investment in the Seattle-based medical home provider Qliance. Found the mention on Tech Flash (thanks, Priest).

While the Qlience medical home model is one I have strongly advocated, I have my reservations about the extent to which they can be broadly successful in the areas where we need it the most: caring for patients living with chronic conditions. Yes, I’m sure they can provide great services for the large majority of young, healthy people, but their contribution to the overall healthcare dollar is relatively small (depending on who you ask between 5% and 10%).

But when it comes to advancing chronic care management, you need a medical home that is not silo’d off from the rest of the continuity of care. Quite the contrary, the medical home needs to be the fulcrum around which all care is managed. Yes, I know some think ‘managed’ an ill-advised word to use – loaded as it is with 1980’s ‘managed care’ baggage. However, that’s exactly what’s needed to ensure the appropriate care if provided and care is truly coordinated to reduce errors and duplication of effort.

Don’t quite see how the Qliance model works in the big bad world of chronic care management, but I like the concept.


You better believe it.

The second edition of Best Care Anywhere: Why VA Health Care I Better Than Yours just hit the bookstore shelves and I just lapped it up. I was offered the first edition of this book back in 2007 when I was new to working in health care and so very uninformed about it. This book really swept away the cobwebs in my mind in that I had no concept that the incentives imbedded in our system of medical care delivery did not always encourage the best care. It, in fact, encourages more care which as we know from decades of work in comparing medical effectiveness (see Dartmouth Atlas of Health Care) actually suggests a negative correlation to outcomes.

In that way, this book very much undersells itself – it’s about way more than just the VHA. It does what it sets out to do by spelling out what researchers have found which is that in a broad range of metrics, the care provided our veterans in the Veterans Health Administration is the best care available in America  today. It’s also telling that this second edition is made available some 3+ years after the original and the data still hold true.

What is this data, you might ask:

  • New England Medical Journal noted that the VHA was “significantly better” in all measures connected with fee-for-service Medicare
  • Annals of Internal Medicine reported that the VHA was the best in all seven measures of quality in comparison to its private industry counterparts
  • RAND study concludes that the VHA outperforms all other sectors of American health care in 294 measures of quality
  • National Quality Research Center in Michigan found that the VHA had the highest patient satisfaction of any public or private sector health care system
  • Journal of the AMA wrote in 2005 that the VHA “quickly emerged as a bright start of patient safety”

That’s not even the whole list. And, by the way, they do it at a per-member cost that is a little over 8% less than private sector counterparts. More value at lest cost. I thought that was only supposed to be possible in the private sector.

Well, as it turns out, another thing the author succinctly points out is medical care does not behave like other markets. The author refers to this phenomenon as Roemer’s Law. Put succinctly: in typical markets, increased supply leads to lower prices, in medical care more supply just results in more utilization and higher costs. See, all this stuff in a very small package – and extremely quick read – and you have the makings of a classic. And it is.

Dr. Donald BerwickSomehow I let several days go by without commenting on President Obama’s nomination of Dr. Donald Berwick to lead the US Centers for Medicare and Medicaid Services (CMS). When this news was telegraphed a few weeks ago, it was like I was a tween who had just learned her favorite boy band was coming to town for a concert: I just had to call everybody who I thought might have a slight interest in the news. To be clear – it is big news.

In an earlier post, I expressed my delight that we were able to get substantive health insurance reform signed into law in this country. To say (as some have) that this step was not a big deal just flies in the face of the facts … it really was a big deal (I know, ‘cause Joe told me). It is also true that no matter how much we change the rules around how medical care is financed, unless we take on the much more difficult task of re-orienting the incentives for care around patient outcomes emphasizing both primary and secondary prevention, it just won’t matter. At current course and speed, we’re headed off a cliff.

Enter Don Berwick. Actually, he entered almost two decades ago as the seeds for the Institute of Healthcare Improvement took hold. He has been a relentless and tireless advocate for outcomes-based, patient-centered care. If anyone was wondering how ‘serious’ the current administration is about getting value for our healthcare dollar, this is an emphatic answer.

To get a glimpse of where he want to take this thing, he threw down the gauntlet (in 2008) on the site only a true health wonk could love – Health Affairs:
The Triple Aim: Care, Health, and Cost

Over the months I have been publishing my thoughts here, I have decided to limit my focus to strictly the issues pertinent to maintaining and improving one’s personal health (with just a few exceptions here and there). My hope is you have been exposed to a few things that have been helpful.

That’s about to change. In addition to having done my homework on the areas of nutrition, supplements, exercise and longevity, I have also spent a fair amount of time learning about how health care services are provided in the US. It should be no surprise to you that I have formed very clear perspectives on these matters as well.

After considering starting up a separate blog to cover those issues, I have decided to begin covering those issues in this blog – in addition to providing even more info on how to keep yourself healthy. I hope to persuade you that one of the necessary elements for improving the way health care is provided is to have more of us managing our personal health in a way that aligns better with the bodies we’ve been given.

Given the attention this issue has been receiving as of late I expect it will be broadly engaging (although, it is fair to say I’m on the wonk side of things so prepare to wade in the deep water).

So, by way of introduction, here’s my brief manifesto regarding the health care issues of the day:

  • We need to change the narrative on healthcare
    • Access to suitable healthcare services should be considered a right in this country – as it now is in every other industrialized country in the world
    • There should be a ‘floor’ below which no one would be allowed to go below and a ‘ceiling’ above which individuals would have to pay for their own services
    • One’s access to these services should not differ based on one’s financial means (you can pay more for the guiding, but the core medical services should be equitable)
    • No person should be rendered financially bankrupt solely due to medical bills
    • All persons should be required to financially participate in the system (with suitable subsidies for those who truly cannot afford to pay in)
  • It is imperative that we reform the way for which services are paid
    • universal coverage without respect to pre-existing conditions
    • ending policy rescission practices
    • ensure portability (i.e. remove ‘work lock-in’ and ‘spouse lock-in’)
    • radically alter the business of health insurance that mandates the MEMBERS are the priority, not profit or equity investors (again, like every other industrialized country, by the way)
  • It is equally important that we simultaneously revamp way care is delivered
    • radically alter payment incentives to focus on outcomes as opposed to solely paying fees for services
    • Explicitly emphasize primary care as a means to enable better primary prevention
    • Explicitly pay for care coordination services (“medical home” model or the like) to provide higher-quality, more cost-effective secondary prevention (focusing in on the most costly chronic conditions: diabetes, congestive heart failure, coronary artery disease, hypertension, cancer), with the explicit goal to reduce costly hospitalizations that arise from acute events due to poorly-managed chronic conditions

We must create an equitable and sustainable healthcare system in the US (notice I said ‘create’ – since we do not have a health care system today, doesn’t make sense to talk about changing the existing system).

To get a sense of the perspectives I’ve considered in coming to this point of view, here is a very brief list of books I consider most valuable in becoming knowledgeable on these issues:

Healthcare, Guaranteed: A Simple, Secure Solution for America
9781439816141[1] Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care
A Second Opinion: Rescuing America’s Health Care
The Innovator’s Prescription: A Disruptive Solution for Health Care
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
Chaos and Organization in Health Care
Money-Driven Medicine: The Real Reason Health Care Costs So Much
Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer

In the weeks and months to come, I will provide more background on additional books and other resources that will help you become better informed citizen and more empowered consumer of health care.