Informatics for Consumer Health

Informatics for Consumer Health is a consortium of federal agencies seeking to empower providers to manage care and increase the ability of consumers to gain mastery over their own health. Their web site offers news on health informatics from the academic literature, upcoming events and funding opportunities. It seems directed primarily to academics and IT professionals, but health care providers and patients might find it useful as well.


Enjoy!

More care means lower costs?

The Commonwealth Fund recently published one of their very excellent issue briefs titled Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve? by James D. Reschovsky, Arkadipta Ghosh, Kate Stewart, and Deborah Chollet. This paper reports on a simulation model of the effects of improving reimbursement for primary care services (as Medicare did last year). Based on data showing that more primary care leads to lower total costs via lower rates of hospitalizations and other expensive services, the authors conclude that "promoting primary care can help bend the Medicare cost curve."

Other than rationing, getting patients into primary care is just about the only known way to reduce utilization. There are many ways to increase use of primary care services (such as automated systems to increase engagement between patients and providers), but none of them will work if there aren't enough primary providers. There is clearly a shortage of primary care providers now and it will only get worse as demand grows in the future due to improved insurance coverage and an aging population. If primary specialties aren't made more attractive by increasing payments (and lowering administrative burdens, too, while we are at it), we will never see an end to the health care cost crisis.

Is Disease Management Dead?

Archelle Georgiou thinks so. Her very well-written post (on her own blog here and on Managed Care magazine here) is a thoughtful obituary. She puts the time of death last November, when the New England Journal published Nancy McCall and Jerry Cromwell's report on the CMS disease management pilot program (N Engl J Med 2011; 365:1704-1712). The various DM programs showed little or no benefit, but they cost CMS $400 million. Yes, I agree: disease management, as we know it, has bought the farm and ought to be buried.

Dr. Georgiou offers several quite cogent reasons for DM's failure. The most compelling is that DM as implemented has drifted from the format and target audience originally proven effective in clinical trials in the 1990's. Again, I think she is spot on.

What should we do to improve outcomes and reduce costs going forward? Many of the ideas being proposed appear promising, but have less of a justification than the currently-employed versions of DM have. We just wasted billions of dollars and many years by failing to use the evidence base correctly. It doesn't seem wise to me to abandon the requirement for solid evidence before we invest again. Rather, we should take steps to ensure that we use technologies and programs that are evidence-based AND that we employ them as close to tested as possible.

What are those technologies and programs? Classic disease management for heart failure patients has been proven effective many times and should be retained. Use of automatic systems to support chronic disease patients (and their providers) are very low cost and have also been proven in large randomized studies. Lowering co-pays and barriers to access for essential medications and services is another strategy with a large evidence base.

Let's not throw out the evidence-based baby with the DM bathwater.

The psychology of exchanging health information with patients

How does exchanging health information work to improve health? Getting the facts about your favorite subject (you!) is extraordinarily motivating. It is the reason why actionable communications like those embedded in effective patient outreach systems work. Here's a nice review of the psychology by Joe Kvedar at Connected Health: Self-Quantification as a Driver of Behavior Change

QR Codes for communicating with patients...

QR Codes are those funny little black and white squares that look like a checkerboard with a screw loose. They can contain a surprising amount of information. For instance, here is the URL for this blog:

If you scan this code with you phone, you will be directed ..... right back here.  You can also do text. This one contains some words of wisdom from Mark Twain:



QR Codes are starting to be used in marketing (I've seen them on posters and flyers), but now that smart phones are so ubiquitous, they provide an option for sharing information with patients (an others). If you turn their medication list into a QR Code, they can scan it right into their smart phone and have it handy whenever. Here is a 6-minute video from the folks at Skyline Family Practice, in Front Royal, Virginia with some examples:

(http://www.youtube.com/watch?v=FSBIXSk4nbg for the non-scanning crowd)


Have fun scanning!

National Medical Home Summit

Benjamin Littenberg, MD, Chief Medical Officer at Patient Engagement Systems to Discuss Advanced IT for Primary Care at the National Medical Home Summit The Fourth National Medical Home Summit, the Leading Forum on the Development and Implementation of the Patient Centered Medical Home, takes place Sept. 20-21 in San Francisco Media Contact: Christine Dunn Savoir Media (617) 484-1660 cdunn@savoirmedia.com Burlington, VT - September 16, 2011 - Benjamin Littenberg, MD, Chief Medical Officer for Patient Engagement Systems, a health-care technology company that provides solutions for improving primary care for people with chronic diseases, will be presenting "Advanced IT for the Medical Home: Engaging the Patient" at the Fourth National Medical Home Summit in San Francisco later this month. At the conference, Dr. Littenberg will discuss how information technology, when applied strategically and purposefully, can create engaged patients and be a key difference maker for PCMH efforts. Dr. Littenberg's presentation will include research that demonstrates that successful patient engagement improves outcomes and saves money. "The future of healthcare is evolving and primary care delivery is changing, making engaging with patients more important than ever to the financial and clinical success of the primary care practice research. The Medical Home model will help this evolution happen, but the right information utilities need to be in place to engrain new methods of health improvement," said Dr. Littenberg. Dr. Littenberg's Mini Summit presentation at the National Medical Home Summit will take place at 2:15 p.m. on Wednesday, Sept. 21. The Fourth National Medical Home Summit is being held on that day, as well as on Sept. 22, at the Grand Hyatt in San Francisco, California. Patient Engagement Systems provides technology solutions that have been demonstrated to improve coordination, compliance and the overall management of chronic conditions by supporting physician decision-making and communication with their patients. Physicians who work with Patient Engagement Systems have found that the technology extended, and expanded, their capability to provide high-quality, cost-effective, and consistent medical care -- ultimately improving health outcomes and reducing expenses. Patient Engagement Systems' technology is the only patient centered clinical solution that has demonstrated effectiveness in a National Institute of Health (NIH) funded study. The National Medical Home Summit is the leading forum on the development and implementation of the patient centered medical home (PCMH). The Summit, a hybrid conference and Internet event that is sponsored by the Jefferson School of Population Health, will bring together the leading authorities and practitioners in the medical home field to discuss how the PCMH model is working, where it has proven outcomes, how it is evolving, and how it fits into plans for delivery system reform. The conference will present the key building blocks of the medical home model, and four major medical home themes -- IT, care coordination, patient engagement, and the medical home workforce. Each of these topics will be discussed in depth in separate mini summits. For more information about the National Medical Home Summit, visitwww.MedicalHomeSummit.com For more information about PES, visit www.patientengagementsystems.com About Patient Engagement Systems® Patient Engagement Systems® technology enhances patient engagement by fostering communication between patient and caregiver, and by delivering decision support to health-care providers. The PES system has been proven in a National Institute of Health clinical trial to improve health outcomes and reduce costs. The patent-pending PES technology uses automated reminders, alerts, flow sheets and population reports to help health care providers better care for their patients, and patients better manage their chronic conditions. PES has been used by thousands of patients with diabetes in Vermont, New York, California and Texas. Clients include municipalities, private hospital systems, physician organizations, and managed care organizations. For more information about Patient Engagement Systems (PES), visit http://www.patientengagementsystems.com.