This blog is dedicated to a good friend and patient of mine who died last month in hospice. I had taken care of her for 15 years. We had many remarkable and enjoyable conversations regarding her growing up in a home where her father was a physician. She thought very highly of her father and the profession of medicine. She knew the value of good medical care and how much it means to all of us, even physicians and their families. She had seen the human side of medicine in its effects on her father and her family.
Category Archives: care coordination
Health Reform: Healing vs. Cattle Trading
In one of the most profound lectures that I have heard in my life, Dr. Eric Cassell, New York City internist and author, discussed at a Harvard conference on hospice the “Nature of Healing.” His concept regarding spirituality moved me. He said, “Function reaches from the cellular to the spiritual. Something is spiritual when it transcends the individual. Relationships are spiritual. Religion is spiritual. Spirituality is a human function.” As a family physician, I fully subscribe to this spiritual aspect of my relationship with my patients.
Care Coordination (PCMHs) vs. Assumption of Risk (ACOs): Holy Grail of Health Reform?
(Given as testimony on November 19, 2013, to the Iowa Legislature’s Integrated Health Care Models and Multi-Payer Delivery Systems Study Committee)
The Holy Grail of health reform is controlling costs while still providing access and quality. In my mind, the key to finding this Holy Grail is care coordination, forms of which can include patient-centered medical homes (PCMHs) and accountable-care organizations (ACOs). As a former member of the federal Advisory Board for the federal health-care Consumer Operated and Oriented Plan (Co-Op) Program, I helped write recommendations regarding “integrated care,” which was a legal requirement for becoming such a co-op. Our Advisory Board recognized both PCMHs and ACOs as reasonable forms of “integrated care.”
A Culture of Coverage and Health Reform
(This month’s blog post is the text of an article that I was asked to write for a professional publication.)
As chair of the Iowa Tobacco Use Prevention and Control Commission, I was responsible for helping to guide Iowa’s anti-smoking efforts by following a mission statement created by the Iowa Legislature that read, “to foster a social and legal climate in which tobacco use becomes undesirable and unacceptable.” In this same vein of using legislation to create social change, I will review the actions derived from the Affordable Care Act (ACA), also known as Obamacare, in Iowa. From this family physician’s reading of the ACA, I submit that the underlying social change goal is to create a “culture of coverage,” which means that, within certain constraints, the citizens of the United States, and residents of Iowa in particular, will have the expectation that they have health coverage and that they will, in part, be responsible for securing that health coverage.
Obviously this 2,000-page law has many more elements, approaches, and objectives, but for me, this “culture of coverage” is the overarching goal. It is with this goal in mind that I discuss what I perceive as the unfolding of the ACA in Iowa.
Health Reform and the Economy
My premise for this blog is that the basic tenets of health-care reform found in the Affordable Care Act (ACA) are sound. I have for years advocated for universal coverage, an individual mandate, care coordination as a way to improve the quality and cost of health care, an employer mandate (as limited by the ACA), improved private-insurance competition, Medicaid expansion for adults below the poverty level, and improved insurance regulation. I will not categorically support every action found in the 2,000 pages of the law, but, by and large, I think it provides a framework that can produce positive, significant change and that, over time, can be improved as necessary.
Welcome to Health Reform in the Heartland
“USA, USA, USA,” cheered the crowd anticipating the upcoming fireworks off Arnolds Park on West Okoboji Lake at twilight on this Fourth of July — thousands of people on land and hundreds in boats on the bay, all celebrating the birth of the land of freedom and opportunity. It is with this sense of freedom (specifically the freedom of speech, which the Des Moines Register reported the same day to be one of our most-cherished freedoms), and it is with this sense of opportunity for the future that I start this blog dedicated to the improvement of health care in Iowa.
During the next 18 months, guest bloggers and I will describe, evaluate, discuss, criticize, highlight, dissect, potentially improve, and — hopefully at some point — complement the effects of the Affordable Care Act (ACA) on the residents of this great state. We will dig into topics of health-care costs (our biggest problem), health-care access, Exchanges (now called Marketplaces), Medicaid expansion, Medicare, competition in the private insurance market, health-care labor needs, independent physician associations, preventive health care and early detection, coordination of care (our greatest opportunity), government vs. for-profit vs. not-for-profit health care, rural health care, and, most importantly, the value and ultimate economic wisdom of ensuring that individuals have health care coverage (to me, the essence of living in a land dedicated to freedom and opportunity).
As someone who has, for more than 25 years, been active in health-policy issues here and nationally, I have witnessed and been a part of many efforts to improve health care; I have met Iowans and others outside of Iowa who have shared with me their wisdom and visions of how health care could be made better; and, finally, I have spent untold hours considering — as a family physician, geriatrician, and hospice director who has had more than 100,000 patient-doctor interactions — how these theoretical ideas can affect real patients’ lives.
For better or worse, I share some of this with you in this blog. For the better, I will ask some of these wiser individuals whom I have met to guest blog about their own really fine thoughts and ideas.
This blog will end on December 31, 2014, with a summary of how the Affordable Care Act has fared in Iowa. The next 18 months will be a watershed for health care. Iowa, as always, will be a microcosm for this unfolding of the future of health care. That said, let us get started.