An excellent Op/Ed piece in the Wall Street Journal (2/23/12) ...  "The maket is naturally creating an ObamaCare alternative, and the moment for structural reform may be riper than Washington rhetoric suggests.  'Health-care reform' is inevitable.  The only question is whether it will run in the direction of prices and choice or more government control."

Health Care's Coming Price Revolution

From Dan Buettner's book, Blue Zones, on lessons learned from people living the longest, healthiest and happiest lives on the planet:

Kamada Nakazato is a centenarian living in Okinawa, one of the four Blue Zones identified by the research. Hers is just one of many fascinating stories of these amazing people.

When asked her secret to living to age 102, she said: "I used to be very beautiful... I had hair that came down to my waist.  It took me a long time to realize that beauty is within.  It comes from not worrying so much about your own problems. Sometimes you can best take care of yourself by taking care of others.  Eat your vegetables, have a positive outlook, be kind to people, and smile.

"Older Okinawans can readily attribute the reason they get up in the morning ("ikigai").  Their purpose-imbued lives gives them clear roles of responsibility and feelings of being needed well into their 100s."

" A sudden loss of a person's traditional role can have a measurable effect on mortality... Kamada remains functioning longer because she feels needed."

Researchers found a clear evidence of this purpose-driven attitude in the longevity, health and happiness of centenarians across all four Blue Zones.  One 11-year study found that "individuals who expressed a clear goal in life -- something to get up for in the morning, something that made a difference - - lived longer and were sharper than those who did not."

"Massachusetts is in its sixth year of a reform initiative that provided the template for the federal Affordable Care Act of 2010. The Bay State’s health care reform bill, An Act Providing Access to Affordable, Quality, Accountable Health Care (also referred to as Chapter 58 of the Acts of 2006, or simply Chapter 58),was passed in 2006, during the administration of Gov. Mitt Romney (R). Its components include Medicaid expansion, subsidized private health insurance, a health insurance exchange, insurance market reforms, and requirements for individuals and employers—all elements included in federal health reform. As the nation continues a contentious debate on the potential benefits and costs of federal health reform, Massachusetts’s experience provides an early indication of potential gains and challenges."

"The Massachusetts health reform initiative enacted into law in 2006 continued to fare well in 2010, with uninsurance rates remaining quite low and employer-sponsored insurance still strong. Access to health care also remained strong, and first-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery in the state. There were also improvements in self-reported health status. The affordability of health care, however, remains an issue for many people, as the state, like the nation, continues to struggle with the problem of rising health care costs. And although nearly two-thirds of adults continue to support reform, among nonsupporters there has been a marked shift from a neutral position toward opposition (17.0 percent opposed to reform in 2006 compared with 26.9 percent in 2010). Taken together, Massachusetts’s experience under the 2006 reform initiative, which became the template for the structure of the Affordable Care Act, highlights the potential gains and the challenges the nation now faces under federal health reform."

• "Health insurance coverage among nonelderly adults in Massachusetts was at 94.2 percent in 2010, well above the 86.6 percent estimate for 2006."
  
  
• "Massachusetts’ high level of insurance coverage reflects high levels of employer-sponsored coverage in the state. More than two-thirds of nonelderly adults (68.0 percent) reported coverage through an employer. This is significantly higher than the level in 2006 (64.4 percent), before health reform."
  
  
• "In 2010 compared to 2006, nonelderly adults were more likely to have a usual place to go when they were sick or needed advice about their health (up 4.7 percentage points), and were more likely to have had a preventive care visit (up 5.9 percentage points), a specialist visit (up 3.7 percentage points), multiple doctor visits (up 5.0 percentage points) and a dental care visit (up 5.0 percentage points)."
  

Sometimes I learn more about where I'm going by looking back at where I've been --- how about you?

Thanks to my friend, Mary Haley, a senior solutions consultant with IBM, for sharing this article from 2009 highlighting Dr. Paul Grudy, one of the true pioneers in finding ways BACK to the coordinated care that our family doctors (aka "primary care provider") used to provide for our moms' and dads' families.

Rediscovering Coordinated Care is one of the greatest needs/opportunities for the US health care system. 

The Family Doctor: A Remedy for Health-Care Costs?
How making primary-care physicians the center of America's health-care system could drive down costs

By Catherine Arnst with Business Week, June 25, 2009 

 This medical home may sound like the "gatekeeper" model of the 1990s, a managed-care creation that was all about holding down costs. But advocates say the new concept is designed to help patients, not insurers. It's more like doctoring 1950s-style, when a Marcus Welby figure handled all the family's medical needs. This time it's juiced up with digital technology. 

It also represents a politically painless way to streamline a disorganized and wasteful system that chews up a crippling 18% of the U.S. gross domestic product. That burden is felt particularly by private industry, which covers 60% of the nation's insured. Since most businesses try to ferret out waste and disorganization in their own operations, the medical home is a concept they can embrace in good conscience. 

One of the biggest advocates is IBM, which shelled out $1.3 billion last year on health benefits for its U.S. employees and retirees, equal to one month of the company's net income. Dr. Paul H. Grundy, 57, who holds the unusual title of director of health-care transformation for IBM, is a medical-home evangelist who led the company to start the Patient-Centered Primary Care Collaborative, a coalition of some 500 large employers, insurers, consumer groups, and doctors. Part of his goal, he says, is to show that "employers can drive the medical-home idea as buyers of care." 

Four medical societies have also endorsed the concept, and pilot programs are under way in several states. Most significantly, the idea has the imprimatur of President Barack Obama, who has said any health-care bill should "encourage and provide appropriate payment for providers who implement the medical-home model." 

The current practice of medicine in the U.S. is a long way from this model. One recent study found that only 27% of physician practices come close to qualifying as a medical home. Still, for a real-world example, step into a nondescript building in Newport News, Va. There, Dr. Peter B. Anderson is examining Gretchen Parker, 72, his patient for 25 years. A year ago, Anderson warned Parker she was pre-diabetic, a condition that afflicts 57 million Americans. Instead of putting Parker on medication, his team helped her change her lifestyle and lose 55 pounds. Her blood sugar readings are now back to normal. 

A SMARTER OPERATION 

Unlike most primary-care doctors, Anderson and his team take ample time to counsel patients, guide them through lifestyle changes, and monitor chronic conditions with frequent checkups. He has helped patients avoid heart attacks, diabetes, and unnecessary surgeries by focusing on prevention and disease monitoring. He does all this while seeing 30 to 35 patients a day, compared with 20 to 25 for most practices. And he accepts Medicare. "This is what I always wanted to do," says the 56-year-old Anderson, who converted to a medical home five years ago. "I'm seeing far more patients and delivering the best care I've ever done." 

Anderson has three full-time nurses on staff and one part-timer, where most doctors have one or two. The nurses spend much of their time updating patient records, a job that once ate up hours a week on Anderson's schedule. "The history-taking just kills the doctor's time. I don't have to do any of that," Anderson says. It helps that he has an electronic medical-records system, found in only 17% of doctors' offices. Anderson also belongs to a group of 300 specialists and primary-care doctors, all on the same computer network, making it easier to consult with any doctor a patient may need. 

Anderson's nurses spend about 30 minutes with each patient on each visit, working through a long list of questions, assessing new health problems, and reviewing old ones. The nurses also discuss preventive measures and treatment options. Once Anderson takes over, he can spend the visit addressing a specific complaint and warding off future crises. To make sure he hasn't missed anything, he has a nurse sit in with him and the patient during the exam, pointing out details in the medical record that a busy doctor could easily overlook. 

As sensible as this routine may sound, it goes against the grain of most primary-care practices. Medicare and other insurers pay doctors on a fee-for-service basis that rewards quantity of care over quality. There are no reimbursements for discussing diabetes management with a patient, say, or talking over a case with a specialist. "The main hurdle to getting the medical home accepted more widely is the lack of compensation for cognitive work," says Harvard Business professor Clayton M. Christensen, co-author of The Innovator's Prescription: A Disruptive Solution for Health Care. 

IBM's Grundy is campaigning to change all that. There is some self-interest here, as IBM sells the electronic health-record systems that are a must for well-run medical homes. But Grundy, the son of missionaries who fought AIDS in Africa, also argues for social responsibility. He worries about the on-site clinics that many companies are establishing in an effort to control their health costs. "That's just opting out," he says. "We need to transform the system if we don't want two-tiered health care." 

IBM is working with several pilot medical-home projects around the country. The furthest along was started by Community Care of North Carolina almost six years ago, with 870,000 Medicaid recipients and 97,000 children enrolled. CCNC pays primary-care physicians in the experiment a premium of only $2.50 per patient per month to emphasize preventive, coordinated care. Yet a study by Mercer Human Resources Consulting Group (MMC) estimates the state saved $161 million on health-care costs in 2006 as a result. 

North Carolina aside, it is tough for many doctors to focus on coordinated care when there is no mechanism to pay them for their time. A nationwide switch to medical homes is also constrained by an extreme shortage of primary-care physicians, again because of the economics. Medicare reimburses primary care at a lower rate than any other specialty, so only 17% of medical graduates choose to enter the field. 

Anderson insists it is possible to set up a profitable medical home with current reimbursements, but only by increasing patient volume. In fact, he made the switch strictly for economic reasons. "Even though I was working 50 to 60 hours a week, I wasn't able to pay my bills, and one of my nurses was going to quit," he says. "I had to increase my patient load." 

A few years earlier he had heard a lecture about a Kentucky doctor who was able to see 50 patients a day after converting to a medical home. The efficiencies came from relying on a team approach, where nurses take on a lot of the record-keeping once left to the doc Anderson tor. Trying the same model, hired an additional nurse, added some 15 patients a day, and was able to increase his annual billings by $200,000, to $620,000. He personally earns $240,000 and works 45 hours a week.