Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: National e-Health Collaborative

SalesForce as a Patient-Centered Longitudinal Care Platform | I am one happy Diabetic!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

I am pumped!
Years ago…1997 I believe; I had a job working for DocSite: the company founded by Physiatrist John Haughton MD that became one of the premier Registry products used as the EMR community was attempting to define itself. In the DocSite product we collected measures or “clinical indicators” that were compiled around the patient and associated with an infinity of conditions. Essentially the data design allowed physicians and grant recipients to have a single patient record yet extract, analyze and report on any constellation of outcome measures without having to spend money on redundant disease registry products. Example: Blood pressure is an important measurement for diabetes and heart failure. In diabetes the measure importance is 1) how often it is done and 2) the blood pressure value. In Heart failure the same measures of process (measurement frequency) and outcome (BP value) are required but they might be different depending on the cardiovascular guideline and contrasting diabetes guideline. In the DocSite system the blood pressure recording was simply a vital sign. The rules defining threshold for compliance with guideline were defined separately and associated with multiple conditions. When the doctor generated the data for PQRI and the Cardiovascular Excellence programs a single patient outcomes dataset was generated based on the programs associated with the patient. When the patient returned to any clinician using the Docsite system the Visit Encounter Sheet displayed the current measures due, the last values and trends for each measure and gave the physician or extender a place to generate an education note. Inexpensive, simple, multi-user, modifiable for EBG and data submission automated through clerical “generate and send PQRI data”. Now, I owned some stock in the company so I am biased but quite frankly I thought the system was elegant once it received data feeds from pharma and labs!

All of us at DocSite used a Client Relationship Management cloud application in our client services department. After using it for three years or so those of us that had worked in a previous company “the forerunner of DocSite” called Cognimed all thought that Sales Force had the proper design to create a community wide care coordination and patient centered care planning tool We had built one in the 1990s and sold it and moved on with our lives.
Today I see SalesForce has entered the arena. Knowing what I know about its capabilities I hope they capture the market by landslide. Please if you thinking about building a new care management platform…dont. As a patient, I would love to see this thing as an App. in all of my clinicians hands and on my IPhone please. Check out their demo. I am sure it all does not work as advertised but I can attest to the fact that they had the correct data model ten years ago!

Reconciling data in my six health portals

Reconciling data in my six health portals

Time to pull the sheet out from underneath healthcare in America. In one step. Eliminate Insurance, Medicare, Government Programs, and see what we come up with. Please leave a note on my grave as to the outcome.

someone-to-watch

Thank you friends from LinkedIn today. Those discussing our frustration and describing a need to sit down and discuss the disaster that was and the disaster that will be.

Without action that-is!

Rephrased: My friend states our Medical system is far to complicated and polluted with bad ideas to resolve through a bunch of silo business meetings of silo organizations who define for us consumers exactly what health is, what we need to consume to maintain it and how much we should pay!

My point was to provoke: Strictly because I have similar judgments. I recently have seminar to senior men on functional decline over life for avg American male. Then overlay of possible interventions and services through death. Then described business layer and regulatory layer.
Your point Bruce Pisetzner is precisely why we need to define the pain for all stakeholders. When I say “stakeholder” I include consumers from all socio-economic classes as well as the professionals who treat them and the “business opportunities” created between 1965 and today that supposedly state a clear value added to the system of care.
Spent my career sketching iterations of your shell games. It seems to me: and I hold a straw-man judgment; that 1) as a country we have no agreement on what “health”is e.g. functional status, emotional status, absence of disease, bio-psychosocial well being etc. Far too much room to allow a free-market enterprise to explode without revisiting what is necessary to achieve healthy population goals.
Then of course we have the employer – employee entanglement.
Then of course the Government – Defined Benefit issue.
As patient with chronic disease, provider – admin acute care for 8, provider-admin post acute for 10, HIT product architect for 10 and community healthcare integration consultant for 10; predictive analyst for 8: I have watched the money flow. Oh how I have watched the money flow. Some even into my pocket. $25K a year out to stay alive and well with diabetes.
Perhaps it is time we all tell the truth. Insurance company, Large Employers, Small Employers, Provider Types, Patient Types and so on.

I created this blog post on the fly but thought it important to get out here now!

cropped-stcroix-jeff.pngsevere retinopathy

An advocate gets busy while every politician and “talking head” takes credit for healthcare model ideas published long ago.

Reconciling data in my six health portals

Reconciling data in my six health portals

I watched Barbara Starfield again last night. She passed away in 2011 but it seamed as though she was sitting in my living room telling me everything will be alright but many of us will never get our way. Barbara spent several decades studying the characteristics of health systems all over the world. Her final conclusions were simple and easy to implement as long as social agreements were made between consumers of healthcare services and their providers. The contract (sort of) is that my primary care doctor will be available when needed if I promise to contact his or her office before going to the ER for an earache or other non-emergent condition; my doctor also agrees to follow my care as I transition through life stages and address all mental and physical health conditions as they arise by assuring I connect with the correct specialist if required. The specialists in return are in constant contact with my primary care doctor so the primary care clinic is coordinating continuous and comprehensive care and reviewing all interactions between myself and other medical environments. Like I said earlier this week. Someone to watch over me. I first learned of Dr. Starfield in 2001 and followed her publications. Funny, she was never accepted to sit on any best-practice boards but the scientific community considered her work to be spectacular in terms of statistical approach and quality. In other words, she looked for the null hypothesis also.

Again…concerns over repeal and replace.

Some more diatribe with hope at sarcastic humor is written for you below. Please follow through to the end as I pasted a really cool graphic pointing you to a new society of consumers and professionals that might fix the system over the long run.

The conversation doesn’t stop at my dinner table, on my phone, through IM or Facebook. It seems as though my popularity index took a healthy bump after November 8th, 2016. I wish I could be happy about the reasons for the traffic.
“Jeff, you are on Medicare are you concerned?”

Well yes; you see, as we become older the likelihood of needing assistance from case managers, specialists, short stays in skilled nursing or rehabilitation facilities increases. Same with home health services which is always the preferred place to recover from the self-inflicted fractured hip that occurred while my masculine ego informed me of my capacity to clean out my gutters.
One of the most important changes to the clinical language coming from Obamacare is the right for all patients cared for by primary care doctors with Medicare contracts to receive “Coordinated, Comprehensive Care”. Lately you might have heard the terms: “Patient Centered Care” or “Medical Home”. You probably heard President Elect Trump mention “Patient Centered” or a new commercial by Humana presented by a handsome young doctor stating that Humana’s system of Patient Centered Care is superior because of their capacity to coordinate your care within their “medical community”. Then you will watch a local conservative pundit state: “those stupid narrow networks tried through Obamacare didn’t work: here is a toast to repeal and replace.
This stuff cracks me up for the same proponents of patient centered care realize that closely collaborating narrow networks can provide you with clinical personnel that understand your needs better than anyone else! In fact, they have the same attributes of a Patient Centered Care Team using a single medical record and plan of care to increase safety and minimize mistakes. Yet you will hear no one (perhaps save me and a few of us that are tired of scraping the poop off our boots) tell you that the words Patient Centered, Narrow Network, Accountable Outcomes, Value Added Payment, Medical Homes, and all other terms implying a tightly coordinated, error free clinical team surrounding all patients are not original concepts. In fact, they are in place in many of our successful neighbor nations who provide universal enrollment and have always demonstrated lower reliance on emergency room services for basic medicine, better health outcomes and no difference in treatment effectiveness for cancer, diabetes, cardiovascular disease and other leading causes of premature mortality. Our own CMS (The Centers for Medicare and Medicaid Services) have published the policy here July 2016:
So all of a sudden the administration of 2017 will be using terminology invented by others to describe care models that work after years of academic surveillance by healthcare policy analysists and already written into The Patient Protection Affordable Care Act or what the opponents call “Obama-Care”.
My prediction is we will keep the new payment systems for coordinated care and chronic disease care management. However, the credit for the success will fall under a new Trump label. My fears is that the same three insurance companies comprising the oligopoly of payers for American Healthcare will recoup their lost profits of mandated care without premium inflation for the chronically ill by shifting the premiums higher for those with pre-existing conditions. So here is another question from the week:
“Jeff, what will I do now I couldn’t get covered because of my history of cancer before the ACA?” “What if “Trump-care” requires coverage for pre-existing illnesses but allows insurance companies to include the illness in the premium pricing model? “ My response to this question was “not sure, my cost in the NC High Risk Insurance Pool for my diabetes prior to Obamacare was $1200.00 per month not including co-pays. Today it is $350.00.
More on Patient Centered Care AKA Medical Homes AKA Integrated Care AKA Chronic Illness Care.
I discussed the integrated care model and its payment adjustments to my Men’s group on Thursday night as they requested a primer on planning for their last ten years of life. Their hope was that our system of care had evolved and they would not have to lose their homes to cover the long-term care charges. Many of the guys in my group neglected to buy long term care insurance when they were young and healthy, had since suffered a chronic disease diagnosis and episode of treatment and no longer qualified for long term care insurance. They could however place $10 K per month into an account to pre-pay up to one year of long term care. This is what my father did: In 2006 he entered into a contract with a transitional care organization. He paid them $350,000 for full access to assisted living and long term care until his death. They also allowed him to live in the attached apartment complex for independent seniors for an additional rent of $3200 per month including one meal per day. Not a bad deal eh? Oh yeah…one more oversight: My friends ; all retired upper middle class professionals had no idea that Medicare didn’t pay for long term custodial care either in home or inpatient facility.
Now, like I said the other day, I am a bit tired of shouting the truth to those who were unfortunate enough to buy into the following promise: “Oh we will have the most wonderful healthcare system in the world” and “We promise to repeal the expensive policies and replace with something better.
We were on our way folks: The biggest mistake, President Obama’s team was denied the necessary Medicaid expansion for ALL not SOME States by our supreme courts. If you don’t understand the math I will be pleased to describe it in another column. Basically when the folks that would have had access to Medicaid don’t receive the insurance they still consume services. The loss of revenue winds up on the balance sheets of hospitals and providers and they respond by increasing their cost per service. The insurance companies pay more and your premiums increase. So… my neighbors policy (55 year old male) in NC costs $11,000 per year. The very same policy in New Hampshire where they expanded Medicaid costs $5,500 per year. As Mr. Obama leaves keep in mind that the rate of increase in health costs since the inception of Obama Care is the lowest it has been in 40 years.
Somehow, someway; we need to cover everybody. If we do not we cannot cover the losses incurred in the private sector without the Magical Thinking that has been sold you for so many decade. Hide the losses, get others to pay for the losses through modest increases in cost of living and blame the doctors, and hospitals who give away more free care than you could ever imagine.
What would happen if our incredible consumer driven internet harnessed the decision support technology that we use daily on Amazon and instantly brings the right service to you when needed should you or a loved one become ill? What if we harnessed IBM Watson to make the diagnosis thereby reducing error rates and reducing unnecessary utilization of expensive diagnostic procedures?
What if we didn’t need insurance companies any more to assess population risk and perform preauthorization services while we waited for our new medication?
Since we have all of the data connecting lifestyle, culture, nutrition, infection and the human genome can anyone appreciate where we are headed with our capacity to discover the cause of disease and effect of treatment? This is not decades from now my friends; it is within the reach of our children’s lifetime. I have wonderful friends with incredible scientific minds that are creating open source technologies to accomplish human collaboration like humankind has never witnessed. The only barrier to their success is a loss of priority to cure disease, increase well-being and expand the functional-years of human life.
Or…we can keep these technologies secret, forget those we have developed through the natural sequestration of competing private enterprise and traditional silo thinking. If this is where we are headed then the best investment to assure a painless end of life if you are not surrounded by humanitarian friends is my undying support for the second amendment. If you catch my drift.

Check out Right Care Folks!

Right Care Now

Right Care Now

Community Care of North Carolina goes for the gold: Proving valid reduction in hospitalization among Medicaid enrollees with Chronic Disease

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

I have not been posting much lately due to activities with the Patient Centered Primary Care Collaborative. We are working on an analysis of accreditation standards which will ultimately be used to verify Medical Home processes, procedures and clinical outcomes. Check out their website as you consumer types will have a chance to see what others are doing for you to assure you access to the best in health care as we reform the system over the next few decades.

I am very enthusiastic these days as I am seeing the changes I have hoped for my entire life as person with diabetes since 1966. As a child my doctor was always available to teach how to master my illness and provide tips with mechanisms I could use to reduce my cost: especially when I entered college. My docs have been so cool, I can never adequately thank them. Purchasing a glucometer and testing reagents for me when I was uninsured; providing free laser therapy when my employer dumped the plan I had in favor of becoming self insured. If you want an interesting read see an old post of mine titled Physician heroes.

Today I call your attention to Community Care of NC. The organization that employed me as their clinical informatics lead back in 2002. These folks are using a model of population management and patient care that I had seen work in Massachusetts in the 1990s. To that end my wife and I moved here in 2001 to work for CCNC. They use a centralized partnership between private healthcare industry and public agencies including Medicaid, Public Health, Mental Health and Substance Abuse Services, the NC Medical Society and the local branch or thee Academy of Family Physicians.

The central teams keep improving patient targeting and clinical outcomes analysis using a variety of statistical sources and deliver regionalized community information from 12 different 501c3 Community Care Networks. The individual Networks then put care coordinators, case managers, pharmacists and administrative staff in place to create local flavors of patient centered care. All have guiding physician committees and other staff who collaborate with subspecialists as well as local hospitals. The net result is a care continuum surrounding the sickest individuals where the team focuses on goals set by the patient, their family and the team. They have been doing this for fifteen years now and I can attest to the fact that they are one of only a few Patient Centered Medical Home Networks in the country that are using a web-native care plan accessible to all on the patient team as well as multiple other physician practice improvement web apps totally focused on education, assessment of each doctors population and measurement of patient outcome.

This week they published the proof in the pudding. After long struggles against threats to defund the program they survived. They are now audited in full and have demonstrated hospital utilization rates falling at 10% per year in the chronic disease population. We are talking HUNDREDS of MILLIONS of DOLLARS in savings folks on top of hugely improved clinical outcomes and patient satisfaction with their sense of well-being.

I have always said that I needed a lot of help in my life. Since I knew how to assemble a care team for myself I figured I may as well help others do the same. Today, in 2015 we have the mechanisms in play to reconnect patients with their physicians. Please step up and teach your docs about your needs, wants and struggles as it will take us a while to walk out of the woods.

nc hospitalization trends under CCNC

Celebrating physicians who stick with patients that are non-compliant due to financial barriers.

Reconciling data in my six health portals

Reconciling data in my six health portals

 

 

 

THERE ARE LIVES IN THE BALANCE

 

This is a synopsis of my attempt to bring affordable timely retina care to impoverished people with diabetes in Eastern NC. I sent this note to the Medicaid Managed Care entity: Community Care of North Carolina and was able to schedule a meeting as a result.

To: The Executive Director of North Carolina Community Care Networks,

“I have three retina ophthalmologists with nine clinics in four counties that are willing to take Medicaid patients. When I retired they asked me what I wanted to do. They had saved my eyesight and I told them that the disparity in services in NC had been my chief frustration since moving here. I said I would like to find as many diabetics as possible who were not compliant with retinal screening or follow-up care due to financial barriers. They agreed to treat as many as I could find after reading my proposal.

Many physicians are dropping Medicaid patients in NC. I have found some excellent, compassionate doctors who want to help.
Will you please help me strategize for an outreach effort. I will do all the work.”

I created a program guide for Medicaid describing access rules and services available. I started with Medicaid because their process outcomes revealed 40%-50% of diabetics missing annual eye exams. Furthermore this was in counties where over 1/3 of the diabetic populations had poor control (A1c > 9%) and therefore were more likely to have disease of the retina.

I met with the Community Care folks who (in my opinion) have a wonderful care coordination and patient centered care model. They informed me that they couldn’t perform specialty referrals as it showed preferential treatment. I responded with:” Many ophthalmologists do not see Medicaid patients and your data point out an underserved chronically ill population. I went on to say that the local hospital charged for a vitrectomy was $12,000 and that my friends would be willing to contract for $3900. They responded with a requirement that I recruit doctors from other practices.

So the retinal surgeons I was working with created a business relationship with an optometry group to perform annual screenings. Since Medicaid had stopped paying for eye exams in non diabetics, many diabetics stopped scheduling their exams as they also thought their services were dropped. However NC Medicaid does cover optometry for persons with diabetes. I guess the messages have not been tested for clarity and understanding in the Medicaid population?

After spending 9 months working with this ophthalmology group to reach out and treat people who are literally going blind due to gaps in care, addressing the needs of the Managed Care Organization (Community Care of North Carolina or CCNC) and following up with additional requests for an audience with their primary care physicians we received no follow through from CCCNC and we have continued to treat diabetics as they trickle in from primary care and emergency room practices with acute retinal hemorrhage and vision loss.

I imagine this is a political issue, as irrational behavior in healthcare systems is usually due to hidden agendas that go unseen in the public. Unseen you say! Yes the pun is intended.

We apologize to the impoverished diabetics of North Carolina, we are here for you, will  always assure you get the best care regardless of your capacity to pay.

If you need help visit this website and schedule an appointment. Taylor Retina Center

These folks saved my vision and I am sure they will save yours if you are able to get to them in time. I hope to have wider support and advertising from agencies trusted with reaching out to help you in the future. For now, no luck with Medicaid CCNC.

The images below illustrate a normal retina and a young 20 y/o diabetic woman with severe diabetic retinopathy as she appeared during her first visit to the clinic’s practice. One must appreciate how much retinal tissue can be lost before the patient notices the change. This is the underlying reason for annual – biannual screenings. When I interviewed the physicians they stated that 20 patients per year appear in their office with this level of injury who are insured by Medicaid or have no insurance at all. They have never denied treatment. Since they own their laser and have ownership in a day surgery center they are also able to address the financial concerns of the operating room provider.

20 year old woman with severe disease                                                Normal Retina

severe retinopathy

A normal retina

 

 

 

 

An expression of gratitude for my first $28,000 bottle of Harvoni!

Can believe NC?

Can believe NC?

Last week I published my offer to not accept resuscitation services in exchange for a full course of treatment with Harvoni, the new Direct Acting Antiviral from Gilead that has demonstrated a 95% cure rate in Hepatitis C patients with genotype 1.

In most cases insurance companies, Medicaid and Medicare is not paying for the medication unless the patient has end stage cirrhosis and is queued for transplant. The reason is easy to understand from an economic perspective yet certainly Draconian when it comes to well over 2 million people in the US who suffer with this debilitating illness. Furthermore the price discrepancy between countries is 94 X when comparing egypt and the USA for example. 

In the US a 1 month supply of Harvoni is $30,000; in Egypt it is $320.00

For more, please see my slide presentation below. For now, I want to thank Federal Employee Blue Cross for covering this medication as well as my much needed continuous ambulatory blood sugar equipment which makes this diabetic completely able bodied when away from home and alone.

 

 

I do not know how or why I was approved. Neither does my hepatology doctor. Both he and I were in tears when the fax came in through his prior approval desk. I am now in my third day of therapy. 

All I did was write a story on my blog and link it to facebook, linkedin, twitter etc. Within 24 hours my friends at Humana had retweeted my message and called me to see if they could help. They were not even my insurance company but this is a great example of how some payers are monitoring the internet for clients in need. 

Human did not get back to me but within two more days we had the approval from Federal Employee Blue Cross (my wifes health insurance). Since they are acting as secondary to my Ordinary Medicare the authorization was up to them. 

So whoever you are at Blue Cross, this is one lucky American who thanks you for the generosity to step outside most payers protocol and save my life. 

What a Christmas Present. 

 

THE POST FROM LAST WEEK

I will happily select a DNR status if you pay for my Hep C Treatment 

Hopeful

Hopeful

An economic model for exchange of value between patient and payer.

 Dear America,

I have been notified by both Medicare and Blue Cross that the technology I use for tracking my blood sugar trends will no longer be covered.

I have been notified by both Medicare and Blue Cross that the antiviral medication which has come on the market to cure my Hepatitis C will not be covered.

I would like to negotiate for coverage of these technologies using my history as a patient and known economic data regarding the cost of care at the end of life as a proposed value exchange. 

I understand that the insurance industry AND public sector should grind their teeth when presented with the $1000 per pill cost of the new therapy’s. I also imagine payers are stratifying patients needing transplant for first access to care since the drugs work on damaged livers. What I do not understand is the 287/1 disparity in cost between America and Egypt?

 

Hooray Humana for providing useful tools to family caregivers.

Yikes!!

Yikes!!

Lately I have complained about the lack of utility if not barriers created by various e- communication tools that seem to complicate the process of educating consumers on the topics within the domain of self-mastery.
After losing my poa agreement with my father, Humana finally
Let me know that I am now Pop’s designated healthcare proxy.
I find the letter engaging with plenty of contact info content and a promise to send me a care-advocates guidebook with accompanying educational material for visit preparation, medication reconciliation and financial management.
I will let you know how useful it is when received.

For now, a gratuitous thank you to a payer stepping into the medical home care team role with both patient and family!

A Chronic Disease Patient Reports On e-HR and p-HR utility

 

Reconciling data in my six health portals

Reconciling data in my six health portals

I will be attending the PCPCC annual conference next week and moderating a session on Do It Yourself Primary Care Medical Homes.

Most of my time of late has been attending to my ‘case’ as the demands of self-management are now more complex with the advent of new tools which were to lighten our load. Nowadays I spend at lease two hours each week keeping my 4 p-HRs up to date across four specialty physicians.

Why you ask? Well it appears that someone forgot to turn on the ‘interoperability switch’. I am sure it is here somewhere, I just can’t find it. I know the standards were written for certification purposes, I even have a copy of them. For some reason, here in metropolitan RTP North Carolina: Duke, Wake Med and UNC have all established contracts with Epic. The physicians that I use are independent and they have all chosen AllSCRIPTS and this is my patient experience.

NOTHING CONNECTS

I HAVE AN EPIC MY CHART PORTAL AT UNC

I HAVE ANOTHER EPIC MYCHART PORTAL AT DUKE

I HAVE AN ALLSCRIPTS-MEDFUSION PORTAl AT GARNER INTERNAL MEDICINE

I HAVE AN ALLSCRIPTS MEDFUSION PORTAL AT SOUTHERN DERMATOLOGY

I HAVE AN ALLSCRIPTS PORTAL WITH NO MED FUSION AT NC CARDIOLOGY

I HAVE AN ALLSCRIPTS PORTAL WITH NO MED FUSION AT MY ENDOCRINOLOGIST

I HAVE A HEALTHVAULT PORTAL ATTACHED TO LABCORP AND SURESCRIPTS

 I AM UNABLE TO TRANSFER CCR S BETWEEN RECORDS

THE FACILITIES ARE NOT TRANSFERRING THE RECORDS

OUR TAXPAYERS SUPPOSEDLY BUILT THE NCHIE TO CONNECT TO ALL PROVIDERS

I started out on this journey to reduce errors in medicine in 1997. Why are we still here? Please don’t blame it on Obama, Bush, Clinton; well you get the picture.

Here is my ‘secure message’ to my Medical Home

My recent note to my PCMH

My recent note to my PCMH

 

NC Senate : While the rest of the country profits from North Carolina’s success in Medicaid, you throw the baby out with the bathwater.

 

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

cmis_use

 

 

The graphic report (above right) comes from the CCNC data systems developed by the Community Care of North Carolina Program. It allows communities to identify and assist people in need of support or locate systemic problems such as high utilization rates in local emergency rooms. All of this stuff combined fits into the Medical Home Model that out senate suggests purging CCNC; Yet, as you will note below, this program is a locally managed;public-private joint venture that is used throughout the US to achieve cost reductions in health systems. Please read on:

Yet another testimony to the capability of a Medical Home framework to decrease cost and improve health outcomes was published in today’s NY Times.   Here are the data:

  • The payer: Care First Blue Cross Blue Shield
  • The population size: 1.1 Million!
  • The model: Medical Homes (Community Care of North Carolina an early adopter of this strategy)
  • The savings: $130 Million

The article goes on to explain that results have been mixed in Medical Home Evaluations, demonstrating a need to identify the components that are required to achieve such results.   However, The Patient Centered Primary Care Collaborative Chief Executive Marci Neilson noted that the studies are showing promise as Blue Cross Blue Shield of Michigan demonstrated a $155 Million savings in Emergency Room Visits and Hospitalization through their Medical Home Program last year.   So here’s what I have to say to the Senate: WAKE UP… the people providing the knowledge and structure to the programs now receiving accolades from the media cut their teeth in North Carolina through a fifteen year joint effort between public and private industry. Then, after receiving national recognition they were asked to teach other States the basics of the Medical Home that will reduce cost and improve health outcomes.

  1. Local control with State support
  2. Physician directed care
  3. ACCURATE DATA published frequently, reviewed frequently, converted to focused interventions
  4. Care Coordination and patient education from within the physicians practice
  5. Frequent regional meetings to review success and make adjustments to work-flow and design.

Here is an example from years ago in Greensboro (CCNC ORAL REHYDRATION PROGRAM)  

  • The local Community Care Network discovered that many emergency room admissions were attributed to children experiencing dehydration when they had GI Flu.
  • The CCNC Network (Partnership 4 Health) created an oral rehydration program where they reached out to the community of working mothers who would come home to a child experiencing diarrhea and vomiting.
  • As they engaged the family they taught the mothers to rehydrate their children using pedialyte.
  • They distrusted the rehydration kits to physician practices, public health departments and elsewhere.
  • The people started treating their children at home as opposed to the emergency room.
  • The Medicaid emergency department visit rate for GI distress fell and the tax-payers saved money.
  • All of this with happier children as the most important outcome in my opinion.

So what do you think NC Senate?   How about we keep what works!!! If you need further illustration there are a few thousand of us who would be pleased to teach you: Republicans, Democrats, and Independents alike. 

HIT at its best

Check out Telcare Cellular Enabled Diabetes Management Platform.

Now we have a example of a technology applied to address consumer and physician hassles.

One device for measuring, cloud storage, analysis and communication for the patient.

For the doctor: This could be the ultimate registry platform for diabetes specialists.

I am pumped…..well I use a pump but I was referring to something else.

Telcare.