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Showing posts from January, 2017

Start with CHIP to Return to Sanity

Our nation should not waste time and energy on the past. Numerous protests to attempt to preserve ACA may or may not have impact. What is most important is shaping a better future - really shaping a better future. A better future begins with better children - children healthier and more developed mentally and physically and emotionally. Better health outcomes and better outcomes in education, economics, and other areas are about better children. Children are also the key to returning sanity and accountability to the new leadership.
Children's health insurance known as CHIP has enjoyed bipartisan political support for many years. The current movement away from this support is the mistake that should cost current leaders their leadership or force them to be accountable.
The politicians that support slashing CHIP have declared against children, have declared against key needs in Red Counties, have declared against people working their way out of poverty, and have declared against the w…

The Real Future of Family Medicine Is the Financial Design

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Yet another large health system has decided to shut down family medicine residency positions, this time in Ohio. There are consequences to come for the surrounding populations and perhaps some complications in Ohio. Family medicine advocates inside and outside of Ohio are spending a great deal of time and energy on an area outside of their control. Time may be better spent shaping real future for family medicine in Ohio and across the USA. This is about a much better financial design and not training.


It is easy to spend a great deal of energy fighting off FM residency closure. The Bartlesville program closed not long after I became a faculty member and despite stellar contributions to Oklahoma. It did not matter that Oklahoma was in need of family physicians nor did it matter that Bartlesville was in need of the contributions of a family medicine program.

I continue to be amazed when stellar FM programs are closed  including those addressing the higher primary care functions for the …

TeleOutreach or TeleProfiteering

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The 2010s have been a time of great claims of value from numerous innovations. While it seems that much is being done to help to improve health access, there has actually been very little change. The new proposals can actually undermine health outcomes and undermine the local workforce that is most important for access to care. Resistance to Telehealth may be futile, but there will be consequences that we need to understand.




When High Tech and High Touch Go Wrong

Telehealth has much surface appeal. High tech with the appearance of high touch has appeal. It seems so simple. After all in the photos or descriptions it appears that all you have to do is just link up and someone magically appears to address your needs.

For the purposes of discussion we can leave behind the discussions of laws, licensures, privacy requirements, payment uncertainties, certifications, and also controversies regarding the quality of telehealth.

There are a number of reasons why telehealth is not all that …

The Tyranny of Health Care Research

What is must important for health care leaders, designers, and researchers to understand is their limitations. Leaders have chosen the designs and research that they like without understanding the limitations and defects of the research. My vote for what has most set the US behind in health care goes to the tyranny of the aggregate. 
Once again, Dr. Saurabh Jha comes to the rescue by nailing this tyranny the best.
"What is the central tendency of a distribution but a lazy generalization? The aggregate, the mean, is wrong about everyone but the few closest to the mean, yet is so revered because we mistake the aggregate for the truth. The tyranny of the aggregate is the most extraordinary tyranny of our times. The aggregate is built by people who vary, yet it imposes itself on the individuals, the very variation which creates it. It literally bites the hands that feed it."SAURABH JHA, MD (associate editor with The Health Care Blog)
This is likely the most valid critique of q…