Basic Health Access

I find it interesting that CMS overpays for high risk or complex patients, even when there is overcoding and fraud via Medicare Advantage. Yet CMS will not pay more for truly complex patients across rural and underserved areas. The largest do well and the smallest struggle to survive. This is the payment design, the administration design, and the enforcement design. Behind each design and designer is a serious lack of awareness of the consequences for Americans most in need of care. From NPR by Schulte - "Instead of winnowing out abusive corporations, all insurance participants were punished: The study said that a number of large Medicare health plans, which were not named, raised risk scores far above their peers. But the agency chose not to ferret out the worst offenders to discipline them. Instead CMS cut rates industrywide in 2010 by 3.41 percent to offset the jump in risk scores." As noted in the NPR article, the Obama plan has cuts planned for Medicare Advantage, but...

Home school is most local by design. Primary Care Medical School is only about primary care without the option to leave primary care after graduation. The Primary Care Medical Home School is local, primary care, where needed by design. The current health professional training designs for MD, DO, NP, and PA all fail for primary care workforce result. Recovery of primary care is about all influences lined up most specific for recovery. Medical education is not the only higher education in need of redesign. College is too expensive, fails in relevance to career, and often forces students to leave locations where care is needed to go to exclusive settings attending college with exclusive students. Local, normal, and relevant can go hand in hand with online and other modes of advanced education.  The best model for health access recovery is specific to primary care across preparation/college, medical school,  and residency training. A specific design is not difficult to visua...

It is a time when we should be more scientific, but we seem to have more nonsense than sense both inside and outside of science. National Geographic published "Why Do Reasonable People Doubt Science." I would indicate that there are scientific leaders, particularly in health care, that fail to process scientifically. Science journal also pointed out the many failures in scientific studies with regard to scientific approaches - especially the lack of randomized studies regarding health care delivery. Reasons for Science Confusion Those that profit from anti-science - This includes those who profit from controversy and those who profit by paying for their own researchers to "prove" what they want to have proved. Poorly done scientific studies plague both. Major foundations and think tanks often shape support and findings along political or economic lines. Attempts to prove the Triple Aim start and end with this proving focus rather than objective approaches. T...