Showing posts from August, 2016

Bundling or Bungling, Once Again Into the Fray

Once again the innovators are moving forward with their vision of a new and improved health care system. These rapid changes are urged on without critique and are urged on by those best positioned to help - themselves. There are known consequences for now and predictable consequences later.
All providers will lose due to the adjustments to the changes and the costs of implementation. Some providers, as many as half, will get paid less. Some will be paid more, but this payment will go far away from them to the central offices. Whether this gets to the people who deliver the care is unknown. 

A reliable consequences is that the payments will be shifted to providers caring for the advantaged patients - who naturally have better outcomes. Also those already better organized and centralized may have an advantage in "coordination." What is likely is that those doing well will do well and those doing less well will do even less well.
The providers caring for patients with one or m…

Maternal Mortality Increase in Texas - People Factor vs Clinical Intervention Influence

As an advocate it is tempting to look for "evidence" that supports your "side." An example is maternal morbidity in Texas. Advocates are happy with articles that link poor maternal outcomes to declines in reproductive funding. They are claiming the clinical intervention card. The same advocates would likely be the ones that identify disparities as a problem. This is a people factor claim. Which influence dominates? 

Is it People Factor Influence or is it Clinical Intervention Influence?
It is not acceptable to play the people factor/social determinant card for some studies and claim clinical intervention as a major influence at other times. You may or may not be an advocate for reproductive services in Texas. You may want to believe that cuts in funding for clinical services directly impacted maternal mortality, but this disregards the disparities that often tend to shape outcomes to a much greater degree. 

People factors should consistently be dominant as health ou…

Solving Mental Health Takes More than Race and Place

Articles illustrating the problems of minorities in areas such as mental health care access are quite popular. The authors and editors often chose such comparisons to gain attention, readers, and advertising as seen in black vs white, male vs female, physician vs nurse practitioner, and comparisons of good vs bad quality.
Such studies illustrate disparities, but a major question must be asked? Is a focus on race or ethnicity the best way to actually help America address mental health disparities? From the Kaiser Health News Article - "Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people."Analysis Issues But is this difference or disparity about one specific area such as race/ethnicity? With addit…

Health Access Professional Training Should Avoid Medical Schools

As long as we continue to focus 70% of spending upon clinical interventions that can only influence 10% of health outcomes, we will fail to focus attention on the 70% of health outcomes that can be addressed via people factors. Situations, environments, behaviors, relationships, and other people factors are the dominant influence in health care outcomes (and education outcomes, and economics...). Health access professional training needs people change focus far more and clinical intervention focus far less. The reality of true health reform awaits discovery. True health reform must have health professionals with people and people factor focus. The preparation and training and payment designs fail to support the cognitive or person to person interactions that can best change health outcomes.
Health access professionals should understand the people that they serve. This seems obvious, but what is not obvious is substantial movement away from people understanding.

Health access profess…