Basic Health Access

Every day there are articles, blogs, and speeches proposing a fix for primary care. The latest to cross my desk comes from Health Affairs. Another value based plan is proposed to address the needs of patients with dementia. We can agree that individuals with dementia do have complex health care needs and their caregivers are often overwhelmed. We can agree that primary care is the most appropriate care venue for such patients. But I would argue that primary care is currently not capable of the challenge. Before additional proposals are considered such as those involving innovation, digitalization, reorganization, regulation, integration, coordination, or outreach  – the financial design must be addressed. How Does Innovation Hurt Where Practices, Towns, Health Facilities and Resources are Small Innovation Is a Distraction from Real Primary Care Solutions Innovation Focus Forced on Team Members Contributes to Overload Innovation Is More Likely Where Primary Care...

The corporate takeover of health care is more obvious with each passing day. The power goes with the trillions of health care dollars. Insurance corporations, drug corporations, and largest systems dominate. They can dictate the disposition of dollars. They can effectively prevent reforms, They can design legislation and programs that favor their interests. Generally this marginalizes dollars for patient care, dollars for the support of those who deliver the care, dollars for basic services, and dollars for most Americans most in need of care. In other words, health care has been redirected to care of the corporation. Sadly much of the rhetoric that guides this transition claims to be focused on the patient and on better outcomes. This is clearly not the case. Journalists are often engaged in some new innovative intervention that has great promise - but that mostly requires more dollars for same or less outcomes. This is can even be termed value-based even when the outcomes stay the...

One year ago today we had all the evidence that we needed to move away from payment policies that punished practices and delivery team members with meaningless use and other abuse. A year ago today, a landmark comprehensive review indicated that outcomes were not improved by financial incentives.   “In summary, we found low-strength, contradictory evidence that P4P programs could improve processes of care, but we found no clear evidence to suggest that they improve patient outcomes.” from The Effects of Pay-for-Performance Programs on Health,Health Care Use, and Processes of Care: A Systematic Review, Annals of Internal Medicine 1/10/17.     Happy Anniversary to Aaron Mendelson, BA; Karli Kondo, PhD; Cheryl Damberg, PhD; Allison Low, BA; Makalapua Motúapuaka, BA; Michele Freeman, MPH; Maya O'Neil, PhD; Rose Relevo, MLIS, MS; Devan Kansagara, MD, MCR for a fine study - substantially ignored    Not even primary care associations have mov...

The timing is excellent for significant learning regarding what works and what does not work to improve health care delivery. The distractions need to end. We need to return to more efficient and less costly. In other words, we need to transform away from recent transformations. This opportunity could be missed by those clinging to the past, reviving past assumptions,  or past beliefs or those distracted by politics rather than relying upon evidence based studies. The timing is excellent with several major works just published or distributed in the last year. Disparities Creating Barriers to Outcomes   There is the opportunity to grasp the incredible costs of disparities. We can take stock of what we are doing with designs in health, education, economics, and other areas that worsen disparities.  This National Academies work goes a long way to helping to understand just how far we have to go to change outcomes in the nation by changing outcomes in most Americans fal...

It is hard to stop a Bandwagon, but a Bandwagon rolling the wrong way needs to come to a hal t . Pay for Performance has had its 15 years, and has been found lacking.  “In summary, we found low-strength, contradictory evidence that P4P programs could improve processes of care, but we found no clearevidence to suggest that they improve patient outcomes.” from The Effects of Pay-for-Performance Programs on Health,Health Care Use, and Processes of Care: A Systematic Review, Annals of InternalMedicine 1/10/17.  This was more than just an article. It was a comprehensive review. Even more important, the studies reviewed were written by authors that in the large part wanted to demonstrate the benefits from pay for performance. Despite the best intentions, pay for performance has fallen short.   Those immersed in P4P and value based design will have to make some difficult choices. Resistance is likely. This also will delay what must happen. What must h...

The Basic Health Access Blogs typically arise as a critique of various media pieces or claims made by various health care organizations, government bodies, or foundations. Given the sad state of objective critique at all levels and the well-financed need to satisfy numerous distracting agendas, there is far too much subject material. The fact of the matter there is little positive to write about Basic Health Access and this has been true since 1983. If you want the usual news or literature with typical opinions, this blog is not for you. If you want to gain awareness regarding the designs, false claims, and confusions that lead to lesser health care outcomes and deficiencies of health access - read on.  The author has been teaching, researching, and delivering health access since the 1980s policies kicked him and too many others out of rural family practice. He is one of few that has developed physician, county, family physician, and other databases with a critic...