Congress has left Washington for the summer recess, but talk about health care reform continues to stare lawmakers in the face.
As constituents give lawmakers an earful back home, the pundits and lobbyists are gearing up for fall. But if you’re in search of interesting context, look no further.
Joanne Kenen, senior health policy writer for New America Foundation, says in a blog that the D.C. government has begun “a pioneering attempt” with chronic-care pilot programs. The pilots include improving the care of HIV patients who have heart or kidney disease and making certain that diabetics visit a patient educator before he leaves the emergency room because people with severe mental illnesses tend to have other chronic disease that often end their lives prematurely.
“Washington, D.C. is not the picture of health,” Ms. Kenen writes.
“I’m not talking about political dysfunction. I’m talking about the health of the people who live here.
“That may be changing.
“The city has gotten lots of attention for its edgy school chancellor and education reform; it’s also begun (with far less fanfare) a pioneering attempt to address health challenges in a city with a serious, and costly, burden of chronic disease.
“Life expectancy in the nation’s capital is eight years lower then the U.S. average. Mental illness, HIV/AIDS and cardiovascular disease rates are high. Lots of people are overweight; diabetes is a big problem, leading to a high rate of serious kidney disease and amputations. Costs are high (although the uninsured rate at under 11 percent - 2007, pre-recession - is lower than the national average of about 16 percent.)
“The city several months ago brought in Dr. Joanne Lynn, a nationally-known clinician, writer and researcher.
“Dr. Lynn is an articulate champion of dragging health care into the 21st century and making the system respond to the needs of patients. She wants to start with Washington DC. Not in another 20 years. Now.
“She now heads the Chronic Care Initiative in the city’s department of health. So far the city has allocated $10 million in tobacco settlement money to the health initiative. About a dozen programs are underway; more should come on line later this year and next.
“It’s an ambitious project, basically taking the lessons of quality improvement and the goals of population health and applying them across an entire city with an unhealthy population and a fragmented health care system that in its current form is not conducive to managing chronic illness. The Chronic Care Initiative is, in essence, an attempt to reinvigorate primary care (and common sense) in Washington, and to apply city-wide what quality improvement wonks called the Triple Aim goals:
“1) Improve the health of the population.
“2) Enhance the patient experience.
“3) Get value.
“That’s a tall order in the best of circumstances. Here they are trying to achieve the Triple Aim for an unhealthy population that includes lots of people who are poor, sick, and members of racial or ethnic minorities.
“The initiative involves several of the city’s big teaching hospitals as well as smaller clinics and mental health centers. Dr. Lynn calls them the pioneers. They are starting small, reaching finite numbers of patients in specific clinical and community settings. But they are aiming high.
“The programs aren’t occurring in isolation, one in this clinic, one in that hospital. They are part of a collaborative, designed to share knowledge (failures and missteps as well as successes) and to try to knit Washington’s very fragmented health care system into one that can better coordinate care. If you can tolerate a really mixed metaphor, they are trying to weave ’silos’ of care into a community-wide tapestry of care (with primary care at the core). The goal isn’t just to lower the blood sugar of a few hundred diabetics, or to get a hospital in a poor neighborhood to alert the nearby community clinic when a patient shows up in the ER. The goal is to make Washington healthier while getting more bang for the health care buck. …
“This isn’t the health reform that’s being discussed on Capitol Hill. But comprehensive national legislation - expansion of coverage, re-alignment of incentives, emphasis on primary care - all those elements will make it easier for this initiative to achieve its goals, to lead the way. But the national legislation is, to a certain extent, about money and financing, the backbone of health reform. The work going on in this city may prove to be its heart and soul.”
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