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Realigning Health with Care

May 24, 2012

Just released is the Summer issue of the Stanford Innovation Review. This issue has a great article by Rebecca Onie, Paul Farmer, & Heidi Behforouz called Realigning Health with Care. In the article the authors make the case that “through expanding the scope of health care, the place where it is delivered, and the workforce that provides it, the US health care system could significantly improve health outcomes and reduce inefficiencies.” 

Consider the following findings from the article:

  • US health indicators are among the worst of high-income countries. Since 1960, the United States dropped from 12th to 46th in infant mortality rankings (below Cuba and Slovenia), and from 16th to 36th in life expectancy (below Cyprus and Chile), according to the CIA’s World Factbook.
  • In certain neighborhoods in Baltimore, Chicago, and Los Angeles—and other communities across the country—life expectancy for subsets of the population is lower than in Bangladesh.
  • Primary care doctors are the key to improving value-based care. In the 1960s, half of the doctors in the United States worked in primary care. Today, barely 30 percent do. Ironically, health care reform will make the problem worse, not better. Expanded insurance coverage will increase the number of patients seeking care, but from the same number of physicians.
  • Even if all the United States’ 24,750 licensed medical and public health social workers in clinic or hospital settings served only Medicaid patients—and many serve none at all— there would still be just one social worker for every 2,404 patients.

Given these sobering statistics, the article goes on to encourage us to think about how to broaden the definitions of what is offered (product), where services are offered (place) and who provides the service (provider).

And then it adds a kicker that system of care communities know all too well – Medicaid reimbursement for the type of services recommended in the article are woefully nonexistent.

From the article:

  • “Although the 2010 Patient Protection and Affordable Care Act makes significant strides toward expanding insurance coverage and improving quality of care, it leaves unchanged one of the most problematic aspects of Medicaid: It does not reimburse the activity of connecting patients to essential nonclinical resources they need to be healthy, or to any other services delivered by non-clinicians that address the underlying causes of poor health outcomes. To the contrary, the Centers for Medicare & Medicaid Services’ State Medicaid Manual, which advises states on implementing Medicaid programs, explicitly forbids such reimbursement: “[C]ase management related to obtaining social services, Food Stamps, energy assistance, or housing cannot be considered a legitimate Medicaid administrative expense even though it may produce results which are in the best interest of the recipient…”
  • “But what’s new is this: The US health care system has reached a tipping point. Reform is in the air across the sector, with primary care especially positioned for transformation. “Never let a good crisis go to waste,” said Winston Churchill. The practices of countries that have improved health despite scarce resources are ready for adoption and adaptation. And the US health care ecosystem, including public, private, and philanthropic resources, is ripe to leverage this crisis to implement solutions that will improve it. “Health” is a bold, expansive aspiration. Let’s make sure that what we call “health care” is broad enough to get the job done.”

Straight out of the system of care playbook, folks. Read the article and look for the parallels. It will help you as you prepare to be involved with leading the way in designing services in the new era of health care reform. Download the article here.

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