Prevention better for health, not budget

From the CBO (via AP via MedGadget):

Some policies, such as the increased use of preventive services and the coordination of care, would have clearer positive effects on health than on the federal budget balance.

Prevention: do it because it’s the right thing to do for people.  The conclusion that it will save drastic dollars in health spending seems to be faulty, in the least.  Give back the AHRQ its power to conduct effectiveness research and publish guidelines (by the way, the effectiveness of back–pun fully intended–surgery is still questionable).  Read that last link, it’s delightfully insightful.

Preventive Charity Care

Something different: a collaborative project between Twin Cities hospitals and Portico Healthnet is looking to spend charity care dollars on prevention.  From the Minneapolis Star Tribune:

Now Twin Cities hospitals are going to try an ounce of prevention.

Stung by a sharp increase in charity care, a number of area hospitals are going to fund preventive care at nearby clinics for people with no insurance precisely so they don’t have medical emergencies later.

Starting in January, Abbott Northwestern Hospital, Fairview Southdale Hospital, North Memorial Medical Center, Hennepin County Medical Center and the University of Minnesota Medical Center will contribute a total of $500,000 for the year toward annual physicals, screenings and other primary care at clinics affiliated with the hospitals.

An earlier implemented Portico project has shown results:

Portico says the strategy works: Emergency room visits in the east metro area dropped 33 percent in 2006 for new enrollees. Inpatient hospitalizations dropped 35 percent.

It will be interesting to see how far $500,000 of preventive charity care will go.  Hospitals often bear the burden of the uninsured when they do seek care.  Most hospitals are not-for-profit and are expected to provide this benefit.  We’re getting closer to the breaking point, however.  The demands of the modern hospital industry require management of the charity care benefit.  Spending those dollars wisely to benefit the largest number of patients is becoming increasingly difficult.  Innovative approaches are always applauded.

You have to try stuff to find winners

Jen McCabe Gorman passed along a link to a video via Twitter Tuesday.  It’s a Modern Healthcare highlight reel of the Rocky Mountain Roundtable 2008.  The theme of the short footage is generally about bettering wellness prevention and chronic disease management.

Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group, emphasized community solutions, especially community-based health centers for all patients.

Dr. Tuckson’s talk focused on a four-step approach to improving prevention efforts and disease management:

1. Better leadership

2. Better strategic planning

3. Support research

4. Integrate prevention into clinical care through IT

All good points.  However, his quote about step two is bothersome.  Dr. Tuckson said, “We gotta get better strategic planning, we play around with prevention. ‘I heard a good idea the other day, let’s try that.’  That’s foolishness.  We need data, information that’s locally specific that says ‘here are the problems in our zip code and here are things we need to get at.'”

If trying new ideas is foolishness, fools are what we should aspire to be.

Granted, planning around prevention would improve through locally gathered data.  It would tell us a community’s greatest needs and then we would apply proven methods to address them.  That’s fantastic.  And some day it may work like that.

But varying needs will require solutions of many different feathers.  How do we find such solutions?  When researchers, doctors, public health officials, citizens, patients, etc. say, “I heard a good idea the other day, let’s try that.”

Tom Peters:

If Randomness Rules then your only defense is the so-called “law of large numbers”—that is, success follows from tryin’ enough stuff so that the odds of doin’ something right tilt your way; in my speeches I declare that the only thing I’ve truly learned “for sure” in the last 40 years is “Try more stuff than the other guy”—there is no poetic license here, I mean it.

You have to try stuff to find winners.

It’s wonderful to hear an executive from a private insurer pushing these ideas.  But throwing out the engine (good ideas) that will create innovative solutions to solve our oppressing health care issues is unwise.