Real World Health Care Blog

Tag Archives: therapists

We Need a Little Certainty

When you’ve been diagnosed with cancer like me, you’re faced with an overwhelming amount of uncertainty. Did they catch it in time? Will the treatments work? And for many cancer patients, can I afford good treatment?

Linda Barlow

Linda Barlow

The Emergency Cancer Relief Fund (ECRF) could answer this question, but only if the HealthWell Foundation receives the donations it needs in order to open it.

It’s both sad and frustrating that here, in one of the most highly developed nations in the world, many cancer patients have to wonder if they can afford to save their own lives. Unfortunately, even having health insurance is not always enough of a safety net to avoid personal financial collapse while fighting the fight of your life.

As the bills start to roll in, so too does a new wave of uncertainty: Can you afford what you need to get better?

Providing assistance to people living with cancer has always been a priority for organizations like the HealthWell Foundation. Since 2004, HealthWell has been leading the way in bringing financial relief to more than 70,000 cancer patients with copay assistance through more than 20 oncology funds – yet so many more need help.

That is why I’m turning to you today. HealthWell has made the decision to create the ECRF. It is not yet open, but I want that to change. And for that to happen, HealthWell needs your help today.

Once launched, the ECRF will help people with expenses not covered under traditional current cancer copay funds, expanding services to even more cancer patients who have exhausted all other options and have no one to turn to.

For example, the ECRF can grant as little as $25 to help someone pay for anti-nausea medicine. Larger grants can also help patients overwhelmed by medical expenses accumulated during their treatment, such as medical equipment needs and diagnostic testing.

The ECRF will follow patients every step of the way through their treatment or recovery. It will almost be like having another caregiver watching out for your well-being. And for those of us who have lived through or are living with cancer, we know how important that caregiver network can be.

To that end, I would like to personally recognize and thank all of the health care providers at Abington Memorial Hospital and The Rosenfeld Cancer Center who took such good care of me during my recent treatments for breast cancer. From my initial diagnosis through my follow-up visits, every physician, nurse, therapist and technician I’ve encountered has treated me with both professionalism and the compassion and kindness a cancer patient needs to get through the day.

Compassion and kindness – they’re like life-giving oxygen to a cancer patient. But compassion and kindness aren’t just the hallmark of professional caregivers and loved ones. The ECRF will be proof of that, but HealthWell first has to raise enough money to open the fund so patients can benefit from it.

And that’s where your support comes in. If you want to show compassion and kindness to those with cancer, now is the time. Give to ECRF today so that HealthWell can launch the fund and help cancer patients avoid one more uncertainty in their lives.

(Medical) Home is Where the Care and Cost-Savings Are

The word “home” has many connotations: the building in which you live, the place you come from, and even the end point of a game. Now, there is a new type of home: The Patient-Centered Medical Home (PCMH).

Linda Barlow

Linda Barlow

PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted – and cost-effective – model for how primary care should be organized and delivered, encouraging providers to give patients the right care in the right place, at the right time and in the manner that best suits their needs.

“The magnitude of savings depends on a range of factors, including program design, enrollment, payer, target population, and implementation phase,” explains Michelle Shaljian, MPA, Chief Strategy Officer of the Patient-Centered Primary Care Collaborative (PCPCC). “Most often, the medical home’s effect on lowering costs is attributed to reducing expensive, unnecessary hospital and emergency department utilization.”

When the Affordable Care Act (ACA) was signed into law in 2010, medical homes got a boost because of numerous provisions that increased primary care payments, expanded insurance coverage and invested in medical home pilots, among other programs.

The model has been adopted by more than 90 health plans, dozens of employers, 43 state Medicaid programs, numerous federal agencies, hundreds of safety net clinics and thousands of small and large clinical practices nationwide since then. Among the results:

  • In Michigan, Blue Cross Blue Shield – the nation’s largest PCMH designation program — saved an estimated $155 million in preventative claim costs over the first three years of implementation.
  • CareFirst Blue Cross Blue Shield in Maryland reported nearly $40 million savings in 2011 and a 4.2 percent average reduction in expected patient’s overall health care costs among 60 percent of practices participating for six or more months.
  • In New York, the Priority Community Healthcare Center Medicaid Program in Chemung County saved about $150,000 or 11 percent in the first nine months of implementation, reduced hospital spending by 27 percent and reduced ER spending by 35 percent.
  • In Pennsylvania, Pinnacle Health achieved a zero percent hospital readmission rate for PCMH patients versus a 10-20 percent readmission rate for non-PCMH patients.

The PCPCC is the leading national coalition dedicated to advancing PCMH. According to PCPCC, the medical home is an approach to the delivery of primary care that is:

  • Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preference, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is accountable for a patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients access services with shorter wait times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

According to Melinda Abrams, Vice President of Patient-Centered Primary Care Program at the Commonwealth Fund, to have the greatest impact, a medical home must be located at the center of a “medical neighborhood” inhabited by hospitals, specialty physicians, physical therapists, social workers, long-term care facilities, mental health professionals and other service providers. She notes that it is the role of the primary care provider to coordinate care and make sure that patients don’t slip through the cracks, or receive tests or procedures they’ve already had – a particular concern for patients who see multiple doctors.

The National Committee for Quality Assurance (NCQA) – a non-profit, independent group dedicated to improving health care quality – accredits and certifies a wide range of health care organizations and is the leading national group that recognizes PCMH with the most widely adopted model. Currently, there are almost 5,000 NCQA Recognized PCMHs across the country.

Other organizations with PCMH recognition programs include Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, and URACVideos from the American Association of Family Physicians (AAFP) feature family physicians who discuss practice redesign aimed at lowering costs, maximizing staff expertise and improving patient care.

“Practices seeking to initiate a patient-centered medical home will find that an assessment process is very helpful to understand where they are,” said Shaljian. “Some practices have electronic health records, a very strong history of team-based care, and strong connections with specialists, hospitals, and other stakeholders in the community, while others do not. Some are deeply affected by an internal culture of quality improvement, which makes a huge difference in how successful some medical homes are.”

Want to learn more about PCMH? Visit the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality content-rich Resource Center.

How can health care continue to move the nation to PCMH? And how can the model tackle its number-one challenge: the current fee-for-service payment system?