primary care – Page 28 – The Health Care Blog

Healthy Howard coverage expansion could inform future reforms

Aug 11, 2008• 4

By Sarah Arnquist

Howard County, Maryland is set to launch an ambitious universal health coverage, and the county’s top health officials says the effort will provide valuable lessons for future reformers. Fastfacts

Starting next month, 2,200 of Howard County’s 20,000
uninsured residents can enroll in the Healthy Howard Plan,
which will provide them access to primary, specialty and hospital care, and
prescriptions drugs for $85 or less a month.

Dr. Peter Beilenson, Howard County health commissioner and former Baltimore City health commissioner who ran for Congress in 2006, said this is the most ambitious local effort at universal coverage since San Francisco launched a universal coverage plan in April 2007.

Like Healthy San Francisco, Healthy Howard is not portable health insurance but rather health coverage for local treatment. Instead of levying a "pay or play" tax on businesses like San Francisco, however, Healthy Howard’s funding comes from individual premiums, county general fund dollars and substantial amounts of charity. (The Golden gate Restaurant Association is battling San Francisco in court over its tax.)

Beyond the grand ambition to provide universal health coverage, what Beilenson says distinguishes Healthy Howard is its emphasis on personal responsibility, mandatory health coaching and a forthcoming rigorous evaluation.

The result of the primary care crisis

Jul 29, 2008• 11

By Matthew Holt

Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.

Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.

At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.

Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
them.

Why? Well in a word, money.

It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.

Read the rest.

Rebuilding The Medical Home: What Walgreens Surely Sees

Mar 27, 2008• 11

By Brian Klepper

Though it probably went mostly unnoticed in the cacophony of health care stories, last week’s news that Walgreen’s had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger of very big changes in health care. Walgreens, the ubiquitous drugstore company that, with Wal-Mart and CVS, has already leveraged its pharmacy platform to establish a strong footprint in retail clinics, undoubtedly startled many health care observers with its announcement. After all, isn’t the company doctor a relic?

Actually, no. The worksite clinic – and by way of disclosure for the better part of the last year I have
worked closely with a small, very innovative, Orlando-based startup worksite clinic
firm, WeCare TLC – has been
reinvented and refitted with 21st century tools, and offers the promise
of nothing less than a paradigm shift toward dramatically better care
at significantly lower cost. Understanding how these structures work and how they differ from both old-fashioned medical practices and retail clinics provides clues into what Walgreens likely sees and why that matters to American health care.