Monday, July 9, 2018

Chronic Illness Cost Control

I am very interested in following the new health care institution being created at Amazon, JP Morgan, and Berkshire Hathaway to deal with their combined 1.2 million employees. I think this will be a great microcosm of the US population for a new take on health insurance. 

I do not envy Atul Gawande's issues in leading this new company. However, of the top five key challenges, I am most interested in how he handles the issues relating to chronic diseases.

"Challenge: Attacking chronic disease; and variations in care
How: Leverage technology to improve patient knowledge, contract with select providers
Risk: Changing patient behavior is the hardest thing to do in health care, and may prove costly

A crucial part of Gawande’s efforts will be addressing the crushing burden of chronic disease. These preventable illnesses, such as diabetes and heart disease, dramatically magnify costs: Studies have established that 5 percent of U.S. patients account for nearly 50 percent of spending in the U.S.

“Most of those 5 percent have multiple chronic illnesses that tend to not be well-managed within our fragmented health care system,” said Dreyfus, the Blue Cross chief executive. He added that one of Gawande’s first efforts will likely be trying to understand the extent of the disease burden among the

The new venture could help improve their care and cut costs by standardizing treatment regimens and directing employees to providers with proven track records. Given the expertise of Amazon, JPMorgan and Berkshire Hathaway in analyzing data and assessing risks, Gawande will be able to use machine learning software and other technologies to better predict the onset of disease and take preventive measures.

That’s where Blumenthal sees the greatest potential for Gawanda and the new health venture — using the power of technology to help inform patients and deliver care at the time when it can make the most difference.

“The one major advantage that this combination has is Amazon and its IT capabilities and the network of consumers that Alexa touches,” he said, adding that the PillPack acquisition further enhances its ability to leverage technology.

“I would extend that well beyond the pharmaceutical market to begin to try to influence the decisions that consumers make with their clinicians about health care in a very personal way,” Blumenthal said. “That doesn’t mean changing the way providers behave so much as it means changing the way consumers behave, making them smarter purchasers.”"

I am surprised but not amazed by the statistic that says 5 percent of patients account for 50 percent of medical costs. I had more doctor appointments last year than my octogenarian parents, combined.  My mother has RA as do I. My father had pancreatic cancer and was in active treatment. But I still had more doctor visits.

I would prefer to have my care more combined and less costly for myself and my insurance companies. I also spend a lot of time and effort going to the (damn) doctor. I dislike going to the doctor, being an 'enigma' because of my multiple ailments, and end up with a couple of referrals to take care of additional issues. Even if they are all in the same medical facility, I have to wait to get into to see them. 

Each trip takes a lot of effort out of me. I have limitations on what I can do and if I could get my care more coordinated it would my life much easier. However, standardized treatment does concern me. Every patient is different and we are in the age of individualized care, not standardized. 

But I do look at this as change for the future which could have a huge impact on US medical care. I take the attitude that change is always good. Any other attitude is self defeating.

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