Advocates must still participate in dialogue on health reform

Consensus has been building for a long time about the need to move our health system from its current focus on acute illness care to one better equipped to manage chronic diseases cost-effectively and with better patient outcomes.

Consensus has been building for a long time about the need to move our health system from its current focus on acute illness care to one better equipped to manage chronic diseases cost-effectively and with better patient outcomes.

More than 133 million people – almost half of all Americans across all segments of our society – live with complex and costly chronic diseases that require ongoing monitoring and treatment. By 2020, as the population ages, the number is predicted to increase to 157 million.

Advocates working to improve care for patients with chronic illnesses often get only so far with education and awareness before they encounter great immovable objects built into the present system – lack of time in primary care for patient education and counseling, fragmentation of care and lack of reimbursement for care coordination, and lack of incentives for collaboration and quality improvement.

The growing incidence and prevalence of chronic diseases has generated strong interest in prevention and in coordinated and integrated care in the primary care setting.

The Patient Protection and Affordable Care Act signed into law earlier this year encourages the creation of new models of primary care delivery (like patient-centered medical homes) and payment incentives as a means not only to improve care, but also to lower spending by keeping people healthier and avoiding unnecessary hospitalizations and duplication of services.

The flexibility and openness to innovation that the legislation appears to encourage potentially means a greatly expanded universe of opportunity for those seeking to participate in positive change.

Remember, though, the devil is in the details. Many aspects of healthcare reform have been left to the discretion of multiple federal and state agencies and quasi-governmental groups – even Congress will probably weigh in again – and will be decided only after what is sure to be an arduous process of consultation and negotiation. What issues ultimately rise to the top from an access, quality improvement, and delivery system perspective remain to be determined. 

The conversation is still dynamic, and advocates must still make their voices heard.

Bob Chandler is co-founder and principal of Chandler Chicco Companies.  

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