Last Monday, Stephanie Mensh wrote about her experience with medical homes. Dr. Pamela Mitchell, President of the American Academy of Nursing, has provided Disruptive Women with another perspective.

Guest post by Pamela H. Mitchell, RN, PhD, FAHA, FAAN

There is much talk these days in health professional, health payer, and even legislative circles about the “medical home.” This is a term coined in 1967 by the American Academy of Pediatrics. The medical home was originally meant as a single place for a child’s medical record and was particularly salient for children with special care needs. It later expanded to denote the one place that families with children with special care needs might obtain coordinated, continuous, family-centered and culturally effective care.¹ The concept of a medical home has additional roots in recognized needs for care coordination for people with chronic illness in managed care, case management, disease management and comprehensive discharge planning for complex or chronic illnesses. Most recently, a coalition of the American Association of Family Practice, American College of Physicians, American Academy of Pediatrics, and American Osteopathic Association developed and disseminated “Joint Principles of the Patient-Centered Medical Home.” This document defines the Patient-Centered Medical Home (PC-MH) as “an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians and, when appropriate, the patient’s family.”¹ At its best, this new movement promises quality, coordinated care for people, rather than their diseases. Further, it recognizes that care coordination and management is a complex skill that deserves payment in our current payment system. However, because of the consistent emphasis on physicians as the home “owner” and leading partner, it connotes care centered in a particular practice profession rather than care for the person or family who comes “home.”

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Guest post from Donna Barnes

Chronic disease prevention presents an obvious opportunity for health care reform. The platforms of both Senators McCain and Obama note the potential savings—in dollars and lives—that can result from preventing chronic illnesses. However, by focusing exclusively on chronic disease, we miss an opportunity for prevention of a common cause of death that takes as many lives as Alzheimer’s disease and causes ripples throughout American families and communities.

What I am talking about here is violent death—among others, homicide, suicide, child abuse, and domestic violence that takes lives. Recognizing the growing damage from violent death and recognizing that it can be prevented—just like countless medical conditions—is critical.

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Guest post from Alexandra Carmichael

Open source has emerged as a powerful set of principles for solving complex problems in fields as diverse as education and physical security. With roughly 60 million Americans suffering from a chronic health condition, traditional research progressing slowly, and personalized medicine on the horizon, the time is right to apply open source to health research. Advances in technology enabling cheap, massive data collection combined with the emerging phenomena of self quantification and crowdsourcing make this plan feasible today. We can all work together to cure disease, and here’s how. (more…)

Guest Post by Fran Drescher

A doctor tells his patient, “I have good news and bad news. The good news is you have 48 hours to live.” The woman says, “If that’s the good news, then what’s the bad news?” The doctor answers, “I was supposed to tell you yesterday.”

Too many women are being told that they have cancer today, when they should have been told yesterday.
It took me two years and eight doctors to get a proper diagnosis of uterine cancer. As a result of my experience, I wrote the New York Times bestseller, Cancer Schmancer. I realized that what happened to me had happened to millions of women. It was then that I realized the book was not the end, but rather the beginning of a journey to improve women’s healthcare and raise consciousness of wellness and prevention issues globally. Toward this end, I founded the Cancer Schmancer Movement and Foundation, and made advocacy for Stage 1 diagnosis of cancer my life’s mission.

Cancer Schmancer is a policy-driven women’s health movement that will alert Capitol Hill that the collective female voice is louder and more powerful than that of the richest corporate lobbyist. Through education, prevention, and policy change, we will revolutionize the way Americans think about cancer. The mission of Cancer Schmancer is to ensure that all women with cancer get diagnosed in Stage 1, when cancer is most curable. We want women to understand the early warning whispers of the cancers that could affect them, and the available tests that could save their lives. We encourage them to become better partners with their physicians, and to transform from patients into medical consumers. We all know that early detection equals survival. But what’s being done by patients, the government, and the medical community to ensure early detection? We need to take the right steps forward to ensure that all cancers get diagnosed in Stage 1. (more…)

Guest post from Dr. Val Jones, M.D.

The Partnership to Fight Chronic Disease has taught me a lot about healthcare’s current financial burden. They estimate that 75% of our healthcare dollars are spent on chronic disease management, and that 80% of those diseases are preventable with lifestyle interventions. These numbers are staggering in both their sheer size and personal implications. To put it another way, if we pulled together as a nation to truly become a “wellness culture” we could reduce healthcare costs by 60%. Can you think of any other intervention with so large a potential impact on health costs in America?

Of course, modifying behavior is the holy grail of medicine. We physicians wish that our patients would optimize their diet and exercise choices and become fully compliant partners in managing their chronic diseases. Unfortunately, fifty percent of patients forget to take their meds and over 30 percent don’t refill their prescriptions. Twenty percent say they don’t take the full course of treatment and fifty percent of patients don’t take drugs as directed. What’s a doc to do?

I decided that if I’m going to expect patients to “comply” with healthy living principles and/or medical treatments, that I should model that for them first. So I created an online weight loss group to encourage people to join me in my quest to lose weight, eat well, and exercise regularly. Nearly 3,300 individuals have joined so far, and we have created a vibrant discussion group of enthusiastic and supportive people (mostly women as it turns out). The group is a place to call home – to be honest about your struggles, to track your progress, and get some expert support along the way. (more…)

Guest post from Dijuana Lewis

The role American health insurance companies play in providing affordable access to health care continues to be at the center of the health care debate in this country. While rising health insurance premiums are a key point of these discussions, the reasons for these increases are often missed. Health insurance premiums increase or decrease based on annual health benefit costs, which are estimated at the beginning of a policy year. After reimbursements to hospitals, physicians, pharmacies and other providers, insurers use premium dollars to foster quality care initiatives. This includes valuable investments in prevention, health IT, clinical research and, most importantly, wellness programs that help improve health outcomes and reduce future health care costs for the consumer.

The wellness trend in the health care industry is growing as consumers and employers alike search for ways to become increasingly proactive and control costs. Comprehensive wellness programs that offer nurse hotlines, care management assistance, worksite healthy lifestyles campaigns and preventive care reminders for screenings and immunizations can change the way health care providers, employers and consumers approach health care, and they ultimately enhance health outcomes and prevent health costs from spiraling out of control. When evaluating efforts to reduce costs and improve the quality of care, it is important to note that year-to-year increases in health care costs in 2007 were actually the lowest they have been in six years.

Dijuana Lewis is president and CEO of WellPoint’s Comprehensive Health Solutions Business Unit, which includes provider relations, care and disease management, and WellPoint’s pharmacy benefits management company, NextRx, and its specialty pharmacy, PrecisionRx Specialty Solutions. Throughout her WellPoint tenure, Ms. Lewis has had wide-ranging responsibility for management of utilization/medical management staff to assure proper benefit administration for the membership; case management and disease management to improve the health of the member population; and cost of care trends for Northeast Market states. Additionally, she was responsible for the oversight and direction of all quality improvement initiatives; physician, hospital and ancillary contracting; and servicing to meet network development access needs.