Archive for the ‘Health Reform’ Category
Wednesday, March 10, 2010
Centralizing the “Centered” Models in New Hampshire
By Laura Davie, Project Director, NH Institute for Health Policy and Practice
In my role as project director in the Institute for Health Policy and Practice, I work on multiple projects. Although these projects have different components (including populations segments being focused on, issue being addressed, partners engaged at the table), it is impossible to ignore how these project are (or, at least, should be) connected across the health systems that they span. In my work of late, I notice the word “centered” is used a lot as an important descriptor of projects being implemented across health systems. These projects include the patient-centered medical home within the health care delivery system and person-centered planning in the long-term care system. I believe that, while these two “centered” models serve different functions within their respective systems, New Hampshire will be best served when these “centered” models overlap (and the sooner, the better.)
A previous blog by Heather Staples on this site describes the NH Initiative’s Patient Centered Medical Home project (see the medical home page of the Citizens Health Initiative website for additional information). As described on the website, “[t]he patient-centered medical home concept re-centers health care on the patient’s needs and priorities by providing primary, preventive, and chronic condition care that is personalized for each patient.” In addition to patient-centered models in primary care settings, hospitals across New Hampshire are implementing patient-centered models focusing on care-coordination and care-transition. I recently attended a conference in which Dartmouth-Hitchcock Medical Center presented their “Bridges to Safe Transition” program. I won’t describe that program in detail here, and it is one of many models that exist in the hospital setting. The point is that these primary care and acute care settings models are vital to improving health outcomes. These medical system models improve communication between providers and improve education and care planning with patients. New Hampshire should continue to push for expanding these programs beyond the nine pilots currently implementing medical home and beyond the selective diagnostic cases the acute care model often focuses.
Another health system focusing on centeredness is New Hampshire’s long-term care system. This system has made great strides, and continues to transform itself into a person-centered system. One of the key elements of a person-centered system is utilizing person-centered planning. To quote my colleague, Sue Fox, at the UNH Institute on Disability, “person-centered planning means a process to develop an individual support plan that is directed by the participant and/or their representative and is intended to identify their preferences, strengths, capacities, needs, and desired outcomes or goals.” Two services available through the ServiceLink Resource Centers around the state that use elements of person-centered planning include Long-term Care Support Counselors and Caregiver Specialists. Person-centered planning addresses the social factors such access to food, transportation, and assistance with dressing or bathing on an ongoing bases. Expanding person-centered planning models in our long-term care systems needs to continue to push forward.
The expansion of patient-centered and person-centered models in their respective systems should be a priority for New Hampshire. In addition, these two models should not be considered mutually exclusive. Quite the opposite — it is the overlap of these two (and certainly other related projects) projects that place the person or patient (or whatever term being used) at the center in which the individual is really at the center. True coordination of these systems is what will facilitate improved health outcomes. While the medical system is rightfully centered on the medical aspect, a person’s ability to heal or cope with their health status is dependent upon social supports: Who can pick up their prescriptions? Do they have transportation to the follow up appointments? Did they eat the meals delivered by Meals on Wheels? The long-term care person-centered planning model develops an individual support plan identifying their preferences, strengths, capacities, needs, and desired outcomes/goals. This social support plan is the glue for the medical plan. I do believe all “centered” models will best serve New Hampshire when they overlap. I think we are on our way, but our health systems need to identify and remove system barriers that prevent them from really centralizing around the person.
Wednesday, March 3, 2010
New Hampshire Health Reform: “The Road Not Taken” or “Ambition must be made to counter ambition”
By Dick Cannon, Vice President of Finance and Administration, University of New Hampshire
Many will recognize the first title as the famous poem by New Hampshire’s own Robert Frost. While there are many interpretations of this poem, here I am presenting it as a paean to individualism and non-conformism. The second quote comes from James Madison, 4th President of the United States and author of much of the United States constitution. This quote stems from Madison’s observation that men and women are “not angels,” and there must be checks and balances so that one faction’s ambitions can be checked by the ambitions of another’s. Madison deemed this preferable to potential expediencies, such as taking away the liberties that give rise to factions or “by giving to every citizen the same passions, and the same interests.” These sentiments should resonate well with the ethos of New Hampshire.
But what does this have to do with health care in our state? Let’s start with Madison’s idea of ambition countering ambition. I write from the perspective of an employer who has faced near double digit increases in our medical care premiums year in and year out. We know that part of this increase is associated with costs shifted to employers who “ pay more” to health care providers so they can recoup what they argue are unreimbursed costs of providing care to Medicare beneficiaries, Medicaid beneficiaries, and the uninsured. There are, of course, many other cost drivers I am aware of within our population, including the general public’s appetite for new technology at any cost and for uninhibited access.
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Tuesday, February 16, 2010
Using Technology to Engage Patients in Their Health Care
By Denise Purington, BSN RN
Vice President Information Technology and Services, Chief Information Officer, Elliot Health System
With all the talk of health care reform, the use of electronic medical records, and empowering patients to get more involved in health care decisions, it seems appropriate to share what health care providers around the country are doing to get patients more involved. The question I am hearing most often is, “why can I do my banking online, pay my bills online, make an appointment to get the oil changed in my car online, but when it comes to accessing my health care providers, I still must depend on the telephone or a face to face visit?”
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Tuesday, February 9, 2010
Public Health: improving health, preventing disease, and reducing health care costs for all
By Kristina Diamond, Policy Director, New Hampshire Public Health Association
The mission of the New Hampshire Public Health Association (NHPHA) is to strengthen the public health system to more effectively protect and improve the health and safety of our population. Many people don’t realize that public health initiatives help improve health, prevent disease and reduce health care costs for all. Our current health care system isn’t working and we need to fix it. With the uncertainty now of whether national health reform will pass, we must take the opportunity to not only educate the public, but also NH policymakers on the importance of integrating prevention and wellness into all aspects of our lives.
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