Archive for the 'Lee Partridge' Category

There’s No Place Like (A Medical) Home

Published on May 23, 2012 in Health Care, Lee Partridge, Quality and Reform. 0 Comments

Lee Partridge, Senior Health Policy Advisor

Today, fully 1/3 of our health care spending is wasted on payments for medical mistakes and poor quality care. We also have a system that values expensive technology over basic primary and preventive care, rewards volume of care over outcomes or appropriate care, and makes no distinction in payment based on quality or health outcome. But thanks to the Affordable Care Act, things are looking up.

The health care reform law is advancing a promising approach to addressing these problems: the “Patient-Centered Medical Home.” At the National Partnership, we consider medical homes to be one of the most promising models for delivering truly patient-centered care — they improve access to primary care, help coordinate patient care across settings and providers, and make patients, family caregivers and providers partners in making decisions about care.

Recently, I spoke with the American Academy of Pediatrics about the potential of patient-centered medical homes, how families can get involved in improving quality, and how practices can support patients as partners in care. Take a look!

 

Cause for Hope in North Carolina

Published on July 12, 2011 in Lee Partridge and Reproductive Health. 1 Comment

Lee Partridge, Senior Health Policy Advisor

Infant mortality rates are widely used in this country and internationally as a barometer of the quality of a community’s, or a nation’s, health care system – and with good reason. Despite our sophisticated and expensive health resources, the infant mortality rate in the United States is significantly higher than that of many other countries.  In 2005, for example, our infant mortality rate of 6.9 per thousand births put us above that of most European countries, Canada, Australia, New Zealand, Hong Kong, Singapore, Japan and Israel.[1]

Our maternal mortality rate – the measure of women dying in childbirth – is also shockingly high compared to that of European countries.  What’s worse, it is rising.  In 1990 in the United States, 343 women died in childbirth; by 2007 that number had increased to 548.[3] A report[4] released July 6 by the National Institute of Child Health and Human Development documents some progress on reducing the incidence of preterm birth, down from 12.8 percent in 2006 to 12.2 percent in 2009.  But that rate is still woefully behind the U.S. Healthy People 2010 target of 7.6 percent of all live births.

Taken together, these statistics should be a cause of major concern and inspire action to reverse that trend.

One state, North Carolina, has set out to address these problems.  In March, North Carolina opened a Pregnancy Medical Home program for women eligible for Medicaid.   Working with their medical community, local health departments, and a network of community support organizations called Community Care of North Carolina (CCNC), state health leaders combined payment incentives and specific care requirements into a package they believe will improve pregnancy outcomes throughout the state.

Here’s how the new program works.

Maternity care providers – obstetricians, family practitioners, nurse midwives, community clinics – can apply to be designated as a Pregnancy Medical Home.  They must agree to do four things:

  1. At the first obstetric visit, administer a standardized pregnancy risk tool that provides not only clinical health history but other information about the woman and her situation that could indicate she is at risk of a poor outcome.  The questions include poor nutrition, smoking status, use of alcohol or possible physical violence.   If a women looks like a high risk, the provider must contact his or her CCNC network and arrange for care management services for that patient throughout her pregnancy.  The provider and patient also develop a plan for managing her care.
  2. Ensure that none of the providers in the Pregnancy Medical Home perform “elective” deliveries – deliveries for which there is no medical reason to induce labor — prior to 39 weeks of gestation.  Early deliveries increase the likelihood of infant death, admission to a Neonatal Intensive Care Unit, or life-long health problems for the child.
  3. Provide the drug 17 alpha hydroxyprogesterone caproate (commonly called 17P) to patients at risk of preterm delivery.
  4. Aim for a caesarean-section rate for low-risk, singleton births below 20 percent.  C-sections expose both mother and child to surgical risk and possible infection, and can create complications for future pregnancies.

To encourage providers to enroll in the Pregnancy Medical Home program, the state Medicaid agency will pay Pregnancy Medical Home practices $200 more per patient over the state’s usual maternity fee.  $50 of this money is paid upon completion of the pregnancy risk tool, and the remaining $150 for managing the care is paid once the women has had her post-partum visit.  The post-partum visit must include screening for depression, reproductive life planning, and referral for ongoing care if necessary.  The state expects to offset the cost of the additional reimbursement through savings in hospital costs.

North Carolina is not the only place trying to improve maternity outcomes; projects are underway, for example, in California, Ohio and Washington state.  But to my knowledge, North Carolina is the first to employ the patient-centered medical home model in that effort.    This is a promising program, and we will all likely learn a lot from the state’s experience.

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[1] NCHS Data Brief, #23, November 2009; www.cdc.gov/nchs/data/databriefs/db23.htm.

[2] NCHS Health US 2010, Table 36; http://cdc.gov/nchs/data/hus/hus10.pdf#glance.

[3] Child Health USA 2010, Health Resources and Services Administration, U.S.DHHS; www.mchb.hrsa.gov/chusa10/hstat/hsi/pages/202lbw.html.,

[4] America’s Children: Key National Indicators of Well-Being 2011; http://childstats.gov.

The “Business Case” for Eliminating Health Care Disparities

Published on April 26, 2010 in Health Care, Lee Partridge and Quality. 0 Comments
Lee Partridge

Lee Partridge, Senior Health Policy Advisor

No one would deny that health care in the United States is riddled with disparities – in access, in treatment, and in outcomes. There are disparities due to gender, race/ethnicity, place of residence, socio-economic status, age and insurance status. Until recently, few attempts have been made to examine how those disparities affect costs. A spate of recent research, however, builds a powerful case for paying much more attention to the connection.

As our nation grapples with how to complete and implement reforms, and gain control of health care costs, we should take this new evidence to heart. Here are some of the findings.

Finding #1: Using data from the federal Medical Expenditure Panel Survey (MEPS), Thomas LaViest of the Johns Hopkins School of Public Health and colleagues estimated the potential savings to the health care system of eliminating health disparities between adults of various racial/ethnic groups. After sorting everyone into subgroups based on race, ethnicity, age and gender they used seven health status measures to calculate what the savings would have been if race/ethnicity disparities been eliminated, i.e., if each racial/ethnic group had achieved a health status equal to the one with the best health status for its age/gender group. The result: eliminating disparities would have reduced direct medical costs by $229.4 billion over the four-year period 2003-2006. The indirect costs to society from lower productivity due to disability or illness totaled an additional $50.3 billion.

Finding #2: Timothy Waidmann of the Urban Institute, also using MEPS data for that time period, focused on the impact of disparities on the prevalence of certain chronic diseases – diabetes, hypertension, stroke and renal disease – between the non-Hispanic white population and the African American and Hispanic populations. Both high blood pressure and diabetes are more prevalent among African American and Hispanic populations than among whites, and both are major contributors to incidence of renal disease and stroke. If we could eliminate those gaps, Waidmann estimates health care costs in the Medicare program alone would have declined by an estimated $7.3 billion in 2009. He notes, further, that failure to reduce the incidence of these costly chronic diseases will result in higher excess costs to Medicare in the years to come.

Finding #3: A still more sobering set of research findings made front-page headlines in the New York Times last December. Stephen Crystal and colleagues from Rutgers and Columbia determined that poor children (defined as those with Medicaid coverage) are four times more likely to be prescribed powerful antipsychotic drugs than their middle-class counterparts. Furthermore, they’re more likely to receive anti-psychotics for less serious conditions, like A.D.H.D. and conduct disorders, than their privately insured peers. While there could be reasonable explanation behind some of this disparity, such as higher prevalence of mental health conditions in lower income families or limited access to alternative treatments such as psychotherapy, this is an alarming discrepancy. Anti-psychotics are powerful drugs with potentially harmful side effects capable of creating lifelong physical problems. They also are associated high medical costs, down the road.

The new health reform law, passed by Congress and signed into law by President Obama, will begin to address disparities in health care in various ways including expanding access to health coverage through Medicaid expansions and health exchanges, as well as expanding access to preventive care for everyone. It also calls upon all federally conducted or supported health programs to collect and analyze patient demographic data, which can then be used to identify what disparities exist where and to develop strategies to reduce those disparities.

But we’ll need to do even more if we are to eliminate health disparities all together. For example, we need to improve coverage and payments for language services for patients with limited English proficiency, and increase cultural competency training. Clear communication between patients and their providers is essential for patient safety and providing patient-centered care. It will also be important to ensure that quality improvement initiatives focus on not only raising the bar for all populations, but also closing the wide gap in quality of care among racial and ethnic groups and, for many conditions, men and women.

The data shows that unaddressed disparities in health care are a continuing source of unnecessary health spending in this country. We have a moral imperative to build an equitable health care system and these findings show us we can build a fiscally sustainable one at the same time. As the implementation of health care reform moves forward, reducing the disparities gap should be a major priority for all of us.

Virginia is for … Moms-to-be: New On-Line Tool Helps Expecting Parents Choose Hospitals, Doctors

Published on September 9, 2009 in Health Care and Lee Partridge. 0 Comments
Lee Partridge

Lee Partridge

You’re pregnant, your first language is Vietnamese, and you’d like to find an obstetrician who speaks your language. You had your first baby by emergency C-section, in another state, but you want to try to deliver the second vaginally, and you’d like to find a doctor who seems to use C-sections sparingly. Or you want very much to breastfeed your baby, and you’d like to deliver at a hospital with lactation consultants available.

If you live in the state of Virginia, you’re in luck, because the Virginia Health Information (VHI) organization has just released a Web-based, interactive consumer guide to obstetrical care that has just the data you need.

VHI is a private, non-profit organization that was started in 1993 and works with Virginia health care providers, the state government, and the research community to develop health-related databases that support quality health care. The obstetrics guide is the product of several years of work with a special task force and aims to give consumers a balanced picture of what they can expect, what questions they should ask, and information they would find useful in making choices of providers. It allows you to compare hospitals and compare physicians in multiple ways. It also contains a very useful short discussion of clinical issues and a glossary of terms.

Whether you live in Virginia or just want to look at it (wistfully) as a model for your own community, you can find it here. Once there, in the comparison sections, you can search by hospital, by region, and by physician name. The hospital and physician segments also include risk-adjusted performance evaluations on their c-section rates, episiotomy rates, and cost of care. And don’t miss the hospital services data under Prenatal Services tab 5. That’s where you can find the really cool tips – like which hospitals offer music therapy, birthing balls, or maternal massages to assist you during labor!

Virginia Health Information’s new consumer guide to obstetrical services is a great example of transparency in health care information. It’s exactly the type of tool we need to empower consumers in their health care decision-making and improve health care delivery and quality all across the nation.