Chronic Wellness Promotion v. Chronic Disease Management in Medical Homes

February 9, 2009 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Quality of Care & Safety / 2 Comments

One of the hottest health reform topics is Medical Homes: Medicare has Demonstration Project starting this year, several states have implemented, (or are implementing), medical home related initiatives, the Center for Studying Health System Change (CSHSC) released a great white paper titled “Making Medical Homes Work,” and the New York Times just had a story about how IBM is teaming up with United Healthcare to promote Medical Homes for their 11,000 employees and dependents in Arizona.

Definition of Medical Homes
One of the controversies in Medical Homes is the definition. CSHSC and many others use the definition developed by 4 national medical societies which combines aspects of preexisting primary care and chronic care models with the goal of creating a primary care “home” that can more effectively address the needs of patients with chronic conditions.…

Quality of Care in Medical Practices – Size Does Matter

January 19, 2009 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 6 Comments

The Journal of General Internal Medicine published a study last month that looked at primary care medical practices in Massachusetts to see how well they were able to provide the quality improving capabilities of Patient-Centered Medical Homes. These structural capabilities represent process measures that assess the quality of care in medical practices. However, these same measures could also help patients select their own primary care physicians.

Study Finds Larger Practices Have More Quality Related Capabilities
Not surprisingly the study found that larger practices, (and to a lesser extent those affiliated with larger networks of practices), provided more capabilities to improve the quality of patient care.…

Making Physicians Better, and Making Better Physicians

December 10, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Economics & Financing, Health System Reform, Public Health, Quality of Care & Safety / 5 Comments

A few recent reports point to ways for improving the quality of physician delivered care that has little to do with technology or complex interventions. The first involves how physicians interact with patients, and the second examines the work hours for physicians in training.

Etiquette in Medicine
The first article, by Dr. Michael Kahn in the New York Times, describes six recommended actions for physician to create a good rapport with hospitalized patients. Dr. Kahn collectively calls these actions “etiquette-based medicine”:

Ask permission to enter the room; wait for an answer
Introduce yourself; show your ID badge
Shake hands
Sit down.

…

Engage With Grace

November 26, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Public Health, Quality of Care & Safety / 1 Comment

Many bloggers are posting information today about a initiative to encourage conversation about a very difficult topic: How we want to die. This collective effort to prompt discussions about this topic at the beginning of the holiday season is very timely, and it is a good complement to my post last week about empathy and compassion in healthcare.

What follows is essentially the same text that appears on many other blogs along with a picture of the “One Slide” listing the 5 conversation promoting questions that are at the core of the Project:

———————————————————-

Engage with Grace: The One Slide Project is an astonishingly simple idea that literally touches everyone.…

Humana Does Drugs

November 20, 2008 / Michael D. Miller MD / Economics & Financing, Information & Communications, Innovation, Miscellaneous, Patents & IP / No Comments

Humana has put another couple of videos on YouTube in their ongoing series to explain – from their perspective – how the healthcare system works.

The first new video is “Insurance Companies and Prescription Drugs.” Like their other videos, this one paints the insurance industry’s as rosy and altruistic, while stating that “Prescription drug manufacturers are allowed to set their own prices, and they often build large profit margins into name brand drugs to recoup the costs of researching, marketing and advertising.”

This statement strikes me as very curious. First, how do companies “build large profit margins into name brand drugs?”…

Proposals for Expanding the Full Range of Compassionate Care

November 20, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Quality of Care & Safety / 3 Comments

Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of previous awardees. These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.…

Another Humorous? Humana Video

November 17, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Economics & Financing, Information & Communications, Miscellaneous, Private-Employer Based Health Insurance / No Comments

Last week I wrote about Humana’s YouTube videos designed to “explain” parts of the healthcare system. Well they just put another one titled, “Some Doctors Cost More. Why?”

Two interesting points about this video: First, at the beginning they describe insurance companies (like Humana) as “Providers.” (The narration uses the term “health coverage providers,” but the graphic shows “PROVIDER.”)

While physicians and other clinicians really dislike being called providers, I think they wouldn’t want to see that term used for insurance companies either, since it implies that the insurance company is actually providing healthcare. (I usually reserve the term provider to describe broad groupings of clinical entities, such as, “providers of oncology care in the Chicago area,” – which would include physicians, nurses, hospitals, etc…)

And second, the title and content of the video doesn’t focus on the total costs of care or services provided by individual physicians, but mostly only patients’ co-pays – which are lower when they use the physicians that are in-network for their insurance plan.…

Personalized Medicine – Fulfilling the Promise of Genetic Research

November 17, 2008 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, FDA, Information & Communications, Innovation, Quality of Care & Safety / No Comments

It has been 55 years since the discovery of the structure of DNA, and 40 years since James Watson published his account of that discovery in his book, “The Double Helix.” (A picture of my autographed copy is below.)

Ever since DNA was discovered to code for the structure of most living things, there has been the hope that understanding abnormal genetics would lead to the ability to treat or cure a vast array of illnesses. Unfortunately, that progress hasn’t been as rapid as originally hoped. But medical science is now beginning to put genomic research discoveries into actual medical practice, and start customizing medical treatments based upon each individual patient’s genetic makeup – the fundamental concept of “Personalized Medicine.”…

Managed Care/Health Insurance Direct-to-Consumer Advertising or YouTube Educational-Propaganda Videos?

November 12, 2008 / Michael D. Miller MD / Economics & Financing, Information & Communications, Miscellaneous / 3 Comments

I saw a very interesting couple of videos today put on YouTube by Humana – the managed care insurance company. Apparently they are the first in a series that they are calling “Stay Smart Stay Healthy.” According to an email I got today promoting the second video, “Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry. Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.”

While that sounds like good corporate citizenship, the actual content of the videos doesn’t seem quite so innocent.…

Medical Homes, Hammers and Nails

November 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Comparative Effectiveness, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 2 Comments

Medical homes are being promoted as a way to improve health care delivery by increasing the coordination of patient’s primary and specialty medical care. The goal of medical homes is to ensure that patients’ care is comprehensive, appropriate and patient-focused.

One of the benefits to the patients and the healthcare system is that medical homes can help sort out the confusion that can arise from the phenomenon sometimes described as, “When you’re a hammer, everything looks like a nail.”

In healthcare delivery what this means is that sometimes the diagnoses or treatment recommendations from specialized clinicians will reflect their expertise – and thus their may be inconsistencies or conflicts in the recommendations coming from several specialists.…

Communicating Health Information and this Blog’s Goals

October 30, 2008 / Michael D. Miller MD / FDA, Health Policy and Communications Blog, Information & Communications, Quality of Care & Safety / No Comments

Noting that I’ve written about a wide variety of health and biomedical research issues, someone recently asked me about the focus of this blog. My response was that my goals are two-fold: First, to present synthesized information – created by combining different sources and analyses – in ways that provide new perspectives on important issues so that people have both broader and deeper understanding of these issue. And second, to reach multiple audiences with this information and perspectives so that the spectrum of healthcare stakeholders can better communicate and understand each other. Which is just stating in a different way what I wrote in my first posting, that the reason I started this blog was “to provide stakeholders of all types, (such as patients, clinicians, administrators, payers, researchers, regulators, legislators, etc.)…

Direct to Consumer Advertising: Drugs, Hospitals, Research….

October 23, 2008 / Michael D. Miller MD / Access to Healthcare, FDA, Information & Communications, Politics / 4 Comments

A very contentious health policy issue is that of advertising. Usually the specific topic is the advertising of medicines directly to patients – known as “Direct to Consumer Advertising.” There have been proposals to limit or ban this activity, and some states have, (or have proposed), limiting or requiring disclosure of other marketing activities by pharmaceutical companies – such as marketing directly to doctors and hospitals.

However, I’ve found it intriguing that many other components of the healthcare industry advertise directly to patients. For example, the Boston area free daily paper, Metro, contains lots of ads recruiting people to participate in medical research trials. …

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