Coordinating care a key to health reform

Kenneth Thorpe, PhD

Last month, Emory held its fifth annual predictive health symposium “Human Health: Molecules to Mankind.”Researchers, physicians, health care workers and members of the community from throughout the country learned of intriguing research and listened to provocative commentary by health care experts. Kenneth Thorpe, chair of health policy and management at Emory’s Rollins School of Public Health, discussed the elements of health reform that may be getting lost in the reform process– redesigning the delivery system to prevent and avert the development of disease.

Thorpe focused on Medicare because he says, it’s “the most acute, offender of the system.” That is, it encompasses some of the most difficult problems that health care reform faces. One of those problems involves the typical Medicare patient ––an overweight hypertensive diabetic with back problems, high cholesterol, asthma, arthritis, and pulmonary disease. And that typical patient sees two different primary physicians, a multitude of specialists, and fills 30 different medications.

That may sound like a clinically complicated case, but it’s typical one, says Thorpe. Yet, Medicare does nothing to coordinate the patient’s care. As a result, preventable admissions and readmissions rates are “off the charts,” he says. But, data show that coordination could cut those rates in half. What’s more, seven conditions are driving up the cost of Medicare and all those conditions are related to excess weight: diabetes, high blood pressure, high cholesterol, arthritis, back problems, pulmonary disease, and co-morbid depression.

Another challenge says Thorpe is that Medicare’s payment system is based on the type of patients treated in the 1950s. Those patients had a very different medical profile than today’s, because they often they were acutely ill and treated only periodically. Patients today, says Thorpe, have chronic health care conditions that require medical management. He says the hope is to develop preventive and personalized health plans that identify problems before they manifest and if they do, employ care coordinators to guide patients while they’re at home.

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