The economic case for minimally disruptive medicine

A colleague just brought this piece by Gerard Anderson from Johns Hopkins published in US News and World Report Health section.

Mr. Anderson does a good job at focusing attention on the matter of patients with multiple chronic conditions, the focus of our attention in minimally disruptive medicine. He also makes the point that this problem affects the elderly, but only the elderly. This is in part due to the explosion of risk-defined diseases (diseases defined by committee) and the general deterioration in quality of life and well being in our populations. It is also summarizes well how unfit the healthcare system is at managing these patients.  Indeed, we believe minimally disruptive medicine is one approach that the healthcare system can take on to begin to overcome its limitations.  What justifies this effort?  Mr Anderson summarizes it as follows:

People with five or more chronic conditions 

  • Represent 22% of all Medicare beneficiaries and 69% of all Medicare spending
  • See an average of 13 physicians per year
  • Fill approximately 50 prescriptions
  • Are 99 times more likely to have a preventable hospitalization than someone without a chronic condition, and 98 percent of all hospital readmissions within 30 days occur in Medicare beneficiaries with five or more chronic conditions.

Can goldilocks care, care that fits the patient’s context (multicomorbidity, limited capacity to face the demands their care requires), and the patient goals be the solution?

It is our impression that many healthcare systems are ready to take on a change in their practice to accommodate this model of care.  The financial models, the workforce training and readiness, and the technological underpinnings will take time and dollars to develop.  But this is an innovation worth pursuing. And that is the road our team is treading.

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