Results of Community Health Care Discussion sent to the National Health Care Transition Team

December 31, 2008

In response to a request made by Senator Tom Daschle, Secretary-designate for Health and Human Services, the employees of Family Care Network have been engaged in a Community Health Care Discussion via email from December 15 through December 31. The purpose has been to provide the Health Care Transition Team with fresh ideas about the best ways to promote the new administration's vision of quality and affordable health care.

Here is a summary of our input:

Discuss health care reform - what do you believe is important!

• All individuals should be covered, so that access to early preventive care and treatment is possible, and costs are shared equally
• While coverage is important, it is even more important to consider access and quality. In the rush to make sure everyone is "covered" we must not sacrifice the quality of our care and the access to it.
• Primary care services need to be paid for at a rate that attracts doctors and others into primary care specialties, or good insurance coverage will be pointless without access to early, primary care services
• The personal medical home as advocated by TransforMED and the NCQA, should serve as the basis for ideal primary care practice
• We need simplification and transparency of the existing system, so everyone understands how things work and what is covered. Uniformity of rules between plans.
• Let plans compete on service and price, but "do not allow cherry picking" that excludes those who need care the most.
• Continue both government plans and competing private insurance plans, and then hold all accountable to the principles agreed upon above
• We need more accessibility and better coordination of healthcare for veterans of foreign wars, particularly Vietnam. Allow care veterans to have care in their own communities from local physicians.
• Reform and improvement in coverage and accessibility for mental health disorders, which should be covered as any other health care.
• How about an independent national FAQ line or website patients could access for coverage info?

Tell a story that exemplifies the need for health care reform:
Health care reform HAS to include accountability: A story told by one of our doctors:

My very bright patient comes in with acute back strain and tells me that the day before she was in such pain she took her coworkers advice and went to see the chiropractor she swore by.  She went into his office and he never touched her back, but laid her on the exam table on her back and placed magnets on her stomach, and some "vials" of various substances.  He then asked her to lift her arm and had her resist his pull on her arm.  From this analysis, he told her she was seriously deficient in certain enzymes and that her back pain could be cured with the purchase of over $200 worth of "supplements" he sold out of his office.  She left in a disbelieving haze (fortunately did not buy the supplements). All of this was paid for by her insurance.

Health care reform HAS to include accountability for all the various complimentary practitioners that are getting part of the health care dollar, to include evidence based support of the care they get covered, at least to the same scrutiny that allopathic doctors are subject to.

Access to health care, where is the need to improve? Primary Care? Specialty Care?

• Access to primary care is the most pressing need. Without this, care is delayed, and the result is missed opportunity to improve health at reasonable cost.
• Specialty care administered to patients without a primary care personal medical home is often less effective and less coordinated.

Long-term care- should it be included? Why?

• We had a divergence of opinion here. Some felt that this was very important, while others were concerned that a focus on this area would make it more difficult to afford early intervention that might lower the need for long-term care. It is an important need for some, and perhaps should have an income threshold for eligibility.

Available treatment and medications - what should be covered?

• We believe that promoting the personal medical home should emphasize a solid foundation of basic health care services of high quality, as advocated by TransforMED and the NCQA as a first step in reform, and that we should not try to be "all things to all people".
• Emphasis should be on primary care provision for children, pregnancy, health screening, chronic disease care, injury and emergency care. This should include other disciplines outside of medicine that have been shown by evidence based assessment to be safe and effective.
• Medications should include a participation in the cost by the patient, based on income, and whether or not it is a generic or brand name drug
• The government should be able to negotiate price of drugs

Other health care concerns - what would you like to suggest?

• Build cities and new developments to encourage safe walking and biking
• Do not allow advertising to children below the age of 16
• Support programs that help patients manage their own problems.
• Emphasize education and ongoing support for chronic illnesses
• Try innovative teams across disciplines for difficult problems such as eating disorders
• Consider an independent commission apart from insurance companies, to decide on which treatments and therapies should be paid for as part of regular care.

These results were reported to the Health Care Transition Team on December 31. 2008.
 
David A. Lynch, M.D.
Medical Director, VP of Clinical Process Improvement
Family Care Network
709 West Orchard Drive, Suite #4
Bellingham, WA 98225-0066