Major federal programs to improve health and reduce costs have uniformly failed. They failed to show any significant changes in quality measures. This includes the Medicare Medical Home Project, Comprehensive Primary Care (CPC), CPC+, etc.
The reason these projects failed is they don’t follow the evidence. I have shown you the huge variation in practice performance in treating chronic disease. Quality is a systems property. Increasing risk factor control rates with best practice medications requires systems. The evidence exists. Our leaders persistently refuse tpo follow it. The tragedy is it is just not that hard. Here is the evidence.
“The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms.”
I worked with a team of pharmacists that did just that at Holston Medical Group in East Tennessee. We used evidence-based protocols consistent with best practices. The pharmacists could change treatment in real time under a collaborative practice agreement. As you can see from the slide, we dramatically moved the numbers. If the systolic pressure was elevated, we dropped it 29 mm/Hg.
“The current care systems cannot do the job. Trying harder will not work. Changing systems of care will.” I hope we move to make the required changes before I die.
You sound like Semmelweis trying to get doctors to disinfect their hands before touching women giving birth. What you say is obvious and easy to implement. Trying is not key. Following the evidence is key. Getting the powers that be to listen is a hurdle. How best to get listening and implementing what works?
The huge white whale in the room is the lack of early detection and early warning systems to deliver information for primary prevention and lifestyle optimization. The evidence is overwhelming that metabolic dysfunctions are the cause of most of the chronic diseases. Ignoring this evidence is the root cause of the systematic failure.