The analogy with military special operations teams is almost spot on. Every soldier in the US army goes to boot camp for general training. Then some receive additional training to become members of special operations teams. Given a specific mission, they will study what equipment and resources are necessary to accomplish the task with minimum damage to our forces. Then they will train for weeks using models of the target so that every team member understands their role in the attack.
Teams like this already exist in primary care. They care for hospitalized patients and patients with urgent care needs, but that is not where the greatest opportunity exists. Chronic illnesses generate most premature death, disability, and medical costs. The National Academy of Medicine provided a roadmap for the extensive changes that are needed two decades ago.
“The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive. The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.
Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. Yet there is strong evidence that this frequently is not the case. Crucial reports from disciplined review bodies document the scale and gravity of the problems. Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.”
We have done nothing.
Sixteen years ago the American College of Physicians described the Advanced Medical Home. This is an advanced primary care team within a larger medical home designed specifically to address the primary needs of patients who face a chronic disease every day.
“This policy monograph highlights some of the major problems with the health care system in the United States today and proposes a fundamental change in the way that primary care and principal care are delivered and financed. It recommends voluntary certification and recognition of primary care and specialty medical practices that provide patient-centered care based on the principles of the Chronic Care Model; use evidence-based guidelines; apply appropriate health information technology; and demonstrate the use of “best practices” to consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided.”
Again, we have done nothing.
Here is the greatest opportunity. New guidelines for management of patients with coronary artery disease call for optimal medical therapy first—before stress tests, bypasses, and stents. You cannot consistently produce the product optimal medical therapy at a high level without an advanced medical home team. Cardiometabolic conditions like heart attack, stroke, congestive heart failure, chronic kidney disease, high blood pressure, diabetes, obesity, and high cholesterol are all related at the level of epigenetics and molecular biology. New science enables us to address all of these conditions very precisely with lifestyle and medical interventions that target the responsible biology and produce much better clinical and financial outcomes. New systems bring together clinical and financial analytics, population health tools, protocols, triggers to identify gaps automatically, and systems to identify high-risk, high cost patients automatically. The fully developed team brings together nurses, medical assistants, nurse practitioners, physician assistants, patient coaches, pharmacists, physicians, and counselors. A single focused nurse practitioner in a rural area 100 miles away linked to this team can deliver the product optimal medical therapy at a high level. It is a hub and spoke model. A capitated payment model that holds teams accountable for outcomes supports it all. You can find the training to certify team members here along with patient education resources. We have the other tools needed to support your teams as well.
It is time to do something!
This is where a decentralized properly monetized, protected, and distributed data-ownership by the real owners come in. The care teams will be responsible for unbiased objective, also properly monetized data-vetting, to stain the trustworthy unadulterated accuracy and efficient rapid reporting to enable the real 💯 % evidence based validations for the safety and effectiveness of ANY lifestyle optimization prevention measures, drug treatments, surgical procedures, and management strategies with the focus on delivering the best possible outcomes for the lowest possible cost. Our technology, the Multifunction Cardiogram Technology platform is the tip of the spear to lead this fundamental transformation! Stay tuned, folks!
Welcome to the transparent, keeping-everyone-honest 💯% empirical evidence based 21st Century Digital Medical Information Age. No more the corrupt and evil cherry-picking of our data used to deceive, commit violence, and plunder of our hard earned tax dollars by the ugly late stage sickness seeking profiteering of the American Medical Industrial Complex Kabuki Dance Theatre!