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Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
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OCR for page 6
Chronic Care
William L. Roper
Good evening. It is a pleasure to be with you and it has been an honor
to serve on the committee. The task that was before us and we are pleased
to describe for you tonight is a large-scale one. What is new about the
endeavor we have undertaken at the request of Secretary Thompson is
the notion of implementing a variety of demonstrations across the spec-
trum of issues facing America's health care system, all at the same time.
The federal government has long done demonstration projects to learn
how to do things better. But they typically have been done only in one
area at a time. The Department of Health and Human Services, of course,
is probably the most demonstration-prone department within the federal
government, but I don't think it has even been done in quite this fashion,
across the spectrum of issues, all at the same time.
What I am going to talk about for the next few minutes is the section
focused on chronic care, but I want to stress a point that Gail Warden
made a moment ago. These sections should not be seen in isolation. For
example, one of the components of the chronic care demonstration is in-
formation technology and we are anxious to demonstrate integrated ap-
proaches to information and communications technology.
So, these demonstrations might well fit together. The objective of the
chronic care demonstration is to reduce the toll of chronic conditions on
individuals and communities. I would stress the word "communities."
This is not just about making individuals better but takes a population
perspective. Our report and its approach tracks previous IOM reports and
6
OCR for page 7
CHRONIC CARE
other work done in the field. So, we are trying to build on the work that
has previously been done.
We are taking a two-pronged approach in the demonstration we have
proposed. One is to redesign the health care delivery system to improve
management of patients with chronic illnesses. Of course, the vast major-
ity of expenditures in health care in America are focused on people with
one or more chronic illnesses. But we also want to take a community-wide
prevention approach, looking at how to make the whole population bet-
ter.
We envision a demonstration that would have the Centers for Medi-
care and Medicaid Services issuing a Request for Proposals that would
ultimately take 10 to 12 sites, likely in individual states. It is probably best
for these to be done on a state basis, initially focusing on Medicare benefi-
ciaries. The reason for this is severalfold. These are the patients who have
the most chronic illnesses. Because the federal government has the most
control on things and, therefore, can directly undertake innovations in
this area, we envision that this would quickly, if done right, enable other
payers to participate in such a demonstration.
A second opportunity would be the patients who are eligible both for
Medicare and Medicaid, but ultimately private payers in a given state
might well choose to participate in this demonstration. We envision a one-
year planning grant and three years for implementation. We think over
time this would be budget-neutral but probably would require an initial
investment for the information and communications infrastructure.
We envision a four-step process that begins with establishing a coor-
dinating structure to provide leadership within a state or a community.
Such a structure might well include a consortium of health care provid-
ers, community groups, businesses, or others in a community to enable
that leadership and then to build out the community-wide information
and communications technology infrastructure, establish chronic care
management programs and, again, sponsor community-wide health pro-
motion educational efforts.
Step two focuses especially on the information and communications
technology work. What we are planning is to identify in a given commu-
nity or in a given state the various things that the experts in the field have
been saying need to be done. We believe that a demonstration project of
this sort is the best way to move forward.
Step three involves implementing new models of care delivery. This
requires the involvement of admitting physicians and other health pro-
fessionals, hospitals, and other health care institutions with a real empha-
sis on patient education and support, multidisciplinary teams and other
caregivers, and outreach effort in the community. This would all be pulled
together using the information technology that we have talked about.
OCR for page 8
8
FOSTERING RAPID ADVANCES IN HEALTH CARE
We continue to repeatedly stress the community-wide education ef-
forts. Prevention and health promotion is a major part of this effort, along
with primary prevention, early detection of illness, and slowing the pro-
gression to chronic illness. That is our idea for a demonstration in the
chronic disease area.
Representative terms from entire chapter:
communications technology
