( continued from page 19)
medicine doctors and 42 % of internists and pediatricians reported symptoms to the American Medical Association( AMA) during 2024. Primary care providers have to render an increasing amount of behavioral health services. Since more than 50 % of the primary care workforce is over age 55, there will be an accelerating loss of family physicians, general internists and pediatricians over the next decade. Dr. Wang quoted Debra Moser, PhD, RN, from the University of Kentucky who said,“ Just telling people to seek care for cardiovascular risk factors is ineffective. There aren’ t enough health care providers and there’ s little focus on preventive health care. You have to teach people to manage their own care when it comes to making lifestyle changes.”
Dr. Wang offered a unique perspective, currently being studied by people funded by PCORI, about engaging community-based organizations to help in low-income neighborhoods. They are engaging peer support to motivate people to change their risk factors. She cited barber shops, beauty shops and faith organizations that are trusted in their communities. For everyone with a smartphone, the use of social media( including telehealth, smart watches and social apps), plus employer affinity groups and social organizations, may be effective strategies. These are all under funding review by PCORI.
Health data is essential for defining national and local health policies. Kevin McAvey is the managing director for Manatt Health and is a health data scientist based in Massachusetts. He focuses on understanding a health care system that does not operate as we all would hope. His fear is that without interventions, we should anticipate broader, potentially sub-optimal systemic change that is imposed on us. So, to get ahead of this trajectory, we need more data. He suggested that we start with identification of the data needs for policy, regulatory and / or business decision making. Just having large numbers such as average costs or mortality is not granular enough to lead us to more strategic thinking. He believes that we need state-specific data-driven infrastructure pulling information from all segments of the health care sector, i. e.“ all-payer claims databases.” By collecting, measuring, benchmarking and analyzing health cost and outcome data, we then might use market force to promote absolute improvements. Currently eight states are in the process of setting up benchmarking programs, while 22 states have established all-payer databases. Kentucky is not one of them.
Collecting data at a local level can be more helpful in working with private and public health systems to address the specific state health concerns. For example, Georgia used its database to increase breast cancer screening by 10 % in both urban and rural areas. Minnesota used its database to address chronic conditions by age, developing more tailored education programs for the subgroups. The goals of locally based policies and regulators are to find ways within each state to improve heath outcomes, reduce disparities among various populations of a state and offer affordable health care growth.
20 LOUISVILLE MEDICINE
“ Improving health care affordability by empowering purchases to drive down health care spending” was the presentation by Mairin Mancino, Vice President for Policy in the Peterson Center on Healthcare. The Peterson Center is a nonprofit organization based in Manhattan and focused on identifying and supporting new directions that may make access to health care services more affordable. Her presentation focused on how people can“ make better health care purchasing decisions.” A growing initiative within Peterson is providing reports comparing various health care strategies and technologies based upon both clinical effectiveness and economic impact. For example, therapeutic strategies for treatment of opioid use disorder( OUD) compared medication-focused management with digital wraparound services. From analysis of the medical literature, the clinical evidence for effectiveness of digital adjuncts such as apps and motivational videos, was solid. However, medication management treatments remain so variable that no conclusion could be drawn. There are economic studies showing that medication management does reduce health care spending in patients with OUD, but that adding apps, etc. erases any cost savings. At the end of the day, Peterson gave a green light to medication-focused care but only a yellow light to digital add-ons.
From these findings, the Peterson Center is digging into what changes could be made to improve results including ensuring that digital platforms are grounded in clinical practice and trying to define the characteristics of people who respond better to one therapeutic strategy over others. Treatment of OUD cannot be one size fits all, but must be tailored to best results data sets, and of course, one’ s individual conscience and readiness to change.
Ms. Mancino provided a model of collaborative efforts by empowered purchasers, engaged consumers for elective medical services and market-based competition to slow the health care cost spiral.
Providing context to the presentations were panel discussions that included both local and national leaders such as Leah Binder, CEO of the Leapfrog Group in Washington, D. C., and Dr. Alex Ding, a UofL radiologist and AMA Board Trustee. The annual conference this year focused on“ value” in health care with perspectives from clinical and preventive health, data analytics and costs. This made the conference quite well rounded and provided some useful insights that can lead to incremental changes for employers, hospitals and doctors. The Kentuckiana Health Collaborative intends to continue providing thoughtful insights and practical education programs.
Dr. James is an internist / pediatrician seeing patients at Family Health Center.
Printed with permission from Ms. Mancino