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News August 2013

Washington Watch

Saves Money, Saves Lives, But Will Medicare and the Health Care Community Adopt this Model?

By Alan M. Schlein

This, to Coburn, is the core truth, and core problem, of today’s medical system: The change to living with chronic illness has changed the problem and the health care system simply hasn’t kept up. So Coburn and HQP are attempting to adjust to changing medical needs for seniors with multiple chronic conditions.

c_stinger0813-smEver forget to take your pills or simply fail to measure your blood sugar or some other routine health care daily chores? Would it help you remember if you knew that a nurse was coming by regularly to check in and make sure you were doing what you were supposed to do?

Simple things sometimes can be revolutionary. A Medicare experimental program, being tested in Doylestown, Pa., that brings a nurse to regularly visit you for continued care even when you aren’t seriously ill, has been given an 18‑month reprieve from being shut down. If it is successful and implemented on a much wider scale, it could change the direction of health care.

The idea of continued consistent care, in the form of home visits by a nurse, has Medicare officials paying attention, and hospitals and doctors worried because the success of the program could cost hospitals important dollars at a time of tight budgets.

At least for the next 18 months, this Medicare experiment from a company called Health Quality Partners (HQP), has been spared from being shut down. It came so close to being killed off in late June that they recently began to dis‑enroll patients and shut down operations until Medicare extended the program at the beginning of July.

Ken Coburn, who runs HQP in Doylestown, Pa, likes to show visitors a graph that explains why he’s doing what he’s doing. As he explained to Washington Post columnist Ezra Klein, who wrote about it last spring, if Medicare could see the graph, they wouldn’t even think about threatening to shut down his program.

The graph, using numbers from the Centers for Disease Control and Prevention, shows the U.S. death rate for infectious diseases between 1900 and 1996. The line starts all the way at the top. In 1900, 800 of every 100,000 Americans died from infectious diseases. The top killers were pneumonia, tuberculosis and diarrhea. But the line quickly begins falling. By 1920, fewer than 400 of every 100,000 Americans died from infectious diseases. By 1940, it was less than 200. By 1960, it’s below 100. When’s the last time you heard of an American dying from diarrhea?

For all the millennia before this in human history, Coburn told the Washington Post, it was all about tuberculosis and diarrheal diseases and all the other infectious disease. The idea that anybody lived long enough to be confronting chronic diseases is a new invention. Average life expectancy was 45 years old at the turn of the century. You didn’t have 85 year olds with chronic diseases.


Alan Schlein runs, an internet training and consulting firm. He is the author of the bestselling “Find It Online” books.

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