Tuesday, December 7, 2010
Heart Disease and Health Reform
The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.
Francis Scott Fitzgerald, 1896-1940, The Crack-up (1936)
Two themes run through the health reform bill as a means to improve care while cutting costs.
One, consolidation of care into large centralized entities managed and monitored through interoperable electronic systems.
Two, entrepreneurial innovations that render care cheaper, more convenient, and more effective.
In the words of David Kibbe, MD, and Brian Klepper, PhD, who launched a new online health forum, Cost &Care.com, on December 1, .."two overarching themes" are emerging . One is the health care cost crisis, which remains very much with us and threatens the stability of both the industry and the US economy. The other is the countervailing trend, the explosion in innovative solutions - tools, programs and designs - aimed at making health care better, cheaper and more available.”
Here I will focus on health reform and hearth disease – easily the number killer of Americans and arguably the most preventable.
The latest mortality figures for the U.S. are:
• Number of deaths: 2,423,712
• Death rate: 803.6 deaths per 100,000 population
• Life expectancy: 77.9 years
• Infant Mortality rate: 6.75 deaths per 1,000 live births
Number of deaths for leading causes of death:
• Heart disease: 616,067
• Cancer: 562,875
• Stroke (cerebrovascular diseases): 135,952
• Chronic lower respiratory diseases: 127,924
• Accidents (unintentional injuries): 123,706
• Alzheimer's disease: 74,632
• Diabetes: 71,382
• Influenza and Pneumonia: 52,717
• Nephritis, nephrotic syndrome, and nephrosis: 46,448
• Septicemia: 34,828
The Comprehensive Organizational Approach - Kaiser Permanente Heart Disease Prevention and Management
Kaiser Permanente, the prototype of the large integrated health organization with 8.6 million health plan members,167,300 employees,14,600 physicians 35 medical centers,and 431 medical offices. Kaiser has reduced death rates from heart disease to 30% below the non-Kaiser population in California. Kaiser has done this through a broad-based educational program of its members based on understanding about living the healthy life – plenty of exercise, eating right, not smoking, managing stress – and understanding treatment options based on evidence of personal health risks.
In a study of 628 heart patients at Kaiser Permanente Colorado, Kaiser achieved a 88% reduction in cardiac mortality compared to a control group. Cost reductions were $60 less per day compared to contro0ls, or $21,900 per year.
The Individual Private Physician Approach - Shape Medical Systems, Inc, St. Paul Minnesota
It is one thing to be a huge, sophisticated integrated health organization like Kaiser with a $3 billion electronic medical record system It is quite another to be an independent physician in private practice, the dominant mode of practice in the United States. These physicians must evaluate all incoming patients, some with puzzling symptoms. One of these symptoms is shortness of breath. Is this dyspnea due to coronary disease, heart failure, or chronic obstructive lung disease? Shape Medical Systems, Inc., founded by a couple of exercise physiologists, has developed a small, compact, portable, risk-free device, the Shape-HF Cardiopulmonary Testing System, that can be used in private offices, in place of traditional heart stress treadmill machines, to test for coronary disease, heart failure, and COPD. It offers accurate diagnostic, prognostic, and drug-response information. It gives physicians options for early stage therapeutic intervention to control disease progression and to monitor patients suffering from chronic conditions over the long term.