Health Reform is a Civil Rights Issue

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Jan 18th, 2010 | by Toni Bigby

Martin Luther King, if he had been given the time, must eventually have tackled the health care issue as an essential civil right.  As a nation, we’ve focused so much on the tactics and details—public options, mandates, “Cadillac plans” and so on—that we may be forgetting why increasing health care accessibility is important to us as a nation.

So this is just a reminder for all of us: without health care, personal growth and success are limited indeed.  Children with sensory or behavioral problems are not treated, or whose simple illnesses are not cared for, cannot learn.  Adults with a chronic disease (like diabetes or asthma) can earn a living—but only if they have the care and medications they need.  Families that lose a parent to a disease that could have been cured if caught earlier, suffer consequences that can hardly be measured – stability, opportunity, potential.

If we are serious about equal opportunity, education, stable families, social justice at any level, we must embrace health care accessibility as an essential civil right.

Physician-Know Thy Patients!

Author : Craig Thiele, M.D.

Chief Medical Officer, CareSource Over 16 years of clinical leadership experience with a strong background in case and disease management. Oversees clinical and quality initiatives at CareSource and manages medical policy, clinical care guidelines, utilization parameters, and quality assurance for its health plans.

Aug 18th, 2009 | by Craig Thiele, M.D.

So here’s an interesting story:

A doctor I work with encountered a pretty common situation with a patient.  She’d prescribed an inhaler for a patient complaining of shortness of breath. On a follow-up visit, the patient said his symptoms had not changed. Normally, the doctor’s response would be increased dosage, new medication, or perhaps additional tests. But in this case, the physician had the Member Profile CareSource provides at hand, showing that the patient had not filled the first prescription in the first place. What ensued was five minutes of patient education explaining the importance of the medication, exploring why the prescription was not filled, a new copy of the prescription, and a successful treatment at no unnecessary cost.

We hear a lot about the need for digital medical records to provide complete, detailed, accessible record of treatment: they will certainly help cut costs and improve care in the long term.

But valuable as such records are, what they can’t provide is the topline overview of an individual’s health status that can help doctors when they first meet a patient or provide information for quality ongoing care…the kind of broad-spectrum profile of age, family status and other personal information, prescriptions ordered and filled, preventive screenings, previous providers, even non-medical issues affecting health and well-being.

With such a record in hand, any doctor—whether, in any emergency room, urgent care facility, clinic or private office in the U.S.—could jump-start the process of caring for a new patient, or providing quality long-term care for a current patient with a holistic picture that goes beyond the medical situation at hand.

A concise profile like the one CareSource has developed gives physicians, specialists and other providers integrated, up to date information about their patients electronically, so they can provide faster, more accurate assessments and diagnosis, treatment decisions that integrate with the patient’s other care, insights into behaviors that could affect outcomes, and potential problems that may not be presented in the office visits. All that adds up to better information, better care…and lower costs.

Care Management:  Where Aggregated Patient Information Lives

The reason currently utilized personal health records, valuable as they will be, can’t do this job alone is simple:  they may or may not be accurate or complete. Physician records are more reliable, but only cover care the specific doctor provided directly. They likely don’t contain information about which prescriptions were filled (and who prescribed them), what emergency room visits transpired across the state, nor important medical diagnoses from the patient’s past. Knowledge of this information can affect patient diagnosis, care and health.

But that’s precisely the information CareSource gathers using multiple information sources. We realized that the information we already have on our members could be put to excellent use by providers to the benefit of their practice, their patients, and health care costs overall.

Granted, it was no simple matter to find a way to make all this information easily available to providers.  But now, CareSource Member Profiles are up and running. Physicians now have critical information at their fingertips including:

• Member demographics
• Primary care provider information
• Prior prescribing information (updated daily)
• Historical diagnoses
• Patient-specific quality metrics (such as mammography screening, A1C value, and more)
• Prior hospital admissions
• Emergency room visits
• Specialist visits
• Case management activity

It’s About Relationships, Too

What we’ve already discovered since CareSource Member Profiles have been available is that they create a virtuous cycle.  Patients have a better feeling about a doctor who understands them, so they rely on that doctor’s opinion more, in lieu of using providers who are not familiar with their medical history. In addition to reaching positive outcomes, physicians with enough information can empower patients to take better care of themselves. By investing in tools physicians appreciate and use every day, CareSource builds stronger relationships with providers based on a lot more than making payments to providers caring for our members.  And that means, as our nation moves toward health care reform, we will be able to work together to evolve a system that puts the resources of physicians and care management companies to their best and highest use.

As an emergency room doctor asked when we first presented Member Profiles, “why don’t all care management companies do what CareSource is doing?”  The answer:  I hope someday they will.