It is important to broaden our definition of health care provider to include advanced practice nurses. The US will not be able to have enough MDs interested in primary care, yet there are many advanced practice nurses looking for jobs; and would do a stellar job at the job. One example in Glide Clinic in San Francisco, a nurse run clinic, a universtiy partner ship, serving more than 3000 people annually.
The Institute of Medicine latest report “The future of Nursing” also emphasises this point.
You want to look outside of the box to Community Health Workers. We should also consider community/public health nurses and advanced practice nurses.
Some excellent content but really, “primary care doctors are the key”? What about “primary care providers” as in Advanced Registered Nurse Practitioners? The data on outcomes and patient satisfaction are compelling and clearly support their work. They also have expertise and most often, interest, in the management of chronic diseases. Demographics tell us to anticpate upsurges in chronic illness/conditions as more of the population ages. Advanced Practice Nurses are Certified Registered Nurse Anesthetists, Certified Nurse Midwives and Clinical Nurse Specialists also. In more states than ever, they practice independently.
We need physicians managing the most complex patients and applying their advanced education and expertise there, where they’re also most often attracted.
Look into the Jobs to Careers initiative funded by the Robert Wood Johnson Foundation, The Hitachi Foundation and the US Dept of Labor. This program enabled frontline health care workers (many of whom came from poverty backgrounds) to increase their skill levels , expand their roles, climb a career ladder and allow the better paid clinical health professionals (e.g., physicians, nurses) to work to their skill level. The hierarchical organization of health professions needs to be restructured. It will be whether through reform or collapse.
Jobs to Careers promises to be a sustainable model and may be part of the overhaul in the US health system that is clearly needed.
This was a great well written article and very informative….. It should be sent to as many as possible social service venues in all aspects of health care related services as a tool and model especially in the areas of HIV/AIDS…...
For-profit insurance companies answer first to shareholders and quarterly dividend expectations. Paying claims is called “medical loss.” These forces have driven insurance companies to find ways to shift as much cost of actual care on the consumers. That’s why we now have health savings accounts and pregnancy is considered a Pre-existing condition.
With all the great points made in this article, we can never forget the keystone upon which out current system is built. There are models abroad that use private companies for delivery but they are non-profits.
The only caution I would add is that efforts to realign and broaden our healthcare delivery to “physician-extenders - including health coaches and emerging models of para-professional care delivery - not be limited to only our impoverished populations. Community health centers have long-provided an excellent model of multi-disciplinary care and outreach that the private practice of medicine would do well to emulate.
In the context of America’s declining middle class poised to defer even more needed medical care because of the out-of-pocket costs of high-deductible health insurance, there is a pressing need for such measures for all Americans. Perhaps this might broaden potential financing sources to include employers and insurers as well.
In any event, congratulations on an excellent analysis and presentation.
This article speaks so well to the question “why treat people.. without changing what makes them sick?” in reference to the social determinants of health. I have seen a similar community health worker model in southern India. These care extenders seem to be a win-win for patients, providers at all levels, and the healthcare system as a whole. My question is, are there more studies on this model of care than the few mentioned in the article? I’ve read one on successful community health workers in the Pacific Northwest that had a community-based participatory research design. But can we expect acceptance on a large scale without community-level controlled trials? Is that the next step?
Onie, Farmer, $ Behforouz make an important contribution to the discussions surrounding the Affordable Care Act and health care reform, in general, not least by focusing our attention beyond the borders of the U.S. This is no mean feat, as Americans are loath to think we have anything to learn from other countries. T.R. Reid and Michael Moore have given us similar opportunities in recent years.
The authors provide many good examples from low-resource settings of innovative, efficient models ... but they miss the most important (in my view) point. These are from low-resource settings! The U.S. health care system is anything but low in resources, notwithstanding their allegation that it is at a “tipping point” and that the market has “imperatives to cut costs.” These are evidence-free claims; remember when we were approaching 10% of GDP in health care spending and 25 million uninsured? Surely, we said, this was unsustainable and something WOULD be done. We safely passed that tipping point thirty years ago!
No, $2.7 trillion buys a lot of flexibility and is its own sustainability. The market in health care in America has every imperative to INCREASE costs, since that means higher incomes and profits. For example, the authors suggest the development of retail medical clinics in malls and WalMarts are analogous to PIH’s accompagnateur model in Hait. But the latter was, I believe, developed to increase access to care for poor residents, while the former was developed to provide revenue streams for corporations and, in some cases, patient referrals for larger health care systems.
The key question, then, is “How do we make the U.S. health care system resource-constrained?” The market will never do that, as we have seen quite well. The lesson we should be learning from other countries, both poor and rich, is that to create the conditions in which models of efficiency and effectiveness in providing quality care and improving health we must restrict the flow of money. That will require either direct government budget control (as in the UK, Canada, and the Scandinavian countries) or heavily regulated markets as in Germany or the Netherlands.
That is the most important lesson we should be taking from the great examples in this essay.
Excerpt from a response by Deborah H. Bae, senior program officer, Pioneer Portfolio, and Jane Isaacs Lowe (@jisaacslowe), team director, Vulnerable Populations Portfolio:
“Despite our agreement with Onie, Farmer and Behforouz, we see challenges ahead. To begin with, we need more champions—across all sectors—for programs such as Health Leads, Saude Crianca, or any other model that addresses the gap between a patient’s medical and social needs. To increase awareness and understanding and expand the pool of those willing to advocate for changes in the health care system, the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released the results of a poll late last year highlighting the fact that the vast majority of physicians believe unmet social needs are leading directly to worse health for all Americans. In early April, we hosted an online discussion asking people to share their ideas on bridging the gap between physicians’ desire to address their patients’ social needs and their lack of time or sufficient staff to do so effectively.
In addition to finding champions, we need to continue to eliminate silos that make it difficult for health care providers to address the social factors that are defining their patients’ health outcomes. Hospitals are never going to become social service agencies and they shouldn’t; that’s not their expertise. We need to “properly execute the solutions we already have” by building more successful integration between health care providers and those who have the know-how and capacity to respond to patients’ social needs.”
Great point on the kind of innovation that we need to solve the health disparities problems in the underserved populations at home. The innovations - tools or processes that have been proven successful under the extreme conditions in poor countries are clear demonstrations of American ingenuity. I agree with the authors’ suggestion of bringing home those proven innovative solutions, a process sometimes called “reversed innovation”.
What I would like to add is that we should also think of “disruptive technology” in order to build the new infrastructure and a full set of tools required to achieve health equity in the underserved populations in our country. The technologies that we use in big hospitals to improve access and quality of health care may not be easily extended to community clinics, community health centers, and rural clinics. Similar to the challenges in the developing countries, providers caring for underserved populations here - people with low-income, without insurance, or speaking limited English, or migrant workers, are also having very limited financial and human resources. Very often they simply can’t afford the existing technologies such as traditional EHR and clinical decision support system. I think it’s time to apply the same proven concept of developing affordable solutions specifically for the underseved populations here at home. Very likely the solutions for underserved populations will be different from those in big hospitals.
The phenomenon of leapfrog in technology adoption in developing world can happen in US as well. For example, ONC and IOM have started to explore how to build the ultimate efficient health care system called “learning health system”. When I recently participated in the first “learning health system” summit, I was thinking whether it’s possible for the clinics and health centers in the underserved areas to leapfrog to the future of health care system. It may sound crazy, but I believe the American ingenuity will be once again proven its relevancy to solving domestic healthcare crisis.
A recent report shows that EHR functionality has not changed much in the past 30 years. It seems to me that it will make much more sense to skip the adoption of tradition technologies in community and rural clinics and jump to the new generation of technology. If the innovators from industries and government start taking a fresh look at the healthcare issues in underserved populations, new solutions may come from “revered innovation”, “disruptive technology” and other venues we have not thought of yet. Hopefully, the public-private partnership “National Partnership for Action to End Health Disparities” established by HHS takes note from this intriguing SSIR article and start to think out-of-box. As the government reports show, the country has made little progress in reducing health disparities in the past decade. Clearly, we don’t have the effective solutions yet. Innovations from very different angles may be the only hope.
There’s some valuable information here and sadly most of the promising programs are in other countries. We should all realize that health care is more important as a commodity and the Market is not going to give it up easily. As long as patient care is treated as a ‘medical loss’, we will not see significant improvement fiscally or in terms of patient outcomes.
The Market Cap figures for the Health Industry vary day to day and very accurately depict one of the major obstacles to real reform.
This is a very well written and comprehensive article—but I am flabbergasted that the authors chose to ignore the drain on US health care resources caused by the private insurers! And the influence and rapacious practices of the latter will only worsen if and when the ACA exchanges are implemented.
Surely the authors realize there is something obscene about encouraging us to emulate and/or expand programs that truly serve the poor, here and abroad, while we allow US insurers to bleed our system dry. No other advanced industrialized nation does so.
I read the article twice to find references to insurers. Needless to say—little was said. When mentioned, they were listed among the innovators. You betcha’! They are looking for new ways to cut care while maintaining the income stream to their shareholders.
These comments speaks to the need for having a robust dialogue on innovative, out-of-the-box ideas and solutions to increase access and to provide care and basic needs such as food, housing, etc. As commenters have pointed out here, we need to redefine the role of health care workers, eliminate silos among health care providers and workers, and adopt technology in underserved areas that will leapfrog the current fragmented system in the US.
The Pioneer portfolio at the Robert Wood Johnson Foundation is interested in disruptive innovations in health and health care and we’re especially interested in learning what’s been successful in other parts of the world. Send us your ideas at: http://rwjf.org/pioneer/submission.jsp
I am a Journalist of over 4 years that Infected was by HIV disease,this disease has over come my body system. My brain fog and memory loss and physical issues made me a vegetable for 4 years.
Few months ago i came across some testimonies on how Dr Molemen has been using his Herbal Medicine to treat and cure HIV, Some even testified of been cured from Lyme Disease,Cancer and other infections, I have never heard of such before, due to the fact that i always had the believe that one day there is going to be a cure for this disease, i horridly copied the email address of Dr Molemen and i told him about my condition he told me not to worry that he was going to prepare some herbal medicine for me which he was going to send to me right here in my country, eventually after 5 days of communicating with Dr Molemen he sent me a package which i received and he gave me prescription on how i am to use them, after 2 weeks of taking Dr Molemen Medication i became to feel relief in my body and i told him about it, he said to me that i should go for check up in the hospital to know if actually his medicine has worked, i doubted it but i later went to the hospital to get tested and to my greatest surprise I am a MIRACLE and have recovered from the horror of human immunodeficiency virus,and am practicing Journalism again. I applaud you and your efforts and stand ready to give others information about you and i hope they believe and work with you.
You can contact Dr Molemen
COMMENTS
BY sheila Proctor
ON May 17, 2012 01:02 PM
It is important to broaden our definition of health care provider to include advanced practice nurses. The US will not be able to have enough MDs interested in primary care, yet there are many advanced practice nurses looking for jobs; and would do a stellar job at the job. One example in Glide Clinic in San Francisco, a nurse run clinic, a universtiy partner ship, serving more than 3000 people annually.
The Institute of Medicine latest report “The future of Nursing” also emphasises this point.
You want to look outside of the box to Community Health Workers. We should also consider community/public health nurses and advanced practice nurses.
Together we may be able to do something.
thank you
BY Linda Tieman
ON May 17, 2012 01:44 PM
Some excellent content but really, “primary care doctors are the key”? What about “primary care providers” as in Advanced Registered Nurse Practitioners? The data on outcomes and patient satisfaction are compelling and clearly support their work. They also have expertise and most often, interest, in the management of chronic diseases. Demographics tell us to anticpate upsurges in chronic illness/conditions as more of the population ages. Advanced Practice Nurses are Certified Registered Nurse Anesthetists, Certified Nurse Midwives and Clinical Nurse Specialists also. In more states than ever, they practice independently.
We need physicians managing the most complex patients and applying their advanced education and expertise there, where they’re also most often attracted.
BY Bob Konrad
ON May 18, 2012 07:40 AM
Look into the Jobs to Careers initiative funded by the Robert Wood Johnson Foundation, The Hitachi Foundation and the US Dept of Labor. This program enabled frontline health care workers (many of whom came from poverty backgrounds) to increase their skill levels , expand their roles, climb a career ladder and allow the better paid clinical health professionals (e.g., physicians, nurses) to work to their skill level. The hierarchical organization of health professions needs to be restructured. It will be whether through reform or collapse.
Jobs to Careers promises to be a sustainable model and may be part of the overhaul in the US health system that is clearly needed.
BY Theodore R. Chaplin
ON May 18, 2012 11:06 AM
This was a great well written article and very informative….. It should be sent to as many as possible social service venues in all aspects of health care related services as a tool and model especially in the areas of HIV/AIDS…...
BY Art As Social Inquiry
ON May 19, 2012 05:34 PM
For-profit insurance companies answer first to shareholders and quarterly dividend expectations. Paying claims is called “medical loss.” These forces have driven insurance companies to find ways to shift as much cost of actual care on the consumers. That’s why we now have health savings accounts and pregnancy is considered a Pre-existing condition.
With all the great points made in this article, we can never forget the keystone upon which out current system is built. There are models abroad that use private companies for delivery but they are non-profits.
BY John Lynch
ON May 20, 2012 08:56 AM
The only caution I would add is that efforts to realign and broaden our healthcare delivery to “physician-extenders - including health coaches and emerging models of para-professional care delivery - not be limited to only our impoverished populations. Community health centers have long-provided an excellent model of multi-disciplinary care and outreach that the private practice of medicine would do well to emulate.
In the context of America’s declining middle class poised to defer even more needed medical care because of the out-of-pocket costs of high-deductible health insurance, there is a pressing need for such measures for all Americans. Perhaps this might broaden potential financing sources to include employers and insurers as well.
In any event, congratulations on an excellent analysis and presentation.
BY Julie Reynolds
ON May 20, 2012 09:42 PM
This article speaks so well to the question “why treat people.. without changing what makes them sick?” in reference to the social determinants of health. I have seen a similar community health worker model in southern India. These care extenders seem to be a win-win for patients, providers at all levels, and the healthcare system as a whole. My question is, are there more studies on this model of care than the few mentioned in the article? I’ve read one on successful community health workers in the Pacific Northwest that had a community-based participatory research design. But can we expect acceptance on a large scale without community-level controlled trials? Is that the next step?
BY Aaron Katz
ON May 21, 2012 11:54 AM
Onie, Farmer, $ Behforouz make an important contribution to the discussions surrounding the Affordable Care Act and health care reform, in general, not least by focusing our attention beyond the borders of the U.S. This is no mean feat, as Americans are loath to think we have anything to learn from other countries. T.R. Reid and Michael Moore have given us similar opportunities in recent years.
The authors provide many good examples from low-resource settings of innovative, efficient models ... but they miss the most important (in my view) point. These are from low-resource settings! The U.S. health care system is anything but low in resources, notwithstanding their allegation that it is at a “tipping point” and that the market has “imperatives to cut costs.” These are evidence-free claims; remember when we were approaching 10% of GDP in health care spending and 25 million uninsured? Surely, we said, this was unsustainable and something WOULD be done. We safely passed that tipping point thirty years ago!
No, $2.7 trillion buys a lot of flexibility and is its own sustainability. The market in health care in America has every imperative to INCREASE costs, since that means higher incomes and profits. For example, the authors suggest the development of retail medical clinics in malls and WalMarts are analogous to PIH’s accompagnateur model in Hait. But the latter was, I believe, developed to increase access to care for poor residents, while the former was developed to provide revenue streams for corporations and, in some cases, patient referrals for larger health care systems.
The key question, then, is “How do we make the U.S. health care system resource-constrained?” The market will never do that, as we have seen quite well. The lesson we should be learning from other countries, both poor and rich, is that to create the conditions in which models of efficiency and effectiveness in providing quality care and improving health we must restrict the flow of money. That will require either direct government budget control (as in the UK, Canada, and the Scandinavian countries) or heavily regulated markets as in Germany or the Netherlands.
That is the most important lesson we should be taking from the great examples in this essay.
BY Jenifer Morgan (SSIR)
ON May 21, 2012 03:01 PM
Excerpt from a response by Deborah H. Bae, senior program officer, Pioneer Portfolio, and Jane Isaacs Lowe (@jisaacslowe), team director, Vulnerable Populations Portfolio:
“Despite our agreement with Onie, Farmer and Behforouz, we see challenges ahead. To begin with, we need more champions—across all sectors—for programs such as Health Leads, Saude Crianca, or any other model that addresses the gap between a patient’s medical and social needs. To increase awareness and understanding and expand the pool of those willing to advocate for changes in the health care system, the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released the results of a poll late last year highlighting the fact that the vast majority of physicians believe unmet social needs are leading directly to worse health for all Americans. In early April, we hosted an online discussion asking people to share their ideas on bridging the gap between physicians’ desire to address their patients’ social needs and their lack of time or sufficient staff to do so effectively.
In addition to finding champions, we need to continue to eliminate silos that make it difficult for health care providers to address the social factors that are defining their patients’ health outcomes. Hospitals are never going to become social service agencies and they shouldn’t; that’s not their expertise. We need to “properly execute the solutions we already have” by building more successful integration between health care providers and those who have the know-how and capacity to respond to patients’ social needs.”
Read the full response here: http://www.ssireview.org/blog/entry/positioned_for_transformation_expanding_the_scope_of_health_care
BY AJ Chen
ON May 24, 2012 07:41 PM
Great point on the kind of innovation that we need to solve the health disparities problems in the underserved populations at home. The innovations - tools or processes that have been proven successful under the extreme conditions in poor countries are clear demonstrations of American ingenuity. I agree with the authors’ suggestion of bringing home those proven innovative solutions, a process sometimes called “reversed innovation”.
What I would like to add is that we should also think of “disruptive technology” in order to build the new infrastructure and a full set of tools required to achieve health equity in the underserved populations in our country. The technologies that we use in big hospitals to improve access and quality of health care may not be easily extended to community clinics, community health centers, and rural clinics. Similar to the challenges in the developing countries, providers caring for underserved populations here - people with low-income, without insurance, or speaking limited English, or migrant workers, are also having very limited financial and human resources. Very often they simply can’t afford the existing technologies such as traditional EHR and clinical decision support system. I think it’s time to apply the same proven concept of developing affordable solutions specifically for the underseved populations here at home. Very likely the solutions for underserved populations will be different from those in big hospitals.
The phenomenon of leapfrog in technology adoption in developing world can happen in US as well. For example, ONC and IOM have started to explore how to build the ultimate efficient health care system called “learning health system”. When I recently participated in the first “learning health system” summit, I was thinking whether it’s possible for the clinics and health centers in the underserved areas to leapfrog to the future of health care system. It may sound crazy, but I believe the American ingenuity will be once again proven its relevancy to solving domestic healthcare crisis.
A recent report shows that EHR functionality has not changed much in the past 30 years. It seems to me that it will make much more sense to skip the adoption of tradition technologies in community and rural clinics and jump to the new generation of technology. If the innovators from industries and government start taking a fresh look at the healthcare issues in underserved populations, new solutions may come from “revered innovation”, “disruptive technology” and other venues we have not thought of yet. Hopefully, the public-private partnership “National Partnership for Action to End Health Disparities” established by HHS takes note from this intriguing SSIR article and start to think out-of-box. As the government reports show, the country has made little progress in reducing health disparities in the past decade. Clearly, we don’t have the effective solutions yet. Innovations from very different angles may be the only hope.
BY Sea Star RN
ON May 27, 2012 09:53 AM
There’s some valuable information here and sadly most of the promising programs are in other countries. We should all realize that health care is more important as a commodity and the Market is not going to give it up easily. As long as patient care is treated as a ‘medical loss’, we will not see significant improvement fiscally or in terms of patient outcomes.
The Market Cap figures for the Health Industry vary day to day and very accurately depict one of the major obstacles to real reform.
Today it’s at $37.3 TRILLION and I’ve seen other days when it climbs to $70+ trillion.
http://biz.yahoo.com/p/5yied.html
BY Harriette Seiler
ON May 27, 2012 03:26 PM
This is a very well written and comprehensive article—but I am flabbergasted that the authors chose to ignore the drain on US health care resources caused by the private insurers! And the influence and rapacious practices of the latter will only worsen if and when the ACA exchanges are implemented.
Surely the authors realize there is something obscene about encouraging us to emulate and/or expand programs that truly serve the poor, here and abroad, while we allow US insurers to bleed our system dry. No other advanced industrialized nation does so.
I read the article twice to find references to insurers. Needless to say—little was said. When mentioned, they were listed among the innovators. You betcha’! They are looking for new ways to cut care while maintaining the income stream to their shareholders.
BY Deborah Bae
ON June 4, 2012 09:28 AM
These comments speaks to the need for having a robust dialogue on innovative, out-of-the-box ideas and solutions to increase access and to provide care and basic needs such as food, housing, etc. As commenters have pointed out here, we need to redefine the role of health care workers, eliminate silos among health care providers and workers, and adopt technology in underserved areas that will leapfrog the current fragmented system in the US.
The Pioneer portfolio at the Robert Wood Johnson Foundation is interested in disruptive innovations in health and health care and we’re especially interested in learning what’s been successful in other parts of the world. Send us your ideas at: http://rwjf.org/pioneer/submission.jsp
BY Myles
ON June 24, 2014 09:28 AM
The needs made by your family associates will improve and you might battle to cope to meet them.
Someone may be carrying things a bit too far this 7 days and attempting to make mountains out of mole hills.
BY Rita
ON January 28, 2016 08:47 AM
Very interesting article. Good job Health Leads 😊
BY Shannon12
ON November 5, 2016 07:57 AM
I am a Journalist of over 4 years that Infected was by HIV disease,this disease has over come my body system. My brain fog and memory loss and physical issues made me a vegetable for 4 years.
Few months ago i came across some testimonies on how Dr Molemen has been using his Herbal Medicine to treat and cure HIV, Some even testified of been cured from Lyme Disease,Cancer and other infections, I have never heard of such before, due to the fact that i always had the believe that one day there is going to be a cure for this disease, i horridly copied the email address of Dr Molemen and i told him about my condition he told me not to worry that he was going to prepare some herbal medicine for me which he was going to send to me right here in my country, eventually after 5 days of communicating with Dr Molemen he sent me a package which i received and he gave me prescription on how i am to use them, after 2 weeks of taking Dr Molemen Medication i became to feel relief in my body and i told him about it, he said to me that i should go for check up in the hospital to know if actually his medicine has worked, i doubted it but i later went to the hospital to get tested and to my greatest surprise I am a MIRACLE and have recovered from the horror of human immunodeficiency virus,and am practicing Journalism again. I applaud you and your efforts and stand ready to give others information about you and i hope they believe and work with you.
You can contact Dr Molemen