Anne Finger, MA

When members of the Alliance gather in Orlando January 21–24 for the 37th Annual Conference, it will be the first full assemblage since the organization set forth its broad new vision, mission, and strategic commitments.

One of the most potentially far-reaching is the third commitment: “Be visionary and proactive in strategically aligning the Alliance with the emerging healthcare environment while remaining sensitive to current needs.”

Much too often, the barriers physicians face seem beyond the purview of CME as we know it. Issues surrounding reimbursement, or insurance, or even the physician’s lack of time to provide the best care in the rush to see enough patients, demand systemic change. Since all these issues ultimately inhibit the ability to achieve the primary mandate—improvements in patient health—perhaps the Alliance needs to carry its advocacy efforts beyond continuing professional development directly to matters of healthcare reform.

These are murky waters, and the very word reform conjures up vastly diverse definitions. But the Alliance, having expanded its emphasis from physicians to healthcare professionals, is already moving in this direction. Focusing on the interprofessional team is in line with integrated or collaborative care, which is widely accepted as an important aspect of improved care. Such teams have been found to have an impact on the health of chronically ill patients, the sickest 10 percent of the U.S. population, noted bioethicist Ezekiel Emanuel, MD, in a New York Times opinion piece (November 20, 2011).

The state of the art of “high-touch” medicine is rather low-tech: teams of healthcare professionals work with patients, caregivers, and care coordinators to arrive at plans individualized for the particular patient. Frequent monitoring of blood pressure, blood glucose levels, and weight through phone calls and home visits, and careful communication with select specialists are some of the ways this approach works. And it does work: A number of groups throughout the country are already demonstrating that high-touch medicine reduces the complications that send chronically ill patients for frequent hospitalizations.

Emanuel stressed that improving the care of chronically ill patients will also reap the greatest healthcare savings, as this group consumes 64 percent of U.S. healthcare dollars. “Avoiding just one hospitalization for shortness of breath or a gangrenous foot can pay for a lot of home monitoring and specialized clinic visits,” he wrote. He contends that, for high-touch medicine to move to society at large, fee-for-service must be replaced by “bundling” payments for patients with chronic illnesses.

Inevitably, the issues of quality of care that are central to the goals of the Alliance lead to the debate about the design of our healthcare system. “It is impossible to deliver high-touch medicine in a fee-for-service system that emphasizes quantity over quality,” Emanuel states provocatively. “In fact, most specialists and hospitals lose money if they keep the chronically ill healthy.”

Is there a role for the Alliance in this debate? If so, at what point does the organization enter the fray?  

Anne L. Finger, MA, is the executive vice president of Veritas Institute for Medical Education, Inc. Reach her at anne.finger@veritasime.com. The opinions expressed are those of the author and do not constitute the views of Veritas Institute for Medical Education, Inc.

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