Tuesday, July 13, 2010

Lamont Gets Healthcare

Today, Ned Lamont released his health plan, and as an RN, I can tell you he "gets it." Let me tell you why.

Information technology (IT) is the cornerstone of any future efficient health care system. Right now, when a patient leaves the hospital, he gets a piece of paper with medicines written on it. If the home care nurse checks the list against the pill bottles in the home and it doesn't match, then the nurse has to track down the doctors involved to find out what the patient should be taking. That's wasted time for the nurse and causes needless delays that could harm the patient. How many tests are repeated because the results are not universally available, especially evenings and weekends? A medical chart that can be accessed by authorized providers would easily save billions of dollars and lives as well. Lamont has a well-developed approach to health information technology in his plan.

Streamlining care delivery is also essential. Every person should have a medical home where care is coordinated. Again, this will reduce errors caused by conflicting orders from multiple care providers and will save truckloads of money by eliminating duplication. Managed care tried to do this by making doctors gatekeepers who could authorize visits to other providers. That's not what we're talking about -- we're talking about coordination. Lamont describes how we get this done.

We also need to provide options besides the most expensive -- nursing home care -- for the medically frail and elderly. I've met very few patients who wanted to live in a nursing home. Daily care at home costs less than half of what care costs in a facility and is almost universally preferred by patients and families. We need to leverage those cost savings and increase opportunities that allow people with medical needs to stay in their homes. Dan Malloy doesn't get it. He just wants to spend more money on nursing homes!
Malloy: Properly fund our nursing homes to cover the actual costs of providing care. In urban areas, I will ensure the homes are kept open so local residents can remain near family.
Plus, he wants to put together a "Workforce Council" for home care.
Malloy: Establish a ‘Workforce Council' for the growing home care industry so that our caregivers have a voice in the development of care requirements and job standards, including wages, benefits, training, and more. This Council could also maintain a statewide list of caregivers to assist consumers in finding referrals.
Without a plan to fund care at home, what's the point? How is this going to be paid for? The agencies for aging throughout the state already have these lists of care providers.

Overall, two themes run through Ned's plan -- themes I have not seen anywhere else. One is to examine innovations from all over the U.S. and adopt the most successful here in CT. There is no need to reinvent the wheel -- we just need a leader in state government who is able and willing to reach outside the state for great ideas beyond boilerplate.

The second is to leverage all of the federal and private grant money available to fund these initiatives. It's outrageous how much money has been left on the table because of the Rell administration's laziness and inertia. Ned's plan makes it clear that those days will be long past in a Lamont administration. He knows where money is available and how to get it.

Malloy's plan is big on prescriptives, and small on understanding and innovation. It's boilerplate "what should happen" without identifying how we're going to pay for it, where savings can be realized, and how to get it done.

For people who don't see much difference between the candidates, take a look at these healthcare plans. You'll clearly see the difference between a politician's standard issue plan from Malloy and an entrepreneur's outside the box thinking with a "get it done" approach from Lamont. One might say the difference is like night and day.


Fred said...

I took your advice, Kirby. I went and read both candidates plans. I just could not disagree with you more. Malloy's 'standard issue' plan is anything but, it talks about real sensible reform and legislation.

Lamont's continues with his entrepreneurial mumbo-jumbo. I don't want an entrepreneur (who isn't in the medical field) making my policy decisions - I want someone who has shown to actually be an effective policy person and advocate.

It's time to get over your goosebumps from 2006. Putting someone like Ned Lamont in the governor's seat will not shake things up. People use that language every year (and always fall for it). Let's put someone there who knows how to actually get things done from a policy sense.

CT Bill said...

The link to the Lamont health care plan doesn’t work, but no matter. Connecticut already has the most far-reaching health care reform plan in the nation – the SustiNet plan. With thousands of supporters across the state, it was passed over a Rell veto. Since then, SustiNet’s committees have been working on all the issues mentioned by the two candidates and are making their reports. This wheel has been invented –- with continuous input from business, unions, providers, advocates and the general public. What we need from Lamont and Malloy is not MORE plans and rhetoric. All we need is this simple statement: “I fully support SustiNet and will work for its smooth implementation and necessary funding.” (THAT'S the vote -getter!)

CT Bob said...

Fixed the link.

And with something like 400,000 people in CT still uninsured, I don't know if the entire answer is SustiNet. Let's try for a plan that will reach everyone, is that too much to ask?

CT Bill said...

CT Bob,

National health care reform + full implementation of SustiNet = 100% quality, affordable coverage in CT.

So no need for more "plans" from candidates on this one (unless they're talking national single payer - which they ain't!)

BTW: It's all explained, in great detail, by Kevin Lembo and colleagues, at: http://www.ct.gov/sustinet/lib/sustinet/board_of_directors_files/reports/sustinet_60_day_report_05272010.pdf

CT Bill said...

Better link: http://tinyurl.com/25smle6


Kirby said...

Thanks, CT Bill for the link to the info. I agree with you on SustiNet, but things still need to be done to make care more cost-efficient because somebody is going to be paying for it.

Each hospital is now in its own IT tower. There is no inter-operability. None of these computer systems can talk to each other.

As a former ER nurse, I almost literally drool at the idea of being able to log in to a patient's record, know what his last blood count was, know what medicines have been prescribed for him, and what his allergies are, without having to guess or spend hours trying to track down the info or repeating tests because we can get new results more quickly. at $1000+ for an MRI, those duplicates add up fast.

Nopartisan said...

2 Huge roadblocks to an efficient streamlined system.

Companies involved in healthcare won't want to spend the money, and labor will fight it because making the system efficient means fewer people will be needed to do the work. More efficiency=less work=fewer workers.

The next Governor will have to fight both interests and will have to ignore traditional allies attempts to dilute healthcare reform.

If the new governor does succeed, it will because he has beaten both Business & Labor.

Kirby said...

Actually, efficiency won't mean fewer workers -- at least with information technology. It will just mean that the current workers won't be wasting their (our) time tracking down results and information and will be able to spend the time actually providing care to patients.

Staffing has already been leaned out -- better efficiency and better information sharing will making waiting times shorter and move the process along quicker -- with an aging population, I don't see a loss of healthcare jobs as a result.