Remaking Chronic Care in the Age of Health Care Reform: Changes for Lower Cost, Higher Quality Treatment

Remaking Chronic Care in the Age of Health Care Reform: Changes for Lower Cost, Higher Quality Treatment

Remaking Chronic Care in the Age of Health Care Reform: Changes for Lower Cost, Higher Quality Treatment

Remaking Chronic Care in the Age of Health Care Reform: Changes for Lower Cost, Higher Quality Treatment

Synopsis

Remaking Chronic Care in the Age of Health Care Reform: Changes for Lower Cost, Higher Quality Treatment is nothing less than a blueprint for a new mode of chronic care. It depicts a current system in which there is little financial incentive to furnish coordinated services via appropriate primary care and few penalties for failure to deliver such care. Arguing that the current system is unsustainable, the book documents efforts that have been made to promote better coordination of care through patient-centered medical homes and accountable care organizations.

Specifically, the book focuses on linking the ongoing innovations in health care practices with the supports for scaling up innovations found in the Patient Protection and Affordable Care Act. It shows how expanding and improving primary care as the vehicle for care coordination will reduce costs for those with conditions such as arthritis, diabetes, hypertension, or other longstanding disorders, but also makes it clear that incentives have to be realigned if such improved primary care is to become a reality.

Excerpt

Chronic illness and its care in the United States is a subject that is of major concern in an aging society. It is often the case that both public and private insurance, as well as out-of-pocket expenditures, as utilized, do not always realize improved quality of life, prevent declines, or ward off death. Failure to receive appropriate chronic care is a major social problem since individuals are left without the opportunity to use their skills and talents to attain security, recognition, and self-regard.

In fact, a society could be judged ethically according to how well citizens are able to achieve a capacity to use their freedoms to choose to follow their dreams and do things that are meaningful to them, according to the Nobel laureate economist Amartya Sen (2010). To some of us old-timers, this statement is much in the spirit of Franklin Delano Roosevelt’s Four Freedoms. To Samuel Freeman (2010), in reviewing Sen’s The Idea of Justice, this freedom, in summary, sits on a foundation of social support.

Important capabilities include have adequate nutrition; health and lon
gevity; personal safety and freedom from fear; physical mobility, liter
acy and numeracy; and being able to appear in public without shame.
(p. 58)

Chronic illness often calls into question the capacity of a society to distribute fairly these supports. The absence of this capacity has brought forth impressive advocates, both among the chronically ill and within the healing professions. The problems of chronic care have generated some exciting opportunities to remake it, even in a society . . .

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