The real world, that's a good place.  It's where you and I operate most of the time (except for those occasional day dreams we have where people don't get sick, they eat all their vegetables, stay away from fatty foods, and exercise regularly).   So, just the title alone intrigued me,  and, I'm pretty interested in finding out what works and what doesn't when it comes to helping people with chronic conditions "do better."

 

This summary touches on four or five approaches others have used to address prevention and disease management that truly worked.   It quotes D. W. Edington, Ph.D. from the University of Michigan's Health Management Research Center.  Dr. Edington said "Where do the high-risk people come from?  They weren't born that way.  Sixty percent of the people are low risk, and you do nothing for them, you just wait for bad things to happen.  They go from low risk to high risk to disease to high cost.  Where's the investment?"  (See, I told you these two articles were inter-related.)  Dr. Edington goes on to say, "Individual behavior change is a good idea, but it doesn't work.  You can't change enough people."  It's that old problem, when they leave work and go home, they are back in a community over which you have little impact.  So, what do you do about this; what can you do?

 

In an on-site clinic, you reach out to every employee, dependent, spouse (even children, right?   You address them as individuals but also as a part of the whole, the community.  You work on keeping the low risk people at low risk.   You don't wait for them to become high risk (and  outliers on your reports), you get in there early and work with them.

 

The brief goes on and really describes the "medical home model;" the heavy dependence on primary care with a new payment methodology for the physicians, and identifying "gaps in care" through the data you have at your fingertips. 

 

Get the entire brief at this link.