happy new year

Wishing all of us good health, good tidings and an abundance of love and joy in 2008.

The Blue Cloud of Medical Home Wonderfulness

Psst.....

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Download this soft, friendly, fluffy quality increasing and cost saving image and paste it onto several pages, liberally and repeatedly add the words "Advanced Medical Home" or "The Chronic Care Model," lather, rinse and repeat.

Introduction, RAND and DMAA

Welcome to the Disease Management Care blog.

This is not only a chance to keep up with news and events in that growing segment of the health care industry called "disease management" aka care coordination aka population health, but a place for readers to share comments.

Speaking of which, the latest news of some note is another publication casting some doubt on the effectiveness of disease management. Drawing on a wellspring of 317 studies, Dr. Mattke and colleagues at RAND were only able to find evidence of reductions of hospitalizations in chronic heart failure and increases in outpatient care among persons with depression. While there was evidence that DM can improve processes of care, the long term impact on outcomes in other diseases (for example, diabetes mellitus) was unknown. Except for depression (ruh roh, costs increased), there was inconclusive or insufficient evidence of any impact. Not only did RAND post this on their web site, the news spilled over into the lay media.

Think DMAA will take that lying down? Not when their members have a $1.8 billion revenue stream at stake and the folks at Medicare are pondering just what they're going to do about this disease management thingy.

Among the DMAA responses: purchasers, unlike academics, are forced to make seasoned judgments without the benefit of conclusive evidence, that findings from peer review may not apply to their settings and what's more, other swaths of health care are also lacking in evidence. What do the very smart Medical Directors, Operations VPs, CEOs and CFOs in the commercial insurance industry know that the peer review literature doesn't?

If I may say so, waiting for conclusive proof before instituting a needed intervention also has its downsides (like unopposed gravity).

Let the games continue.

10 lb terrorist

This is Eli.

He is asleep on the dog bed that J-Dog got for Christmas.

J-Dog really likes his bed but Eli really, really likes it, too.

Eli weighs 10 lbs.

J-Dog weighs more than 50 lbs.

But J-Dog always defers to Eli, who I recently decided is related to the Fishing Cat.

things i can count on: boys will be boys and a dog will have dinner

My spouse left the kids in the back yard while he went to shovel the front walk. When he returned, D. was digging and shovelling looking focused and determined. Nine year old S. was nowhere to be seen.

Turns out he was completely buried in snow.

I am choosing not to be disturbed by this (although D. did look like he was really enjoying himself) and instead, to be pleased that they were playing together without fighting.

This is another rare sighting of my children playing together.

And this is where it all falls apart.

And this? It's a picture of my dog having his Christmas dinner with all the trimmings. Except cranberry sauce. Because that would be excessive.

when do my children go back to school?

Just asking.

California Insurers Lose a Big Court Case In the Health Insurance Policy Rescission Controversy

Here's one for a Harvard Business School case study: A few months before voters in the state are going to decide the future of your industry get into a losing battle about retroactively canceling sick peoples' health insurance policies.A unanimous California Appeals Court decision has decided that California health insurers have a responsibility to check the accuracy of applications for health

The First Year For This Blog

This month marks the first anniversary for this blog.As of today, folks have visited 95,558 times. From less than a thousand visitors that first month, 14,000 a month now visit and that number continues to grow briskly.As long as you keep reading it, I'll keep writing it.

A November Ballot Initiative Over California Health Reform Would Be The Biggest Thing Ever To Happen In The Debate

With news that California Governor Arnold Schwarzenegger (R) and the Democratic controlled General Assembly have agreed on a health reform proposal we may be on the cusp of a huge referendum on the Democratic version of health care reform.The next step is for the State Senate to approve the plan. The Assembly approved it earlier this month on a party-line vote with Republicans in opposition. The

Why Couldn't CIGNA Make the Right Decision In the First Place?

The Christmas weekend was full of news stories about a 17 year-old girl who was denied a liver transplant by CIGNA.The insurer ultimately reversed its decision but the girl died a short time later.I have no idea if the outcome would have been different had CIGNA made the decision to approve the transplant in the first place.Health insurance contracts--and government plans like Medicare and

"Health Care Quote of the Year"

Brian Klepper joins us again today with his nomination for the "Health Care Quote of the Year."Health Care Quote of the Yearby Brian KlepperI was reading through some other peoples’ blog posts yesterday and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston. Paul made news by establishing a blog called "Running a Hospital."I think

kingston women get down

Taken this morning, under the influence of coffee with Baileys.

Whatever you're doing, whatever you celebrate, wishing you love and laughter this holiday season.

Washington Post: McCain "Has Some Good Ideas on Health Care"

The Washington Post is not known for favoring Republican prescriptions for health care reform. That is why their editorial today calling the McCain health care reform proposal, "the most detailed and thoughtful of the Republican proposals," caught my eye.McCain has gone further in some respects than his Republican opponents on health care. Instead of providing people with a tax deduction, McCain

The State of Primary Care--How Much Responsibility Do Specialty Physicians Bear?

Our good friend Brian Klepper, posting over at "The Health Care Blog," has some provocative things to say about the state of primary care and the role the specialties, and even the American Medical Association, have had in getting us to where we are.Among Brian's points:"American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes

serendipity

Sometimes the most amazing things happen.

Or are done by amazing people.

Two weeks ago we had nineteen people to our house for a family Chanukah party. The cooking was shared (my spouse refers to Chanukah as "the festival of fried things"), the cleanup was shared and everyone had a great time.

After the meal, the children in the family exchanged presents.

There was also a package with my name on it. As I started to protest that this was against the rules, I was told that it was something special from my oldest niece (she'll be twelve this year).

It turned out that she had knit me a hat. It was her first non-scarf project and it is perfect. It's the most beautiful shade of turquoise, fits beautifully and just happens to be the exact same colour as the turquoise flecks in the scarf that I wear every day. And it looks great on me.

Just that week, I had tried to knit myself a hat but there was something wrong with my yarn or the pattern and it hadn't worked out. Just that day, I had been thinking how much I love it when people knit things for me and that I wish it would happen more often.

I love that hat with a passion because it is perfect and because it was so thoughtfully and carefully made, just for me.

And I have another example of an amazing thing.

I have been feeling kind of down lately. Part post-NY and Chanukah let-down, part grief for my old life and part chemotherapy blues, I've been feeling the dogs of depression nipping at my ankles. I've been fighting them off (and figuring out how to be healthier) but it has been a bit of a struggle (and of course the sadness is compounded by the guilt of a recovering Catholic: "I should be ashamed to be feeling so sorry for myself when I have responded to treatment so well, have good insurance and such great support!").

Two days ago, I wrote about feeling uninspired.

Yesterday, a book appeared in my mailbox, bound with a ribbon, on which was written the following:

"I like reading your blog and I find inspiration from it. Here is a book for you, may it bring you inspiration."

(It was from J., an artist friend, with whom I once worked closely and haven't seen in a long time. To think I inspire her means a great deal to me).

You know the expression "my heart lifted"? I now know exactly how that feels.

And how could she possibly have known that I have been scouring the Internet for patterns for knitted bags?

Sometimes, life is very hard. And it's not true that everything happens for a reason.

But sometimes, the right thing happens at exactly the right time. Or good people know to make good things happen.

The picture above was taken yesterday from the my spouse's downtown office window. Perhaps not the brightest woodpecker in the world, but I thought his appearance was pretty amazing, too.

uninspired

Perhaps it's NaBloPoMo burnout.

Also, Chrismukkah craziness and the chemotherapy blues.

Blondie says I shouldn't feel guilty about it, though.

The Shadegg Bill––A “Health-Insurance Solution” That Is a Waste of Time

Merrill Mathews, writing on yesterday’s Wall Street Journal op-ed page, asks why Representative John Shadegg’s (R-AZ) “Health Care Choice Act” isn’t a “no-brainer” for the Congress to pass.Shadegg’s proposal would enable consumers to buy a health insurance policy in any state thereby bypassing the states with the most costly benefit mandates. At the top of his costly mandate list are state “

Health Wonk Review Is Up!

David Harlow over at the "HealthBlawg" has a particularly entertaining holiday edition of Health Wonk Review up. It covers some of the best posts in recent weeks from the world of health blogs.

Republican Candidates Wouldn't Have Been Able To Get Coverage Under Their Own Health Reform Plans

Republican presidential candidates have called for a greater reliance upon the individual health insurance market. But many of these same candidates have had cancer and wouldn't have been able to get individual coverage under their own health reform plans at the time of their treatment.Ricardo Alonso-Zaldivar had a great story in the Los Angeles Times recently.Ricardo points out that Rudy

a very short post

The last couple of weeks have been unbelievably busy.

Off to chemo shortly.

More time to blog, as I recover.

Go read Jacqueline's account of my trip to New York. She made me a little weepy. And she pretty much said exactly what I would have about our time together.

Kindred spirits, indeed.

Mike Huckabee's Health Care Plan

Mike Huckabee is now among the front runners for the Republican nomination. So, what is his health care plan?First, he doesn't have a plan so much as a set of principles that would have to be detailed. On the surface he seems to want a lot of it both ways--no more government but lots of new program ideas. For example, he calls for tax credits to help low-income people purchase health insurance

december 6, 1989: why i am a feminist

Eighteen years ago today, a gunman walked into the engineering school of the Ecole Polytechnique in Montreal, separated out the women and opened fire after declaring his hatred of "feminists."

I remember exactly where I was at the moment I found out, how I felt as the details emerged. I also remember the outrage and pain I felt in the aftermath, when mainstream Canada refused to accept that these women were killed because they were women, aspiring to work in a male dominated field.

No one disputes that fact now.

They call it the Montreal Massacre and the killer has achieved the kind of recognition posthumously that he sought in life.

I will not re-print his name here.

I will, however, name each of the young women who died that day. Twelve of them were engineering students, one an administrator and one a nursing student. They would all be my age (or very close to it right now). When I think of all I have lived since December 6, 1989, I am reminded that these women and those who loved them were robbed of a very great deal.


Geneviève Bergeron.

Hélène Colgan.

Nathalie Croteau.

Barbara Daigneault.

Anne-Marie Edward.

Maude Haviernick.

Maryse Laganière.

Maryse Leclair.

Anne-Marie Lemay.

Sonia Pelletier.

Michèle Richard.

Annie St-Arneault.

Annie Turcotte.

Barbara Klucznik-Widajewicz.

More People Think Health Care Is An Urgent Issue Than Think The Iraq War Is

A recent Wall Street Journal poll caught my eye.The poll found that 52% said the economy and health care are most important to them in choosing a new president compared to 34% that said terrorism and social and moral issues were most important.That is the opposite of what people thought at the time of the 2004 election.Here's the surprise for me. The poll also showed, "health care eclipsing the

busted!

Just because we're paranoid, doesn't mean they aren't out to get us.

Undercover officer hit riot squad member at Montebello: filmmaker

wonderful wonderful, wonderful

It's as though I didn't know any other adjective, I've used it so much over the last few days.

But it really is the best possible way to describe my long week end in New York with Jacqueline.

I now own two Rebel 1 in 8 designs. Click here and here for pics. Don't I look happy? She made me feel so beautiful.

Jacqueline also made me my very own Rebel necklace, something I have wanted for a long time.

But the joy is about more than the stuff I got (although I do love the stuff I got). It's about kindred spirits, never running out of things to talk about, experiencing unfathomable kindness and being inspired by people and place, touch, taste and sound.

I have been back since late last night and I am still all aglow.

Wonderful, wonderful, wonderful.

Pete Stark Regrets the Stark "Self-Referral" Laws!

David Whelan was kind to point out a great story he just did at Forbes.com on the Stark anti-kickback laws and the bans on provider "self-referral."David writes, "Yet in an interview today the Congressman lamented that he ever made this legislative intrusion into medical practices."Congressman Pete Stark (D-CA) went on to say the laws, "gave every shyster and promoter a loophole" and that he