Outcomes? You Say You Want Outcomes?

The Journal of the American Medical Association (JAMA) can be forgiven for being physician-centric. So when it publishes an article on Medical Leadership in an Increasingly Complex World, the Disease Management Care Blog looks past the politics for the lessons. There's an important one here for not only physicians but, with some additional thought, all health organization leaders.

Leaders are lauded when they increase revenues, build buildings, gain market share and create positive brands. While, for example, academic leaders seek more NIH grants and professional society execs want membership growth, parallel business realities are keeping care management organizations' CEOs up at night.

But are their collective sweat and tears misplaced? Author Robert Brook of Rand wonders if they may be. He notes physician leaders are ultimately using the patient-doc based "medical model" to build their empires. Without mentioning the disease/population health management industry by name, he also recognizes the growth of a second "public health"model ("driven primarily by the quest to eliminate root causes of population behavior that produces poor health"). However, there is also a third "social determinants of health" model that recognizes well being is also a function of income, safety and communities.

His point? Leaders must pursue all three models in balance. He thinks they should be regularly asking what they've done to advance the health of their communities in all three domains. He also thinks medical trainees and members of medical societies should be asking the same question. The DMCB adds the Boards and shareholders of publicly held companies offering care management services should be asking the same question also.

Long ago, while the DMCB was visiting a large health care institution, it asked what would happen to the mortality rate of the surrounding community if its bricks, mortar, equipment, employees, protocols, policies, physicians and nurses all vanished. Would the rate of obesity diminish? Would there be fewer premature births?

There was an uncomfortable silence. It's time to begin answering those simple questions.

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