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Bigbypic2 By Dr. JudyAnn Bigby

 

In the spirited dialogue about health care reform – nationally and here in Massachusetts – a crowded arena of terminology is emerging. Admittedly, many of us who work in government, health care and health-related industries have grown accustomed to the extensive jargon and acronyms that shape our dialogue about various health care issues, in particular, the issue of how we pay for care. Although the jumble of terms can be confusing, let’s not forget that there was a time not too long ago when ‘HMO’ (health maintenance organization) or ‘primary care’  were unfamiliar terms. Today, they are a familiar part of dialogue and debate about health care and its delivery. For that reason, I’d like to focus on one term in particular, which I hope someday will be a familiar and significant one to every resident of the Commonwealth: integrated care organizations, or ICOs.

An integrated care organization – or “ICO” – is a network of related doctors, hospitals and other heath care providers that agree to be responsible for the quality, cost, and coordination of the overall health care needs of a group of patients. These organizations can be groups of primary care doctors, each working contractually with a community hospital, or a traditional integrated delivery system in which providers within a group are part of a system comprising many types of providers such as doctors, hospitals or home health services. 

 

Just as in our current model of health care, in an ICO patients select a primary care physician.  But within an ICO the patient’s primary care doctor takes a more active role in managing the care of his or her patient.  Primary care doctors, nurses and others work together to keep people healthy, manage chronic medical problems and ensure people have high quality, safe treatments across multiple settings within the ICO. It is the collaboration between the primary care doctor and the other providers a patient needs that constitutes the “integrated” part of an ICO.  

 

This is different than the way care was “managed” by HMOs in the 1990s, because today providers have access to much better clinical information and technology so they can manage care as opposed to monitoring costs. Moving away from the current payment methods for health care – which pays for quantity of care, not quality – toward a system that rewards healthier outcomes, will lower overall cost. Managing and coordinating care means fewer unnecessary visits to the emergency department, hospital readmissions and duplicative tests.  

 

The Patrick-Murray Administration strongly supports the formation of ICOs, which are designed to gradually accept more and more responsibility for the care they deliver to their patients. Providing the right care in the first place is essential to successful patient outcomes. For example, today we know how to prevent chronic diseases like diabetes and heart attack. By emphasizing prevention in primary care we can avoid the cost of managing chronic diseases. Similarly, we know how to prevent complications after surgeries such as joint replacements. With teams of surgeons, therapists, nurses and primary care providers working together, people will avoid complications such as wound infections, blood clots and other impediments to their health. When people develop chronic diseases like diabetes, primary care doctors, nurse educators and informed patients can work together to prevent health complications.

 

On February 17, Governor Patrick filed a bill to lower health care costs for consumers while giving the health care industry incentives and freedom to innovate and find lower cost ways to deliver better care. Coordinating care and putting patients at the center of wellness and care is a key ingredient in the recipe for success. The Patrick-Murray Administration’s commitment on this front reflects the steadfast value that here in the Commonwealth, we care not only about achieving health care coverage for all residents, but also about the kind of care we want, now and for future generations.

 

Everyone agrees that health care costs are too high. In order to truly reconfigure a system that costs too much, we have to reassess and restructure how care is delivered – and get accustomed to the terminology that will help deliver solutions.

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