Wednesday, December 18, 2013

Reform should make Medicare, Medicaid more interested in prevention, rural health expert says

Dr. Wayne Myers
While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Perry County in Eastern Kentucky. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

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