Author Archives: Steve Delaronde

Bringing health care and nutrition closer together

Losing weight consistently makes the Top 3 for New Year’s resolutions. Closely related to this are pledges by Americans to exercise and eat healthier. According to a review of the most popular Google “how-to” searches made during the first week before and after New Year’s 2015, learning to cook healthier fare made the top 10, including kale chips (#2), lentils (#5), cabbage (#6), collard greens (#8) and broccoli (#9). Luckily for resolution makers, there are 3 developments in healthcare that will help them follow Hippocrates counsel to “Let medicine be thy food and let food be thy medicine.” Continue reading

Prescribing exercise to achieve the Triple Aim

It’s a fact: Americans have become more sedentary. This not only leads to greater susceptibility to obesity and chronic diseases, but also contributes to increased symptom severity for those with chronic conditions. Getting the entire nation off the couch and on their feet is a laudable goal for promoting overall health and quality of life. Given resource limitations, however, it would be best to focus on patient subgroups, particularly those that would experience the greatest benefit from physical activity while meeting the goals of the Triple Aim – better outcomes, improved patient satisfaction, and lower cost. Continue reading

“What did you have for dinner last night?” Nutrition and the healthcare system

While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Continue reading

Care coordination and the community health worker (CHW) – The time has come

Improving care coordination for the sickest, most vulnerable and highest cost patient segments remains an important component of population health management and achieving the goals of the Triple Aim – better outcomes, lower costs and improved patient satisfaction. Yet, even as we acknowledge the importance of care coordination and devote considerable resources to this effort, the next question is whether these resources are being diverted to the right places to make a meaningful difference in health outcomes, cost and patient satisfaction. Continue reading

Is the accountable care community the next evolution of the ACO?

The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy. Continue reading

Social Determinants of Health- Are They Still Relevant?

What is the impact of the social determinants of health, such as income, education and occupation, as U.S. health care moves from volume to value-based care with a focus on population health management? Providers of health care have been well-trained to focus on the clinical manifestation and treatment of disease, but often struggle with the environmental and social context within which they occur. Continue reading

TMI: How Much Is Too Much Information?

We are in the midst of an information explosion in healthcare, which brings more responsibility to healthcare payers, providers, and patients themselves. Providers must be able to help patients distinguish between information that is useful for achieving important healthcare objectives, such as those espoused by the Triple Aim, and what is just noise. Continue reading

Medical Care: When Do Harms Outweigh the Benefits?

Medical care produces both benefits and harms. There are risks associated with care delivered in the hospital, including infections, medical errors and delirium. There are side effects associated with medication and, ultimately, there are risks associated with all medical procedures. When a patient is suffering from a painful or debilitating illness, it is understandable how they might overestimate the benefits of medical care and underestimate its risks in an effort to obtain a cure or symptom relief. More worrisome is that some physicians may be poor estimators of risk. The medical community often ascribes to the adage that it is better to act than do nothing, whereas “nothing” may be in the best interest of the patient. Continue reading

The Hippocratic Oath in the Age of Accountable Care – First Do No (Financial) Harm

Patients are becoming increasingly responsible for a greater proportion of their medical costs. The upfront share of premium payments, cost sharing at the point of care in the form of copays and deductibles, as well as the proportion of Americans with high deductible plans, have all been increasing. Since patients are the ultimate consumers of healthcare services, the issue of cost and the efforts to minimize the “financial harm” that can result from overprescribing, overtreating, or simply overlooking price differences among similar treatments should be a top concern of healthcare providers. Does the Hippocratic Oath that physicians take upon entering the practice of medicine extend to avoiding financial, as well as physical harm? Continue reading

Population Health Management and the Annual Physical Exam

Population Health Management (PHM) is the application of specific interventions and approaches within a healthcare delivery system designed to improve and maintain the health of a population. PHM strategies should be effective (lead to better outcomes), as well as efficient (achieve the best outcome at the lowest cost). As the U.S. healthcare system continues to promote value-based care and PHM, it’s critical that health systems address the most important issues that lead to the best outcomes. Continue reading