Posted by: knightbird | June 28, 2011

What is really costing us in health care (the root cause)?

I have been advocating for a new strategic financial stability plan for the Alaska Tribal Health System. For the 7 years I have been at Chugachmiut, we have participated in an annual plea for congressional funding increases. As traditional health care costs have risen, our costs have risen as well. Since tribal entities have been entitled to contract with the federal government to provide health care for our tribal members, funding has actually declined when compared to health care inflation, which at times runs in double digits. We have had modest increases, but with the current fiscal crisis, I don’t hold out much hope for significant increases.

My proposal is this: (1) adopting the principles of lean thinking and implementing a management system based on it can free up 10% of the existing cash spent in the tribal health care system; (2) Lean principles increase throughput in most value streams by a minimum of 30%. So, if a practitioner sees 20 patients daily, a 30% increase improves that number to 26. That adds up to 1,320 patients annually (220 days worked). We need 30% fewer practitioners; (3) Incorporating behavioral health into primary care. I have been aware for some time that primary care physicians provide a lot of behavioral advising, but without training. And the literature reports that up to 80% of patients present for medical care without an organic explanation present. The Adverse Childhood Experience Study and Kaiser Permanente have reported that their patients have between 30% and 45% fewer primary care visits after behavioral involvement at primary care. A reduction in patient visits reduces the necessary volume of providers.

I believe that we can substantially reduce our chronic disease burden through behavioral health interventions that work with patients to resolve childhood-acquired trauma. If you are interested in reading more about this effort, send your email address to patrick@chugachmiut.org

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