One of the most dramatic impacts in medicare seems to be a program that tested sending nurses around to see how people are doing and focusing on the human care side of things, not the ‘treat them once they’re in trouble’ side:
“If there is a secret to the success of Health Quality Partners at preventing hospitalizations, it’s this: No one else is checking in with the Bradfields or the Allens every week. Medical technology — from pills to devices to surgical procedures — is so advanced and so competitive that making further gains requires enormous investment and rarely brings high returns. But the exciting field of knocking-on-the-Bradfield’s-farmhouse-door is almost totally empty. Medicine has been so focused on what doctors can do in the hospital that it has barely even begun to figure out what can be done in the home. But the home is where elderly patients spend most of their time. It’s where they take their medicine and eat their meals, and it’s where they fall into funks and trip over the corner of the carpet. It’s where a trained medical professional can see a bad turn before it turns into a catastrophe. Medicine, however, has been reluctant to intrude into homes.
For the most part, the medical system treats the old very much like it treats the young. It cares for them when they’re sick and ignores them when they’re well. Coburn’s basic insight is a discomfiting one. He doesn’t really believe in ‘better,’ at least not for elderly, chronically ill patients. He wants someone going over frequently to see if they’re depressed, if their color is good, if they understand their medications, if there’s anything they need. This isn’t medicine so much as it’s supervision.”
Of course, this may save money in the big picture, but you can imagine that bean counters who focus on short term savings thinking about that. They’re about to shut it down.