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More Media Sloppiness on Prevention

May 6, 2012

The state of Oregon and the Obama administration just announced the approval of a federal waiver to allow innovation in the state’s Medicaid program. The feds agreed to chip in $1.9 billion over five years to get the program off the ground.

The AP reporter covering this story wrote, “Gov. John Kitzhaber’s plan would invest in preventive care to keep patients healthy so they don’t need expensive hospitalizations.”

Maybe I’m too rigid about this word prevention, but I just don’ believe people understand how this new approach would actually save money. I think when most people read the word prevention, they think of screenings for high cholesterol and similar diseases. These interventions do NOT save money — ever.

Further down in the article the reporter writes: “The Oregon plan would create “coordinated care organizations” to manage all mental, physical and dental care for 600,000 low-income patients on the Oregon Health Plan, the state’s Medicaid program. It would focus particularly on the sickest patients with the highest costs, especially people with chronic conditions such as diabetes and asthma or with mental health concerns.

Ohhhh. It’s not prevention, it’s taking better care of patients with chronic disease. Yeah, I suppose we could say that working with a patient with severe emphysema to try to keep him from having such bad disease flares he feels better and stays out of the ER longer is prevention. But I think a better word is something like stable or stability, not prevention.

I couldn’t find many other details about the plan, even from The Oregonian website. It sounds like they’re going to do some sort of PCMH thing. I’ll be fascinated to see how much of their up front investment is in primary care physicians vs. the other bells and whistles of the PCMH.

Of course I really wish them well in their journey to deliver compassionate care at a lower cost. Oregon had its innovative moment in the sun about 20 years ago with the Medicaid coverage list (which was also led by Dr. Kitzhaber). I hope this initiative works and has more staying power than their previous effort.

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3 Responses to More Media Sloppiness on Prevention

  1. John Epling on May 7, 2012 at 8:31 pm

    How about “tertiary prevention”? (buried at this page: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm) Preventing complications of a disease (like hospitalization) once it’s diagnosed. Trouble is, hypertension, hyperlipidemia, mild diabetes…are those really diseases or risk factors? And if they’re risk factors, then addressing them is prevention.

    • Richard Young MD on May 10, 2012 at 10:41 pm

      You’re right that some people use the term tertiary prevention, such as the CDC. Providing excellent primary care can reduce the frequency of admissions for serious chronic diseases, ergo preventing unnecessary admissions.

      Maybe I’m too narrow minded, but I just don’t think most people who use the word “prevention” imagine hiqh-quality care of patients with chronic diseases, but rather attempts to prevent disease in the first place.

  2. Tracie Updike MD on May 7, 2012 at 9:13 pm

    Well, here in Texas Medicaid has opened up several managed care medicaids but I can’t find any specialists to help me manage some of their chronic conditions. I agree screening cost more money then it appears to be worth.

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