Definition of Immunological diseases
In 1991 the phrase “perfect storm” was made popular by the movie of the same name when the Andrea Gail was caught in theconfluence of two powerful weather fronts and a hurricane. The phrase describes the phenomenon where the powerful combined effect of a unique set of circumstances results in enormous impact.
In health care we are entering a perfect storm as the forces of technology advancements, health reform, new payment models, and ICD-10 conversions collide together to create a flood of expanding definitions of health, medicine, and health care. The burning question in my mind is how will the different stakeholders respond to these changing winds in health care? Will they pioneer through the changing pressures, or pause and take shelter for now? Will stakeholders build coordinated systems to support each other and improve value in the overall system?
What’s fueling these paradigm shifts?
- Payment reform: Patient cost risk is shifting from health plans and government bodies to health systems as a whole. Health care models are shifting from fee-for-service to value-based services around risk management such as prevention, chronic disease management, and measurable outcomes.
- Technological advances: New technologies from research into biology, genomics, and imaging are for the first time allowing the health care industry to understand many diseases and treatments at their root level. Medicine is shifting from describing diseases and treating for symptoms to focus on root causes from biological variation that enable personalization of treatments.
- Electronic documentation: Adoption of information technology such as electronic medical records (EMR), mobile applications, and machine learning are enabling detailed capture of structured data about patients. As new coding systems such as ICD-10 are adopted they will offer a more granular view of disease and treatment to finely tune care. The data collected about patients will enable organizations to understand which treatments and care are effective and which are not.
Payment reform: the high pressure risk shifting system
By shifting the bulk of risk for incurring patient costs from health insurers to health care providers, the payment reform changes from the Accountable Care Act have dramatically changed the definition of an effective health care system. To illustrate the scale of this shift of risk to providers, imagine a trade wind that normally flows north to south suddenly shifting to run south to north.
For example, outcomes following care are becoming the basis for measuring effectiveness and hospitals are financially penalized if they have high rates of readmissions. The impact of the reimbursement change is the need for hospitals to build strategies to increase attention to quality during hospital visits, better patient education, and follow-up and monitoring. Before this, hospitals had incentives to keep beds full, and focus on the types of admissions with the highest margins.
Similarly, bundled payments for surgical procedures such as total knee replacement are moving towards a single fee for reimbursement for the overall surgical experience rather than individual payments for each service rendered. This shifts the management of cost controls to the health system and even puts the focus on areas such as comparative effectiveness based on cost and outcomes for surgical supplies such as artificial joints and medications.
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In fact, studies show that the most immunological benefit of the breast feeding is derived if baby is exclusively nurse (no water, no solids) for 6 months. Babies nurse
dexclusively for 6 months have the lowest occurrence of ear infections, diarrhea (including nasty bugs like e
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