Justine Cadet, Editorial Director

This month’s plethora stories herald the fact that for the patient, the physician and the payor there is a need to take greater personal responsibility to improve the state of healthcare in the U.S. In lieu of the personal initiativeto change on the provider and payor side, certain government mandates have arrived to ensure better care.

On the patient side, Humana Chairman, President and CEO Michael B. McCallister declared Americans “a nation of chronically ill, fat people, who are illiterate about our own healthcare.” Citing a survey that Humana conducted of its employees as a microcosm of the larger U.S. population, he said lack of exercise, a poor diet and continued smoking, all contribute to illness, some of which are chronic.

While McCallister is skeptical of accountable care organizations, he sees their value in terms of the collaborative work that can be done between providers and payors. He also spoke to a successful wellness program conducted among Humana employees.

However, the private payors also are being held accountable to reimburse for better quality care by the state and federal governments. Namely, the Delaware Insurance Commissioner has ordered Blue Cross Blue Shield of Delaware to adopt the American College of Cardiology’s (ACC) FOCUS program, based on national medical society-developed appropriate use criteria. 

Finally, physicians, who have always been held responsible for the care of their patients, may be learning that personal responsibility cannot be the only tactic, as collaborative care may provide the best quality—even though that may require a change in the status quo. Specifically, in the care of heart failure patients, more and more caregivers speak to need of coordination for the best transition of care to reduce costly readmissions.

As a catalyst for change, the Department of Health and Human Services, along with many association and industry partners, has launched Million Hearts, an initiative that aims to prevent one million heart attacks and strokes in the U.S. over the next five years. Currently, cardiovascular disease costs $444 billion every year in medical costs and lost productivity for people living in the U.S., according to the HHS.

In the spirit of understanding that cardiovascular care has room for improvement, the ACC and the American Journal of Managed Care launched a joint online venue this week that will allow healthcare professionals to share best practices in care delivery and payment reform.

On these topics, or any others, please feel free to contact us.

Justine Cadet
jcadet@cardiovascularbusiness.com