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Laughing and Learning in Spanish-Language Prenatal Group

Posted By Amy Davis, Thursday, October 8, 2009
Updated: Thursday, June 9, 2011

So, let me tell you about the very best part of my week.

The Marillac Clinic is a clinic for the uninsured in Mesa County with a satellite clinic in Palisade, Colorado. The Palisade site had it's origins as a clinic for migrant and seasonal farmworkers, but now serves the uninsured east valley community at large. The clinic is still a medical home to a largely monolingual, agricultural Spanish community. Included in this community are a group of pregnant women who do not have access to any public assistance for their prenatal care other than emergency Medicaid at the time of delivery.

Historically, the Marillac Clinic has not provided prenatal care given the availability of such services in the private sector. However, changing funding streams created a need to provide these services, as many of these women did not participate in any prenatal care before presenting to the hospital at the time of delivery. In Colorado, 32.4 % of Hispanic women either present late for or have no prenatal care in comparison to 13.8% of white women.

Despite my perception that I should try to provide this service, I was thwarted by my knowledge that even when financial barriers are lessened or removed, disparities of utilization exist in access to prenatal care. I was also concerned about my abilities to efficiently provide care to this community of women when I only attend this clinic one day per week.

I decided to start a group prenatal visit for these women knowing that there are models and literature to support this. I easily convinced my behavioral health colleague at the clinic and our cultural diversity coordinator to join this endeavor. I have to admit we have been rather spontaneous about the project, but have been rewarded with unexpected enthusiasm and participation by our patients.

We usually cannot even get through introductions without the women laughing and "taking off" onto topics which interest them. The group has grown in number and the women bring their friends, mothers, and children. We had hoped during these group visits to provide education concurrently with their prenatal care, which I think has happened. However, more importantly what has happened is that these women have become less isolated, have shared their stories, their experiences, their sadness and their joy. They have shared with us their "creencias" and have taught us how best to help them with their health care.

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Development of Collaboration in a For-Profit Setting

Posted By Patrice Whistler, Thursday, October 8, 2009
Updated: Thursday, June 9, 2011

Primary Care Partners is a group practice in Grand Junction, CO with 21 Family Physicians and 14 Pediatricians. To better manage the behavioral needs of our patients we began collaborating at a distance with a local private counseling group, Behavioral Health and Wellness, about 12 years ago. Over time their staff and ours began to commute between offices and schedule joint patient appointments. Our partnership benefited from grant funding that promoted rapid diagnosis and treatment for ADHD. Through this project our pediatricians co-facilitated diagnostic sessions with their mental health staff.

Gauging our collaborative development using Doherty and McDaniels Five Level model, we started at a combination of Level 1, minimal collaboration, with referrals going to Behavioral Health and Wellness, along with some minimal direct communication (Level 2) before a referral visit was scheduled. This might have been a phone call or email, or faxed notes from the physician visit.

Two of us, myself as the pediatrician and one behavioral health and wellness counselor, started Level 3 (basic on- site collaboration) by traveling to and from each other's sites (7 blocks down a street), to have joint visits for certain complex patients or those who tried to "split" the physician and mental health counselor. This was time consuming and I often scheduled my visits to the mental health office on my days off; impractical but doable. In 2004 Primary Care Partners moved into a new building that allowed us to rent space to the mental health group. They now share a waiting room with our family physicians. Our proximity promotes daily shared patient care including joint visits, curbside consults, and availability for emergent evaluations in both offices. In this way we have fully implemented Level 3 (on-site collaboration) and sometimes level 4 (close collaboration in a partly integrated system)

This year we had a family physician and pediatrician complete Sandy Blount’s Primary Care Behavioral Health certificate program along with a psychologist and family therapist from the mental health office. We are also finalizing plans for a medical home that fully imbeds a few of their counselors into both our family physician and pediatrician exam room pods.

Recently we finalized a contract between the private behavioral health clinic and the state funded mental health center so that Behavioral Health and Wellness will be able to see Medicaid patients in the Pediatric office for up to 6 visits, for initial evaluation and stabilization. The requirements include a "warm" hand off by the physician, bringing the counselor into the room to meet the patient and family, and integrating the note from the counselor into our electronic health record that day.

We begin this program in a few weeks. If a client needs more that 6 mental health visits, they will be referred over to the mental health center, hopefully to a select group of clinicians ready to take the referrals without waiting time. The exciting thing about this program is that we have Medicaid patients served DIRECTLY in our office, the same way private pay or CHP (Colorado Children's Health program) clients are served.

Our physicians have continued to develop this relationship because we have benefited by many positive outcomes:

1. A patient in crisis in our office has immediate intervention with the on-site mental health staff.

2.Accurate diagnosis and medication management is much easier when supported by a thorough work-up and on-going consultation by a mental health specialist.

3. Patient satisfaction increases with the integrated therapeutic relationship of physician and mental health providers.

4. Our mental health partners save us time through continually providing updated records.

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A Day in the Life of a Case Manager

Posted By Fran Parker, Wednesday, October 7, 2009
Updated: Thursday, June 9, 2011

Clinical case management is a core aspect of Marillac Clinic's Integrated Care model. It is provided by a full-time case manager, all of our counselors, and (to a lesser degree) by our medical and nursing providers. These services were recently described in the national periodical for case managers and in a description of Marillac Clinic's integrated care services that was presented to the Advancing Colorado's Mental Health Care initiative.

The following is a description of an actual day in the life of our full-time case manager, Sarah.

Sarah starts her Tuesday at 8:00 am at the weekly mental health providers' meeting. Her participation in the meeting is disrupted when the front desks calls her to help with a patient. Martha, a 58 year old homeless woman, has come to the Clinic, asking for an early medication refill.

By 10 am, Sarah has handled phone calls from two parents calling on behalf of adult children waiting for medications through the Medication Assistance Program (MAP). She's assisted two patients with the disability application process. The local mental health center has faxed a discharge plan for a patient who will be coming to Marillac for service, and she decides she needs to follow up for additional information.

Over the next hour and a half, Sarah gets two requests from women needing early medication refills because of travel plans. Lisa makes her request in person. Sarah is familiar with Lisa's case and provides a brief counseling intervention since her mental health provider is not available. The other early refill request is made over the phone. Sarah is familiar with Karen, who has "no-showed" for several medical appointments. The patient has been told repeatedly she needs to see a medical provider before her prescriptions will be refilled. Sarah tells both women she will need to check with the "medical team" and get back to them.

The Clinical Case Manager also answers disability related questions from another patient, reassures an asthmatic patient who calls concerned that her Advair will not arrive in time, and handles a phone call from a pharmacy provider confused about the pharmacy's new contract with Marillac Clinic. She briefs two of her colleagues, a physician assistant and a mental health provider, about a patient with auditory hallucinations. Sarah's scheduled the two providers for a joint appointment with this patient.

When a medical provider asks Sarah to "meet and greet" a patient just discharged from an inpatient substance abuse program, Sarah goes into the exam room, talks with him, and reinforces his relapse prevention plan. After 25 minutes, the two of them decide he currently has enough structure and support in an aftercare program. Sarah tells him to call her if he needs help.

At 11:40 am, Sarah finds the Medical Officer of the Day (MOD) and discusses the two early refill requests. The MOD approves Lisa's request. However, the MOD does not approve Karen's request. Instead, the MOD writes a prescription with instructions on how to taper down the patient's anti-anxiety medication. When Karen returns from her trip and keeps an appointment with a medical provider, her health status and medication needs can be reassessed.

Before she leaves for lunch, Sarah discusses financial assistance programs with a 29 year old patient who needs shoulder and eye surgery. After lunch, she fields another call from the pharmacy and faxes a voucher so the cost of medication for a homeless man will be billed to Marillac. She listens to voice mail message from a case manager at the local domestic violence shelter who's checking on the status of the agency's request for a psychiatric evaluation of an undocumented person.

There's also a message from a man who needs a psychiatric consultation about potential interactions between his psychiatric and other medications. Sarah has been working for three months to arrange a consultation with an out of town psychiatrist, due to the local shortage of psychiatrists. She makes several phone calls to arrange an appointment on a day the patient will have transportation.

Mid-afternoon finds the Clinical Case Manager getting patient updates from several colleagues, a volunteer counselor and a staff mental health provider. She reviews the records on Larry, who has two prostheses. Larry can't afford the approximately $1,000/year cost of replacement parts. She calls the prosthetics provider about arranging a payment plan.

At 3:15 pm, a medical provider asks Sarah to meet with a woman who's grieving her mother's recent death. Sarah spends nearly an hour encouraging the woman to find some balance between meeting her father's needs and her own self care.

As the day draws near to an end, Sarah talks to a medical provider about potential resources for Leonor, a woman who has a very large kidney stone. Leonor's not a citizen so she isn't eligible for most assistance programs.

She responds to another call from the pharmacy and another patient who's seeking sample medications while waiting for MAP. After receiving a second phone call from a father about his daughter's medication, Sarah checks the Medication Outlet and finds the medication has arrived. She calls the father back with the good news.

Sarah ends her day noting that it has been kind of slow!

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Welcome to Grand Junction, CO

Posted By Steve Hurd, Tuesday, October 6, 2009
Updated: Thursday, June 9, 2011

Grand Junction's healthcare system has received considerable positive press of late. This attention grew on a national level from Atul Gawande's June 1, 2009 article in the New Yorkerand culminated in President Obama's August townhall meeting to discuss healthcare reform. The New Yorker article highlighted findings from The DartmouthAtlas that Mesa County, CO maintains nearly the lowest per capita Medicare cost in the U.S.

There are numerous drivers behind Mesa County's low healthcare costs, including:

    The effective cost controls of a long-standing local non-profit insurance plan;
    The efficiency of one of the nation's most successful regional health information organizations; and
    The presence of a non-profit hospital that sponsors a rural family medicine residency.

There is more to this story. Mesa County is also home to an enduring and expanding integrated care project. Marillac Clinic began providing behavioral health services in the primary care setting in 2000, when this concept was in a pilot stage.Over the past decade, the concept of integrating care for the mind and body has been widely embraced throughout the country.

Much of the work in building the Mesa County system has been carried out by the local Integrated Care Council. Council members represent the largest primary care offices, safety net clinics, public and private mental health offices, hospital services, healthcare payors, consumers, and families.

During this week, we will highlight successes of council members. On Wednesday Fran Parker, the coordinator of a 5-year integration grant, will present a day-in-the-life of a safety net clinic case manager. On Thursday 2 physicians will present integrated care initiatives. Amy Davis, a family physician, will present a prenatal group clinic for migrant families. Patrice Whistler, a pediatrician, will present the development of integration in the for-profit sector. And, on Friday, Randall Reitz, the current council president will describe how we have promoted integration through the creation of a community white paper.

Throughout this week, please take a moment to share some of your community's successes.

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What Potty Training Taught Me About Health Reform

Posted By Ben Miller, Wednesday, September 23, 2009
Updated: Wednesday, June 1, 2011

A.K.A.: "Don't Write Blog Posts Too Late At Night or This is What You Get"

Now that I have your attention, let me really get down to what I want to talk about: What potty training has taught me about health reform. You see, I have a 19 month old who is experiencing the rite that we mostly all have passed (hopefully), potty training. It occurred to me that there are many principles for health reform that also apply to potty training (and vice versa). So, without being too crude let me get started:

  1. Sometimes it is about patience: Patience is usually a great skill to have when entering into any type of new (and often significant) change. There are those who have committed serious amounts of time (read their life’s work) to seeing change in healthcare. While I cannot say that I have spent the majority of my life working on potty training, relative to how long my daughter has been alive, I would argue that it has been a significant amount of her life. Yet, we wait. There have been various aspects of healthcare that lead me to believe that yes, we are close to something big; however, just like potty training, when you think you have it, something inevitably happens that changes your opinion about the directions you are going. Take away: Deep breath, start again…
  2. Those most invested in success may not be who you think: This one is pretty obvious to me, but think about it from a child’s perspective: Why change when I have everything I need already in place? A diaper – check! A parent to change – check! There are those in the current healthcare system who are just this way. A public dependent on health coverage – check! Lots of sick people – check! Why change this? Well let’s begin with the fact that healthcare is a booming business. Even in our current economical situation, healthcare continues to prevail financially. Because many experts agree that payment reform is central to a redesigned and successful system, some may not want their bottom line affected. In addition, there are provider groups within healthcare that are afraid they will lose out because their specialized form of payment could be consolidated within a larger healthcare budget. These are all very real conversations that are happening now! Take away: Examining others motives in success (or failure) is not a bad thing to do.
  3. If at first you don’t succeed… Some failure with potty training is inevitable. I mean, come on, this is the first time the little one has had to demonstrate self-control (and in a major way). There will be small success and some setbacks, but all in all, it will be worth it if you can just stick it out. Healthcare? Well let’s just say that we have been trying to succeed at building a high-quality, cost conscious, efficient system for some time, but aren’t quite there. As a matter of fact, we have regressed in many ways. We pay more and get less for our healthcare than we have in the past, and there is little question that if we don’t change now, no one will be able to afford healthcare anyway! Take away: practice makes perfect (or at least better).
  4. Be prepared for false alarms: Baucus bill emerges; no one likes it. Having your child say the word "potty” meaning they are in the act of (verb) rather than describing the item they wish to use (noun). Take away: One can never really know if this is really "it” but we have to keep working like it is.
  5. Convenience vs. Inconvenience: Imagine this, you have the Cadillac plan for insurance – you are covered from head to toe, and pay relatively little for what you receive. Someone comes up to you and says, "Hey, we should change health insurance.” Your first response is not likely to be "OK that sounds great!” In the same vein, you are at home, and "potty” is mentioned – look how easy it is to access this wonderful and convenient service that doesn’t require you to do too much to accommodate. Now, same scenario – "potty” but you are now out on the road with no potty. Your first response is not likely to be "OK that sounds great!” Take away: Sometimes complex change requires us all to be a little inconvenienced for the sake of the greater good.

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Mental Health vs. Behavioral Health

Posted By Peter Fifield, Monday, September 21, 2009
Updated: Wednesday, June 1, 2011

In a past CBC blog there was a brief discussion around the difference between "Collaborate and Integrate”. Although to some it may only appear to be an issue of semantics, to others there is a need to create consistent definitions in our profession. A reliable discourse within our profession could facilitate the relay of ideas concerning policy, process and practice.

As the concepts of Integrated Care become more and more familiar within the medical landscape, there is a potential need for a universal discourse. On occasion I interact within our local and state-wide communities here in New Hampshire spreading the word of integrated medicine and collaborative care. Naturally, two phrases that are often used during conversations are "Integrated Care” and "Behavioral Health”. Shortly after these words leave my mouth, a look of inquisitiveness often arrives on the faces of anyone lending an ear.

Dr. Ben Miller asked an important question in a prior blog: "Where is Mental Health”? As I read the blog, I thought that before we can identify where "it” is we actually need to know what "it” is. I have a request of you all. Please post your opinion related to the difference between Mental Health and Behavioral Health. I have my own operational definition but quite often I find myself attempting to discern between them and I’m sure my resultant answer is rarely the same. Questions I find myself asking are: "Is it more than just a way to euphemize a service being sold to an unwitting patient?”, "Is there a core practical difference between the two or is it merely a philosophical difference?”, "Does behavioral health only occur in a medical setting and mental health in a specialty clinic?” and "Does anyone really care about the difference aside from the Medicaid/Medicare billing departments?”. I hope that there are some Behaviorists, Gestaltists and Psychoanalysts out there, from a range of professions, ready to respond to this topic.

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Help Create the Collaborative Care Strategic Vision

Posted By Frank deGruy, Wednesday, September 16, 2009
Updated: Thursday, June 9, 2011

The Board of Directors met for a two-day Strategic Planning Retreat in San Diego on July 10 and 11, to clarify strategic priorities for CFHA, and to formulate a provisional action plan for the upcoming year. The external environmental context for this work is the extraordinary interest in health care reform, and specifically the interest in the Patient-Centered Medical Home and related initiatives that will most likely lead to the participation of new "health care teams” of clinicians rendering primary care.

While this is a promising opportunity, there has been little explicit attention to how mental health clinicians and primary care clinicians actually fit together and operate collaboratively. The internal context for this retreat was the need for CFHA to develop a clear focus on serving the needs of its members, on attracting new members who would benefit from collaborative resources, on finding and hiring an executive director, and on ensuring that our annual meeting and summits continue to serve our membership well. The following action plan was accepted by the board:

Hire an Executive Director, which is in process and should be concluded in the next few months. Add advocacy to the desirable skill set of this position, as detailed below.

Discuss and begin planning CFHA-sponsored programs for training physicians in systems, collaboration, team work, and integrated care.

Create a policy-relevant summary of the rationale and evidence for integrated care in terms of outcomes and cost effectiveness. Consider putting together a long paper and a one-page summary to use with stakeholders and policymakers, and develop an aggressive advocacy program while health care reform is still being debated.

Continue the annual conference with additions described above.

Creating community: develop local, state, or regional chapters within CFHA. Develop the blog section in the website. Have a booth at the conference to advertise CFHA, with its short-term goals and demonstrate the website to get participants involved and increase membership.

We are interested in vetting these ideas with our membership. Responses?

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I'm an Optomist

Posted By Gene "Rusty" Kallenberg, Wednesday, September 16, 2009
Updated: Thursday, June 9, 2011

It seems that I have been caught up in a totally new life of late. I have been hijacked by the Collaborative Care Movement! I have actually been a fan and practitioner of this movement for the past 10 years or more. But for the last few months the ride has become exponential. I have been a participant in the following activities that are part of this new accelerated movement to integrate mental/behavioral health into Primary Care:

1 – Planning the Feb, 2009 Annual Meeting of the Association of Departments of Family Medicine – during which a major plenary was devoted to incorporating mental health care into the Patient-Centered Medical Home with a great Canadian faculty, Nick Kates, who related his 14 year experience of embedding psychiatrists in general practice offices in Ontario.

2 – Co-planning the Oct, 2009 Annual Meeting of the Collaborative Family Healthcare Association (CFHA) – which is wholly devoted to integrating mental/behavioral health into primary care.

3 – The above CFHA activity has also involved helping to organize the associated Statewide Summit on Integrating Primary Care and Mental Health/Substance Use Services for the State of California. There will likely be 60+ participants in this statewide Summit.

4 – In order to understand the content of the above Summit I became an advisory board participant to the Integration Policy Initiative – a collaborative effort of the California Institute for Mental Health, the California Primary Care Association and the Integrated Behavioral Health Project funded by The California Endowment. During this tutelage I learned so far is that there are over 50 pilot programs in collaborative care going on in California alone!

5 – At the 2008 CFHA meeting in Denver, I participated in early discussions about trying to establish the Collaborative Care Research Network (CCRN) – the brainchild of Rodger Kessler, Ben Miller and others – which will be used to assess the current state of the practice of collaborative care nationally and will be the vehicle by which the movement will generate the evidence for the benefits of collaborative care.

6 – The CCRN discussions ended up allowing me to – in a small way - participate in the planning for an AHRQ supported meeting to help flesh out and launch the CCRN scheduled for October.

7 – As a follow on to the ADFM meeting – and with much effort of key leaders in the US collaborative care movement – there has been a new interest in MH/BH + PC integration on the part of the Patient-Centered Primary Care Collaborative (PCPCC), which is the driving organization for the new emphasis on the Patient-Centered Medical Home in the health care reform effort. The PCPCC has led a series of 10+ national phone calls that have had as many as 40+ participants from as far away as England. This group of experts has greatly increased the PCPCC’s knowledge base and awareness of the importance of integrating MH/BH and Substance Use into the "whole person” fabric of the PCMH. This effort may ultimately have an impact on the NCQA designation of the critical elements needed for a PCMH.

Now, I am relating these personal experiences not to blow any horns - as my participation has been more of a student and learner than as a major conceptualizer of the future. But rather to indicate the veritable tsunami of effort, attention, participation, and beginning-growing influence on public policy that these efforts and others like them are having on health care dicsussions. The upcoming California Summit will be the 5th one in as many years in association with the CFHA Annual Meeting - Washington, Rhode Island, West Virginia and Colorado being the other four. The PCPCC and NCQA are certainly national organizations. And while mental or behavioral health does not feature prominently in the bills before Congress – the practice community who will carry out health care under the new policies is getting the message.

And in parallel with this very rewarding exposure to both state and national efforts, I have tried to bring home to our own local clinical setting what I see as the increasingly clear pathways to the future of collaborative care. These involve not only increasing the sophistication of our models of practice but also the new emphases on population management of mental/behavioral/substance issues in our patients and the practice-based research efforts that will serve to continuously improve the care we deliver and the outcomes we all seek. These efforts exactly parallel those we are now seeing applied to primary care and medicine in general, hence, we are in good conceptual company!

So I am optimistic about the futures – the future of collaborative care, the future of American medicine and the future of the health and wellbeing of our patients, clients, their families and communities…of our society. Life is getting ever more complex and stressful. If we can put the mind and the body back together again – we will be up for the challenge.

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Healthcare and Social Networking: The Case for Twitter

Posted By Gonzalo Bacigalupe, Monday, September 14, 2009
Updated: Wednesday, June 1, 2011

It's all the rage - you know or else you would likely not be looking at this blog right now. You see, social networking is one way to continue to ensure that our voices are heard. There has never, in my professional life, been an opportunity as timely as now, to take advantage of social networking and engage in the national dialogue on healthcare and health reform.

Harvard Business School posted a nice article outlining social networks. For the full article, CLICK HERE.

One of the points the author makes in this article is that online social networks are most useful when they address failures in the real world. Hmmm. Failure in the real world? You see the healthcare tie in now dontcha? As the IOM stated, "the health-care delivery system is incapable of meeting the present, let alone future needs of the American public". Ah, now you see where I am going.

We are all looking for solutions to the healthcare problem. We need more evidence, and we need an outlet. We need more stories, and we need an easy way to disseminate our information.

Let's start with Twitter. Twitter is like texting, but online - and (almost) anyone can see what you have said. In 140-character messages, Twitter allows users to get their message out there as often as they would like. Being a Twitter neophyte, I am new to much of the "Twitterease", but can tell you that tweeting can have great benefit to healthcare engagement. My Twitter name is not original or witty, but I knew once I heard about Twitter I had to at least check it out.

At first, Twitter was like an old college roommate you had not seen in some time. You were comfortable (read texting), but you weren't sure how your new life would interact with their new life (read everyone reading your "tweets"). You exchange anecdotes ("Del Mar is not a bad place for lunch"), but there is something dramatically unsatisfying about this. You want to go deeper, but you're not quite sure how or what to say.

Then it dawns on you, I am passionate about healthcare, I work in healthcare, I need to know what's happening in healthcare at all times, maybe I should tweet about healthcare (WARNING - actual tweets: "In all the #healthcare debate, we cannot forget about the inclusion of mental health in the patient centered medical home"). You learn the lingo (placing # before any word means that anyone searching for the word following # will see your tweet - try it by clicking on #healthcare above). You learn how to shorten lengthy links with great websites like THIS ONE so that your long website now fits within the 140 character limit. You learn who else is out there sharing information (you follow them). You learn about software that let's you keep track of who is saying what. Once you grasp the subtle concepts of Twitter, your posts evolve (What the public thinks of evidence-based #healthcare? http://bit.ly/4yCJFt & one answer to provide more #evidence: http://bit.ly/1bCAeR).

So, how does this all tie in to natioanl reform efforts? Well, I know that on Twitter, there are a ton of people, and very few of them are talking about collaborative care! I know that while not many people follow me, many people follow some of the people who follow me (you see the systems connectivity here?). I want to disseminate information on healthcare the fastest way possible. I see Twitter as one avenue for doing this.

#Intrigued? So am I!

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Time to Unite

Posted By Ben Miller, Friday, September 11, 2009
Updated: Wednesday, June 1, 2011

It appears that the infamous "Gang of Six" are emerging with a health reform bill sometime early next week (Senate Finance Committee). Will this Bill from the Senate side be more comprehensive? Offer a public option? Many speculate that this Bill may be the one that is most likely considered as a contender in the race for health reform. The Gang of Six is an anomaly of sorts. First, they are bipartisan, and have been from the beginning. Second, they are the Finance Committee. Let's construct these two points for a moment and consider their implications:

1) Collaboration and compromise: There is no doubt that this group had to simultaneously collaborate and compromise to get anything out the door let alone a complex Bill for health reform. Think of who is in this group (Enzi, Grassley, Snowe, Baucus, Bingamen, Conrad), there are some real political difference here. The take away is that there had to be some level of collaboration to get anything done. President Obama has tried to have bipartisan support for health reform, but this has not worked as well as he would like; however, this group may be the lone exception. Now there will be significant compromises here, but it is a product isn't it?

2) Finance Committee: Some of the most significant arguments for and against health reform have come down to money. As we all know, healthcare is expensive. As we all don't know, if we don't change healthcare (and fast) no one will be able to afford it (see HERE and HERE for examples). Oh, and most of us have read and seen Gawande's New Yorker article on cost by now (but if you haven't HERE). So cost (read financing) has everything to do with health reform hence the reason this coming from the people who talk about financing in government is important.

So, if a group of six individuals, representing different states, political ideologies, and interests can come together and deliver a product on health reform, why can't we? Why can't different professional associations sit at the same table and talk about reform? Why can't different disciplines collaborate around a united cause? Not to say this doesn't happen (CFHA as an outlier), but it should happen more!

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Contact Us

P. O. Box 23980,
Rochester, New York
14692-3980 USA
info@CFHA.net

What We Do

CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.