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My way

Practical Commissioning's blogger, Dr Peter Weaving shares some HMO nuggets from his recent US trip

I'm still reminiscing about Kaiser and California. What practical lessons do I want to implement this side of the pond? How can I prove to you and your fellow tax-payers that it makes sense to send my friends and me to the Golden State and visit a health care facility on Hollywood Boulevard?

The messages I want to turn into policy and practice range from minor changes in my own general practice through locality-wide changes in population screening to the abolition of the internal market in the NHS. So nothing too controversial!

Seriously, some nuggets from the home of the most successful health maintenance organisation:

• Case managing frequent flyers (patients at risk of re-admission) does not work and wastes resources.

• Visiting patients at home within one week of discharge does work and reduces their re-admission rate; mainly through effective medication 'reconciliation'

• If 80% of one's lifetime healthcare costs are incurred in the last three months of life a more holistic palliative care approach would be kinder.

• Prevention is better and cheaper, than cure. Screen aggressively for conditions that are expensive downstream – everything from colon cancer and chlamydia cases to risk of femoral fractures in frail folk.

• Integrate everything in healthcare – own the whole show from the specialist and his hospital to the GP and his clinic – and have them all signed up to the philosophy, and payment system, that incentivises them not to do more but do what is right for the patient.

The bottom line from Kaiser is that if you can't measure it you can't improve it and they've proved the benefits of these approaches in terms of better health outcomes and cost effectiveness.