Open Access/CHCF Meeting

[Guest guest]

Last week I attended a conference by

California HealthCare Foundation on chronic disease management. One of the

topics was about Open Access and I got to see the challenges that larger

settings face when trying to reduce backlog and deal with varying mindsets of

the providers around the best way to schedule. Needless to say, I don’t

envy the people trying to pull this off in their large groups. In fact, not

only were there buy-in problems around the staff, I think there were even

conflicts of interest due to concepts like capitated payment plans.

There were some excellent lectures/discussions

around self-care. In this regard, there were some institutional advantages to larger

groups as they are fiscally better able to hire CDE’s and the like. However,

I think that for the motivated small office setting, not having all of the bureaucratic

red tape allows us to better offer these services vs. larger settings. As I

listened to the discussions and lectures on the varying topics, it became

apparent that any advantages of larger settings were offset by the bureaucratic

disadvantages. The larger settings might be fiscally better able to take risks

on new programs and they are probably better of when it comes to resources to

set these programs up, but I suspect the quality of these programs defined as

patient satisfaction and outcomes is less vs. smaller settings.

I think some of this is true around

setting action plans. These sorts of things require relatively close monitoring

and that is something a smaller setting is better at. It would be interesting

to compare action plan follow up in small vs. large settings.

Anyway, there was a lot of excitement at

this conference. Especially noticeable was the non-physician’s being

amazed that doctors attended this sort of conference and were participating in

chronic care.

Lowell