Healthcare Plan Only Covers Five Chronic Conditions

Plan fails to address Musculoskeletal diseases, which account for the largest portion of physical disabling Social Security Insurance (SSI) claims.

April 9, 2008

WAKE COUNTY NC NEWS -- Last week, Governor Easley unveiled his plan to fundamentally restructure the delivery of health care in North Carolina by standardizing the level of care and insurance coverage for five chronic conditions that can be controlled through preventive medical treatment; diabetes; asthma; hypertension; congestive heart failure; and heart attack. According to the Governor, this unique plan will do more than any other in the nation to improve citizens' health, help doctors deliver the quality care they strive for and save hundreds of millions of dollars in medical costs.

Although unique to North Carolina, the Governor's plan is not unique to the nation. Apparently, the Governor has not heard of Hawaii Health Performance Plan, which has already achieved the aforementioned goals and more. Hawaii's State Health Plan, explained in their 2002 State Health Policy Guidebook, is a comprehensive plan designed to use preventive health care to reduce healthcare costs and provide optimum healthcare for Hawaii's people.

For more than a year, the state's major health insurance providers, physicians and hospitals have been meeting under the Governor's leadership to design a set of ''best practice guidelines'' too more effectively treat these five chronic medical conditions, which account for 80 percent of health care spending. The ''Best-practice guidelines'' for care will be implemented for each of these diseases. These guidelines have been developed by experts in the state and the nation and agreed on by the state's medical care providers and insurance companies. The guidelines will be the same, no matter the health coverage for the patient, to ensure consistently high quality of care for all North Carolinians.

The Governor's plan, no doubt will improve North Carolina's deteriorating health care system, but it only focuses on five most chronic conditions. Meanwhile, the plan fails to address Musculoskeletal diseases, which account for the largest portion of physical disabling Social Security Insurance (SSI) claims. These crippling diseases such as Arthritis and Muscular Dystrophies (MD), weigh heavily on North Carolina's labor force causing the unnecessary loss of quality workers. In addition, these patients with musculoskeletal diseases substantially contributed to North Carolina ranking as the 8th highest SSI beneficiary state with more than 39,707 beneficiaries in 2006.

Furthermore, many forms of Arthritis, such as Rheumatoid Arthritis (RA), with the proper medical care can now be controlled enabling patients to lead productive lives, including employment. Therefore, if these patients could afford to receive the needed treatments, would continue in the workforce lowering North Carolina's number of SSI beneficiaries, which also would save millions of tax dollars.

During the Governor's announcement of the 'Best-practice guidelines'' initiative, Easley said:

"This is going to be a revolutionary approach to the delivery of health care in North Carolina. We have worked with the top medical experts across the state, health insurers and physicians to design a health care delivery system that fits the 21st century needs but also takes advantage of 21st century technology.

By putting modern systems in place, doctors will be better able to treat chronic diseases including: diabetes, asthma, and common heart problems. With more effective treatment, many patients will be able to avoid more serious and expensive medical problems.

By spending more time with patients, identifying medical problems before they get worse and treating these problems effectively, we will substantially reduce the cost of health care by keeping patients out of the emergency room and avoiding hospital stays. It will also result in very substantial health care cost savings, which can be used to provide more coverage for more citizens.''

National studies have found that most patients receive half the health care services recommended for their conditions. The plan's strategy is to get every doctor, no matter where they are, to make sure every patient receives the health care services they need, they can help patients stay more informed, know what they must do to stay healthy. Therefore, avoiding millions in health care costs as well as reduce lost workdays that cut productivity.

Further objectives of the indicative will be to mobilize North Carolina's Community Care networks of physicians and the Area Health Education Centers' physician training centers to provide the latest and most effective systems to doctors across the state, to assist them in delivering "best practice" care. Every primary care physician in North Carolina will be invited to participate in this program. While Medical professionals will receive tools for patient support, so patients can play a larger role in maintaining and improving their own health. Doctors will also receive specialized computer software that tracks individual patients, their conditions, medications, appointments and various test results. Additionally, the plan will develop and expand the availability of "care coordinators," individuals trained in the treatment of chronic diseases who will follow patients' progress, including help in taking appropriate medications, scheduling follow-up appointments, understanding the effect of diet and exercise and generally be available to answer patients' questions.

Crowning the Governor's plan, is a program that has been developed to monitor the goals set forth to improved health and reduced costs achieved through "best practice guidelines" initiative in North Carolina. So, hopefully the initiative should at least help curb health care costs in regards to the five chronic diseases, providing patients are willing to participate in preventive health care. As far as the rest of us fighting high medical treatment costs - we're still on our own.