Rendell launching an effort to battle chronic diseases

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Gov. Ed Rendell plans to move forward today on his statewide health proposal by creating a commission aimed at improving care for patients with diabetes and other chronic diseases.

While much of the governor's health plan, Prescription for Pennsylvania, requires action by the Legislature, Mr. Rendell is expected to sign an executive order to establish the commission.

He also plans to issue another executive order today related to the Office of Health Equity, a state Department of Health initiative to reduce health disparities among racial minorities and other groups.

The chronic care commission will focus initially on diabetes, building in part on another effort that created a new state diabetes action plan, said Ann Torregrossa, senior policy manager for the Governor's Office of Health Care Reform. Officials are expected to hold a news conference at the Capitol today to announce that plan.

Prescription for Pennsylvania contains a variety of proposals to expand access to health insurance, cut health care costs and improve quality. Officials consider better management of chronic illnesses a top priority in delivering better, more cost-effective care.

Ms. Torregrossa said about 75 percent of health care costs are incurred by about 25 percent of patients with chronic conditions like diabetes, asthma or congestive heart failure.

In 2005, $1.7 billion in hospital charges resulted from potentially avoidable hospitalizations because Pennsylvanians with chronic problems were not getting optimum care, she said. About $729 million of those charges involved diabetes.

The Rendell administration wants to implement a model approach to chronic care that provides patients with support and information to better manage their health. The commission would determine how the model should be implemented around the state.

Among other duties, the commission will work to create a Web-based registry that would give primary care physicians access to more complete data about their patients, Ms. Torregrossa said. The governor's budget proposes that $2 million be allocated to help create the registry, she said.

The commission is expected to propose payment system changes that would reward a team approach to chronic care, such as having nurses, nutritionists or other health professionals work more closely with doctors. It also will gather data to help measure provider performance.

In addition, it will seek to develop a statewide chronic care information system to provide a more accurate picture of the prevalence of those diseases and outcome data that can be used for planning and quality improvement.

Current health care payment practices pose a challenge to implementing widespread change, said Harold Miller, strategic initiatives consultant for the Pittsburgh Regional Health Initiative. Providers typically are paid more for giving additional treatment than for keeping patients well, he said.

And because payment systems "are so big and entrenched, it's hard to change them," he said.

While much more can be done to improve the quality of chronic care, a team approach to managing those diseases has not been widely adopted, said Dr. Donald Fischer, chief medical officer for Highmark, the region's largest health insurer.

Some area hospitals participate in a program that provides payment incentives for reducing preventable infections, Dr. Fischer said. But in general, he said, the payment system has some "perverse incentives."

"It's not an easy issue to solve," he said, noting Highmark is willing to explore options that could lead to better treatment for chronic disease.

The state diabetes plan calls for a number of initiatives, including efforts to collect and monitor data, work toward health policy changes and disseminate standards of care. A new group, the Pennsylvania Diabetes Action Partnership, plans to work with state health officials to develop and implement the plan.

"We need to get more services to people with diabetes," said Dr. Linda Siminerio, executive director of the University of Pittsburgh Diabetes Institute and co-chairwoman of the steering committee that helped to develop the plan. "There are still a lot of disparities in diabetes care."

A key need is to help people take better control of their health through measures such as changing their diets and exercise habits, Ms. Torregrossa said.

The executive order involving chronic care is the first of several the governor plans to issue as part of Prescription for Pennsylvania, officials said.

Others that will be announced over the next few months involve payment incentives to deliver high quality, cost-effective care; scope of practice issues for nurses or other health professionals; certain health care technologies, such as those that allow the sharing of electronic medical records across health systems; and capital investments made by health care centers in various regions of the state.


Joe Fahy can be reached at jfahy@post-gazette.com or 412-263-1722.


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