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The Wright Side of Wrong April 30, 2008

Posted by Reginald Johnson in African-American, Election '08, Elections.
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What a strange web we weave…

Senator Barack Obama put his historic chance at becoming the next president of the United States before a long-term friendship. This time, after much soul searching, Obama broke with his former pastor, the Rev. Jeremiah A. Wright Jr. He’s trying to what he can to get away from the man.

Probably what was the last straw was Wright’s remarks over the weekend at the NAACP meeting in Detroit and his morning newsmaker at the National Press Club here in Washington. What should be interesting is the fact that during this same weekend Obama talked extensively about his plans as president. Almost no news agency, including the one that he gave his remarks to, gave him much airtime. Everyone has set their sights on the great J. Wright.

Obama strongly believes race should not be an issue in this campaign, but those who support him disagree. Here in the District, I hear people all the time saying, I am going to vote for Obama because he’s black. I’ve even heard his detractors say, “I won’t vot for him because of that reason.”

Many people believe that Rev. Wright doesn’t have Obama’s best interest at heart – that he is attacking his old friend for not standing beside him as he thought he should. Meybe he’s right. Maybe he’s not. Whatever the case, Obama is trying to rid himself of a heavy-weight problem.

After seeing/hearing Wright’s speech at the NAACP, in its entiriety, I have to say that I am not very pleased with his methods of getting his message out there. I’ve attended many black churches growing up and do not recail seeing any messenger of God putting the word out there in that way. It belittles it, if anything.

Obama finally said something, but is it just lip service? Is it, as Wright put it before, “…something a politican would say?” It’s a valid question considering he is a 20 year friend and spiritual advisor. Now I think you are teetering on believability in Barack’s case.

Many people in the democratic party – voters and politicans alike – are surprised at how much media attention this whole thing has brought. Hillary might be enjoying this. Some believe this is enough to give superdelegates pause. ‘I’m a little surprised at how much traction it is getting, and I do believe it is beginning to reflect negatively on Senator Obama’s campaign,’ said one democratic politician. ‘I think he’s handling it very well, but I think it’s almost impossible to make people feel comfortable about this.’”

Several black leaders are a little frustrated at Wright for undertaking a publicity tour in recent days that may have harmed the chance to elect the first black president. He’s putting himself ahead of the movement….or as Obama says, “Change.” With all of this noise going on he’s secured himself a place is pop culture history and maybe a few book deals. Wright didn’t really need to make as much of a show of this situation.

His antics at the NAACP meeting and the National Press Club only showed where his heart lied – in milking this for all it was worth. What really is disappointing is some of what he said is true (his remarks about the black church).

A number of African American church leaders expressed alarm that Wright claimed on Monday to speak for all black churches. Rev. Wright didn’t keep his eyes on the prize. Black religious leaders at the Howard University School of Divinity on Tuesday tried to talk to him about his antics; but Wright declined. Something that I found to be interesting was his remarks during this religious leaders meeting. A reporter tried to ask him to clearify exactly what he said the day before, he responded, ‘You heard what I said [Monday] morning,’ he told a reporter. ‘I just wish that the media would focus on more of what they are saying in there, because they are trying to make this about me and Barack.’”

He personally made this about him and Barack when he said, “If it’s God’s will that Sen. Obama becomes president, there is nothing that voters, or politicians or Man can do to prevent that.” Now what I thought when I heard that was, ‘If he’s not elected, then is then is something that God did not condone?’

All of this goes to what the Boston Globe said:

The Boston Globe: “The condemnation was a dramatic shift for Obama, who had tried to navigate a personal and political minefield: maintaining a relationship with the minister who brought him to Christianity, performed his wedding, and baptized his two daughters, while distancing himself from Wright’s most incendiary sermons and trying to quell a controversy that threatened to undermine Obama’s campaign’s focus on racial unity.”

Barack, this is more than a Sister Souljah moment. Get it together, because that sleek machine that is $42 million strong is starting to show kinks. Remember, Wright won’t simply fade away.

An Understanding of ‘Medical Homes’ April 30, 2008

Posted by Reginald Johnson in Healthcare, Life.
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The term “medical home” has recently become a hot topic, but has been in the lexicon for decades. The American Academy of Pediatrics is credited with coining the term back in 1967, although back then the concept was limited to creating one central location for all of a patient’s medical records.

Today, the concept embraces 21st century technology, melding it with a primary care delivery system, evidence based medicine and reform of primary care compensation.

The American Academy of Pediatrics defines the medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.

Deloitte Consulting, in their recently published paper The Medical Home: Disruptive Innovation for a New Primary Care Model, states a Medical Home “is not a house, hospital or other building. Rather, it is a term used to describe a health care model in which individuals use primary care practices as the basis for accessible, continuous, comprehensive and integrated care. The goal of the medical home is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.”

The following physician associations have been central advocates of the new Medical Home model:
• American Academy of Pediatrics
• American Academy of Family Practice
• American College of Physicians
• American Osteopathic Association

The Patient Centered Primary Care Collaborative is a coalition of more than 40 major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient-centered “medical home.” Various health plans are members of the coalition.
The Blue Cross Blue Shield Association has launched pilot demonstration medical home projects involving 27 of its member plans.

Bridges to Excellence (www.bridgestoexcellence.org) is a non-profit coalition-based organization created to encourage quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, and patient-centered care. BTE works with large employers, health plans, providers and has partnered with organizations including the Leapfrog Group and the National Business Coalition on Health.

Paul Keckley, PhD, Executive Director, and Howard Underwood, MD, Senior Fellow at the Deloitte Center for Health Solutions, in their paper The Medical Home: Disruptive Innovation for a New Primary Care Model, outline the following “Critical Features of the Medical Home”:

• Personal physician
• Physician-directed primary care professional organization
• “Whole person” orientation
• Primary care team is responsible for providing all of the patient’s health care needs.

This includes care for all stages of life:

• Monitored and integrated care using electronic medical records and personal health records
• Measured and managed adherence to evidence-based practices by the care team and the patient
• Evidence-based medicine and clinical decision-support tools guide decision making.
• Physicians in the practice accept accountability for continuous quality improvement
• Patients actively participate in decision-making
• Information technology is used to appropriately support optimal patient care.
• Patients and families participate in quality improvement activities at the practice level.
• Enhanced accessibility: care anywhere, anytime
• Emphasis on physician incentives for improvements in self-care management

The Joint Principles of the Patient-Centered Medical Home, issued by the AAFP, AAP, ACP and AOA state that payment structures should:

• reflect the value of physician and non-physician staff patient-centered care management work.
• pay for services associated with coordination of care both within a given practice.
• support adoption and use of health information technology for quality improvement;
• support provision of enhanced communication access such as secure e-mail;
• recognize the value of physician work associated with remote monitoring of clinical data.
• allow for separate fee-for-service payments for face-to-face visits.
• recognize case mix differences in the patient population being treated within the practice.
• allow physicians to reduce hospitalizations associated with physician-guided care management.
• allow for additional payments for achieving measurable and continuous quality improvements.

Bridges to Excellence has launched the BTE Medical Home Program, which rewards physicians that demonstrate they have adopted really qualifying systems and processes of care, and are using those systems to deliver positive results in the management of their patients – in particular patients with chronic conditions. Doctors can receive an annual bonus payment of $125 for each patient covered by a participating employer, with a suggested maximum yearly incentive of $100,000.

Beyond the historic concept of primary care physician coordinating the needs of member patients that have been promoted by HMOs, the current Medical Home model is much more far-reaching:

• the concept is ideally meant to be applied independent of a particular health plan such as an HMO, instead changing an entire practice.
• Dr. Paul Grundy, IBM’s director of health care technology and strategic initiatives, is quoted in a recent Business Insurance article discussing the new Patient-Centered Primary Care Collaborative that IBM helped found, stating that “the medical home does not serve as a gatekeeper but rather as a gateway to the health care system.”
• There are many more attributes attached to the current Medical Home model, many embracing new technology
• Medical Home initiatives are being advanced in particular with various state Medicaid and Children with Special Needs programs.

In summary – the medical home concept links primary care coordination with centralized electronic medical records and new concepts in evidence based medicine and standards of care. The medical home concept also advocates changes in primary care reimbursement that compensate doctors for care coordination and technology infrastructure, and or quality incentive compensation in addition to standard reimbursement.

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