Healthcare Innovation Leader, Dr. Jack Lord Provides an Insurer's Perspective (Continued)
Healthcare Reform and Delivery
Hannah: Are there particular groups of diabetes patients that will do particularly well with the Affordable Care Act, and others that will be at a disadvantage?
Dr. Lord: I think that it's too early to tell. Clearly the most important benefit is that people will have access to health insurance through this mechanism. What should a patient do? Patients and clinicians need to work as partners. They need to focus on managing their care the best that they can and utilize a couple of new technologies and therapies that are available to get to the best clinical state in their life and stay on that track.
Hannah: Could healthcare reform result in worse quality of care for those with coverage?
Dr. Lord: I think the thing to worry about is that there will be fewer options for care. On the flip side, there will be more places that people can turn to for benefits, particularly those who haven't had benefits before. At the end of the day, I think this is going to be a movement toward the middle where people who had great coverage and great care will probably have a higher likelihood of experiencing some loss and people who haven't had great care or haven't had access to coverage will reap some benefits.
Hannah: What are your thoughts on measures designed to reduce healthcare costs, such as competitive bidding?
Dr. Lord: I think that those are probably strategies that nibble at the edge. At the core, we need to do more than just study more aggressively the therapy's true medical economics. The solution probably lies in engaging patients in their care. I think that when patients are fully engaged, they'll take us down the pathways of the most cost-effective model. I think that when the system insulates patients, either because doctors are making decisions for them or because third parties are paying for things, we'll continue to have a challenge in place.
Reimbursement for Diabetes Technology
Hannah: How do you think we can bring CGM, or in the future, the artificial pancreas, to all diabetes patients who would benefit from the technology?
Dr. Lord: It seems like there are three pathways for the funds of technology related to diabetes care. One is greater education and engagement of practitioners, and that includes general practitioners as well as specialists.Second, we need database information that shows that technologies are actually more effective from the standpoint of both clinical outcomes and medical economics. So the fact that people have better control through the use of new technologies like CGM – hypoglycemic events and emergency-room visits happen much less frequently – supports the fact that patient care costs are lower and outcomes are better. The third is just general education and awareness on the part of patients in terms of their own levels of comfort and experience. One of the things that I always like to point to about the UK is that they've created a level of individuals called expert patients who have quite a bit of experience in managing their disease; they're almost master patients. They help newly diagnosed patients begin to learn how to manage their disease and manage the activities of daily living. We really need to have people who started to use things like CGM help teach people who are just getting started with diabetes some of the best practices in the field.
Kira: How do you foster that type of communication?
Dr. Lord: We're seeing an obvious explosion of social media. I believe that it's important to get information and engagement, to create mechanisms for people to talk with each other and learn from each other. That is one of the great things about your publications. One of the things that both providers and regulators have just not done is gotten their heads around trusting patients. My bias is that most of us as individuals know more about our life, our bodies, and our preferences.. Clinicians may have an expertise with a particular disease. Quite frankly, we need both to work in concert to derive the best outcomes.
Hannah: Can you talk about what role you see social media playing in empowering patients, and how well social media is currently filling this role?
Dr. Lord: The old model of having to go to the doctor's office, sit in the doctor's office, wait, see a physician for a few minutes, and then maybe see a nurse or other practitioner, is subject to all sorts of changes. We have the ability to deliver information and connect people in many different ways. I think that we need to help foster the creation of a new environment where patients who have been really successful in managing their disease help others. I think that social media in healthcare is behind social media in other sectors. We need to discuss how to give people new freedom to share, learn, and manage together.
Hannah: What eHealth or mHealth tools should be held up as models?
Dr. Lord: There are some websites that have done really great work helping patients find each other, connect, and understand the best practices. Dexcom provides some tools for use with the CGM to help people keep track of their disease. We need to continue to high- light in publications like yours those tools that really seem to be helpful for people; and we need to listen to patients themselves. We need to let patients be some of our guides in what works and what doesn't work.
Hannah: Thank you for being so generous with your time and insight.
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