With all the changes in medicine, we sometimes forget the human toll of todays healthcare system. The lack of coordination and communication endemic steals peoples quality of life, not to mention money from their pocketbook. In the past, Ive written about the physician-entrepreneurs who are reinventing healthcare delivery. In particular, they are addressing the Hot Spotters that consume the majority of our healthcare dollars.
One of the physicians mentioned in the original New Yorker Hot Spotters article is Rushika Fernandopulle. His organization, Iora Health, is the living embodiment of the old adage an ounce of prevention is worth a pound of cure in the way they have reinvented primary care.
The payoff has been significant for their patients. The individual described in the story (Maria) was costing her Union Trust dearly. A key reason the union teamed up with Iora was saving money meant they could cover more people and actually give them raises since there is a direct tradeoff between wages and benefits. The union has looked in the eye of thehealthcare cost beastand vanquished it.
Rushika described his patient as playing Russian Roulette with the uncoordinated care she was receiving in his account below. He also highlighted how old approaches fell short. One of the impressive things about Iora Health is they have such a cost effective model, its being offered on a private-pay basis to immigrants not addressed by the Affordable Care Act. Clearly, if its affordable for a low-income immigrant, this is a model that can scale anywhere. [See Nobel Prize Winner Sets Sights on Fixing U.S. Healthcarefor more.]
Rushika Fernandopulle, MD: A few months ago I had the pleasure of caring for Maria, a 68 year old woman from Central America who still worked as a room attendant in a Las Vegas casino. She came to us directly from the hospital, where she had been admitted a week earlier for a fainting episode. She was lethargic and glassy eyed, disheveled and was pushed in a wheelchair by one of her daughters. She was on 27 different medicines prescribed by 11 different doctors, who obviously never communicated with each other. She was, for instance, on 7 different anti-hypertensive drugs, including 2 different doses of the same one, lisinopril.
I asked her daughter how on earth she was able to give her mother so many medicines- and she sheepishly admitted- Well doctor, I actually didnt give her all of them because I thought it was too many. She was right- that many meds would kill a horse.
So what did you do? I asked.
I let God decide, she replied. Each day Id say a prayer, and then reach into the bag and pull out 5 medicines. So on a day when she got one diabetes med, one anti-seizure med, and one or two anti hypertensive meds, her mom did fine, but on the day God wasnt paying attention and she pulled out 4 or 5 blood pressure pills- bam- fainting spell and to the hospital.
It took us about 2 hours that day to get old records, make a number of calls, and figure out what was really going on. I literally threw away 20 of her 27 medicines, told her to stop seeing 10 of the 11 doctors she was going to, and had our health coach spend another hour with the family explaining their conditions and what was needed to be done. We worked over the next few months on titrating her diabetes and blood pressure medicines, and got her on a healthier diet. I saw her last week- she walked in with a new hairstyle and makeup and had a twinkle in her eye. Her blood pressure and sugar were fine, and she felt great.
This story may be a bit extreme, but the basic outline is all too familiar. Patients too often are led to think the way to get good quality health care is to see a number of specialists for each organ system- a cardiologist to manage their hypertension, a pulmonologist to manage their asthma, a GI doc for their reflux, and so on. Unfortunately, as in this case, these docs usually only communicate by sending letters to a primary care doc who is often the most out of the loop, and so you end up with awful outcomes like Maria.
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