Medicine and Its Objects Presents David Meltzer

Medicine and Its Objects presents…





 (Medicine and Economics)

to discuss


with opening comments by

Angelica Velazquillo Franco
(PhD Student, SSA)


Abstract: High health care costs and poor health outcomes in the US are concentrated in a small fraction of the population, many of whom have a history of recent hospitalization, and a disproportionate fraction of who are socioeconomically disadvantaged. The Comprehensive Care Physician (CCP) Program we have developed seeks to address the needs of this population by providing patients with the ability to receive care from the same physician in the inpatient and outpatient setting so that they can benefit from the advantages of continuity in the doctor patient relationship. Since 2012, we have developed and tested this model at the University of Chicago in a randomized controlled trial funded by the Center for Medicare and Medicaid Innovation, in which we have enrolled over 1,800 patients, of whom ~90% are African American, with a median income of ~$20,000 per year, and 1-year mortality rate of 15-20%. The results to date are striking with respe ct to patient experience, outcomes, and resource utilization. We think the efficacy of this model comes from the deep connection that our CCP doctors and teams develop with patients, understanding them as individuals and recognizing and beginning to address the deeper social determinants of their health.


Nevertheless, even as we have pushed the boundaries of traditional health care, for example, by great efforts from clinic staff to connect with patients and by establishing a home care program, we have seen the limits of traditional health care. Many of CCP patients still do not engage fully in care; 1/3 attend <2 clinic visits in the year after enrollment or miss more than 1/2 of scheduled visits. These patients who do not engage in the program cost  more per year and have worse outcomes than patients who do engage, with differences that grow over time. Thus, there may be great potential for savings and improved outcomes if we can learn how to better engage and serve these patients. Talking to patients in clinic, on the phone, visiting them in their homes and communities with the people in their lives, and discussing their needs with them more formally in focus groups, we have come to believe that to better serve them we need a greater presence in their daily lives to address challenges of life made more difficult by poverty, and to provide emotional, social, and spiritual support. Our proposed Comprehensive Care, Community and Culture Program (C4P) will build on the success of our CCP Program to address social determinants of health and better engage patients at high risk of hospitalization. We will provide C4P patients access to community health workers (CHWs) and to cultural and educational opportunities to help them solve critical challenges of daily life, and provide emotional, social, and spiritual support that can ameliorate social isolation to promote health and well-being.

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