This case conference proved to be magical for the family. Raymond Rupert of RCM Health Consultancy was the facilitator. The 3 specialists were able to explain their viewpoints in plain English. The 3 specialists agreed on a neurosurgical procedure for the patient.

The logic and rationale were explained to the family for the first time. The family was able to understand the implications of the surgery including possible side effects and complications but also to understand the possible benefits. Emphasis on possible.

The team at RCM Health Consultancy is committed to organizing case conferences for our clients in order to give patients and their families the opportunity to contribute to the narrative, to understand the basis for decision making and for RCM to advocate for our client’s rights to access appropriate care.

Raymond Rupert patient advocate & healthcare consultant.

info@rcmhealthconsultancy.com

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A small number of patients consume a large proportion of the total national health care budget.¹ 

These medically and socially complex patients have been the target of efforts by health systems and insurers to bend the cost curve of increasing health care expenditures.

To date, care management programs designed to address needs and reduce hospitalizations or disease progression in medically complex patients have shown only modest success.

This cohort study was conducted within Kaiser Permanente Northern California (KPNC), an integrated care delivery system with 4.2 million members. KPNC provides care to a population insured through employer-based plans, Medicare, Medicaid, and the California health insurance exchange.

Members are highly representative of the local populations.¹⁴ KPNC uses a single electronic health record for all inpatient and outpatient care, including all pharmacy orders and prescriptions dispensed. 

The findings of the study suggest that a single care model may not meet the needs of adults with high comorbidity and care utilization.

Highly medically complex patient populations may be categorized into distinct patient profiles that are amenable to varying strategies for resource allocation and coordinated care interventions.

Source:

JAMA Netw Open. 2020;3(12):e2029068. doi:10.1001/jamanetworkopen.2020.29068

Richard W. Grant, MD, et al.

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This 14 year old client is very complex. She has problems covering several medical disciplines. These include: neurology, endocrinology, cardiology, gastroenterology and psychiatry.

We were informed by a recognized medical doctor at the large children’s hospital that their job is to only focus on their discipline and to get her out. The doctor stated that it was her job to focus on only her specialty and that was it.

This was a stunning example of failure to integrate. Why would a large children’s hospital with all of these disciplines with highly trained medical doctors not create an integrated team to address this very complex client?

The only way to address this level of complexity is with an integrated team.

This is certainly a failure to recognize complexity and a failure to respond appropriately with an integrated team. Why would this be so obvious to the team at RCM Health Consultancy when it is not obvious to these very highly trained medical specialists.

I will apologize to the family for the failure of my brothers and sisters in healthcare to act appropriately in addressing complexity with an integrated team approach.

Raymond Rupert patient advocate and healthcare consultant.

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