Fixing a health care system besieged by “The Stealth Epidemic”
Chronic diseases like diabetes and congestive heart failure affect nearly 100 million Americans, and treatment of these illnesses consumes nearly 70 percent of all health care resources. Yet doctors are often unable to prevent needless suffering or even death, and these failures are threatening the viability of our entire health care system.
“The Stealth Epidemic,” Program Three in the four-part PBS series, Remaking American Medicine™…Health Care for the 21st Century, examines the chronic disease crisis by exploring groundbreaking efforts to transform fundamentally the physician-patient relationship. The program looks at the impact of chronic disease on health care systems in Los Angeles and rural Whatcom County in the state of Washington. “The Stealth Epidemic” airs on PBS Thursday, October 19 at 10 p.m. Eastern time/9 p.m. Central.
There are more than 21 million diagnosed diabetics in the U.S. and that number is growing dramatically, especially among younger people. In Los Angeles County, diabetes is threatening to overwhelm the public health care system. Emergency rooms are being swamped with patients who are unable to manage their diabetes. Their resulting complications include heart disease, kidney failure, blindness and amputations. Latinos and African Americans are especially vulnerable: one out of every two will develop diabetes in their lifetime.
“Diabetes is having a dramatic impact on our system, it’s becoming a bigger and bigger share of the work load of the medical care system. There is almost no place that is not having to take this epidemic of diabetes very seriously. I worry for the financial survival of those systems, particularly safety-net systems,” says Dr. Ed Wagner, a physician, epidemiologist and internationally recognized expert on care systems for chronic illness.
Dr. Anne Peters, one of the nation’s top diabetologists, has made it her mission to help her patients manage their diabetes. Dr. Peters has a clinic in Beverly Hills where she treats some of Hollywood’s top entertainers and producers. But she also has created a clinic for the uninsured in East LA, a predominately Latino area, where she cares for some of LA’s poorest residents. Her strategy in both clinics is identical: help patients take control of their diabetes. “If people don’t take responsibility for their own treatment, they’re not going to get better. I’m basically embarking on a partnership with patients,” says Dr. Peters.
Nurses and diabetes educators play a key role in both of Dr. Peters’ clinics. “The problem is primary care physicians don’t have time to help their diabetic patients understand how to manage the disease. I have a whole team that’s on their side. And so people don’t have to take the whole responsibility. It’s a shared responsibility. And that’s what works.”
Dr. Jeffrey Guterman, medical director of the LA County Department of Health Services, sees Dr. Peters’ methods as a way of saving the county’s nearly bankrupt public health system. Says Guterman, “There is a national crisis with care for the uninsured, and it shouldn’t surprise anybody that Los Angeles is at the leading edge of that crisis.”
Dr. Guterman is adopting Dr. Peters’ disease management model throughout the county, hiring teams of nurses and creating new diabetes clinics. “We’re seeking to change the focus from rescue treatment to preventive care. This is a fundamental change in health care delivery,” says Dr. Guterman. Early data shows the program is already reducing hospitalizations and ER visits due to diabetes complications.
Like Guterman, Dr. Peters knows the stakes are very high. “We hope to take basically a city that is facing an epidemic and at least make it a city that’s dealing with the epidemic.”
The second half of “The Stealth Epidemic” was filmed in Whatcom County, a rural community of 170,000 residents tucked into the northwest corner of Washington state. Just as in LA, Whatcom’s health care system is being overwhelmed by patients with chronic diseases. But the major challenge facing these patients is to coordinate their own care among a variety of providers.
Among those profiled is Rebecca Bryson, 45, who is being treated by more than 12 doctors for a range of chronic conditions. Her life is consumed by illness and the added burden of coordinating her own care.
“The fear of not knowing whether or not the doctor who is treating me knows all my diagnoses is overwhelming. There were medication errors all the time because of that lack of communication. I got drugs that I shouldn’t have gotten. I got drugs that I’m allergic to. It was just too much,” says Bryson.
Concerned about how patients with chronic diseases were getting lost in the gaps between providers, health care leaders in Whatcom County joined together in an unprecedented effort to create a fully integrated system of care. They developed a number of innovative solutions. One was to hire nurses to work on behalf of the entire community. Called Clinical Care Specialists, these nurses help patients who are struggling the most with their chronic diseases. “I’ve had a number of times where I would have died without the intervention of my Clinical Care Specialist,” says Bryson.
Whatcom leaders also realized patients need to have control over their own health information. So they developed the “Shared Care Plan,” a personal health record that allows patients to track their medications, health care providers and current and previous medical conditions.
But just like LA, Whatcom County struggles with finding the resources to continue these programs. “In our health care system, reimbursements are for the care of very sick people, the care of complications. Not for the efforts to prevent those complications,” says Dr. Ed Wagner.
Looking for a long-term solution, Whatcom County health care leaders approached Representative Rick Larsen of Washington state’s Second District for federal support.
“We’re trying to find a model that actually pays to make people healthier, rather than just get the services of health care. If we are going to try to save money in the health care system in the future, that is really the kind of model we need to move to,” said Larsen, who was able to secure funds to keep the program running another two years.
“The Stealth Epidemic” was produced, written and directed by Matthew Eisen.
Crosskeys Media®, producers of Remaking American Medicine™…Health Care for the 21st Century, is a group of highly accomplished filmmakers with a long history of creating award-winning theatrical films, television programs, documentaries and non-broadcast videos. Frank Christopher is Executive Producer and Matthew Eisen is Co-Executive Producer. Peabody and Emmy Award-winning journalist John Hockenberry serves as series host.
Funding for Remaking American Medicine was made available by lead sponsor, the Amgen Foundation, with major underwriting from The Robert Wood Johnson Foundation®. Additional funding was provided by the Nathan Cummings Foundation.