Paradigm Shift

March 23, 2014, marks the 4th anniversary of the historic piece of federal legislation, the Patient Protection and Affordable Care Act (ACA).  January 10, 2014, the Centers for Medicare and Medicaid (CMS) and the state of Maryland partnered on a historic piece of healthcare regulation which allows the state to adopt new policies which will, in theory, reduce per-capita hospital expenditures and improve outcomes – goals of the ACA.

Many eyes are on Maryland, watching and waiting if the revision to Maryland’s already unique all-payer hospital rate regulation system will be successful. Success metrics include the generation of $330 million in Medicare savings over a five-year period; limits on all-payer per capita hospital cost of care and quality targets designed to promote better care and health for Maryland’s population. Inherent to the shaping of a historic shift in a payment model is the belief that many of Maryland’s healthcare stakeholders, a willingness that government can indeed “do good”. How did we get to this shift and when will we know if it’s working? We sat down with John M. Colmers, Health Services Cost Review Commission Chair, to find out.

The paradigm and face of healthcare delivery are changing. This issue’s cover photo features Jennifer Bepple, M.D., an urologist with Central Maryland Urology Associates, who was just a few weeks away from giving birth when we held our cover photo shoot. We spoke to her as part of our clinical feature on “the unmentionables”, incontinence and erectile dysfunction.  Your patients may be reluctant to speak with you about either disorder but open and frank discussion offers your patients options for diagnosis and treatment.

We also spotlight intestinal disorders in this issue: Crohn’s disease, colitis and celiac disease. I’ve been guiding one of my 20-something daughters through the journey of identifying which digestive disorder she’s been struggling with. The standard of care is diet compliance which is becoming less challenging with a new abundance of gluten-free offerings yet a number of clinical trials, new medications and better diagnostic tools, mean that life for patients with chronic digestive disease is greatly improving.

Mobile health (mHealth) is beginning to have a significant impact on shifting paradigm of delivery and how patients are managing their own health. The FDA has yet to set firm guidelines for the regulation of mHealth apps that function as medical devices but there are abundant apps available that engage your patients to better manage their chronic diseases. A personal search for managing celiac disease resulted in 46 different apps for a gluten-free life on my mobile phone. Of course the quality varies but the point is that patients are becoming empowered and engaged in managing their healthcare and that’s the heart of healthcare reform.

Jacquie Cohen Roth


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