In need of more data and other letters

Regarding your recent cover story on medical homes “Finding their way home,” Oct. 7, p. 6), it's fascinating to see the divergence of findings. A major Blues plan is moving ahead with wider implementation of medical homes, based on its calculation of savings, while other studies show little or no savings. One of the frustrations is that we have no formal definition of a health home, either in terms of the staff and other resources that are committed, or the specific services delivered. There is no standard way of budgeting for such homes, and no way of comparing their results in a credible manner. In addition, there's the question of establishing a baseline for known and projected claims costs; notoriously, current or recent experience is not a good guide for future costs, since many acute episodes are not repeated at all, or are not regularly repeated. When these kinds of variables and definitions are in hand and paired with good claims data, we'll have much more to go on.

Robert Moore,

Regarding the story on launch of the health insurance exchanges (“Health law glitches: fatal or fleeting?” ModernHealthcare.com, Oct. 8), anytime someone is involved in such an extensive program, the expectations are that they will time the introduction to make sure there are no major problems and there is no bad press. If there are glitches, there is no doubt the program will lose believers and add to the skeptical base. There have been three years, and all the money needed, to put a process and system in place and we still find ourselves unserved and even more skeptical than at the beginning. Since this is a government program, we have to wonder how large the losses are already in trying to get it off the ground.

William Bennett,