Social support important in health—and not just in big cities, and other letters

Regarding the Feb. 3 cover story, “Getting to the root of the problem”, the principles and approaches for a patient-care model that include social support service linkage are as applicable in a community hospital as they are in a large city such as Chicago. In Niagara Falls, the most economically challenged small city in all of New York, we have taken the concept a step further by placing outpatient behavioral health, primary care and social service providers under one roof in our new Niagara Wellness Connection Center.

The center is the one of several grant-funded initiatives we have undertaken in the past year to create linkages that break down the barriers to care, especially for the economically disadvantaged and medically underserved. In addition to improving access to care, these efforts have saved Medicaid, Medicare and regional health plans a documented $2.4 million.

Patrick Bradley

Regarding the online story “Hospitals need to address root causes of violence, experts say”, I can think of no more inefficient use of trauma surgeons' skills than to expect them to use their spare time to solve our social-inequity problems, rather than expecting government and the justice system—as well as social pressure—to do the job. This trend of piling all fixes on doctors' shoulders (tobacco cessation, diet education, home safety, violence mitigation) is as ridiculous and unfair as expecting teachers to teach through or fix hunger in their classrooms.

Dr. Rebecca Jones

In an environment of yearly increases in healthcare costs, the fact that close to 50% of accountable care organizations have slowed the cost of care is promising. (“Providers net uneven results from ACO experiment.”) Most of the ACOs also are improving the quality of care, which should produce greater savings in years to come. It is a total revolution to engage in population management and for physicians to have the ability to access cost-of-care data and make appropriate interventions. It will bend the ascending curve of Medicare expenditures if enough physicians commit to providing adequate, team-based case management to their high-risk, high-cost patients. In our ACO, we are making good progress, improving care while decreasing costs.

Dr. Jose Pena

Regarding the recent editorial “Protect my privacy, but share my data”, another path forward is to encourage patients to donate the data that they can obtain from their healthcare providers into repositories that lie beyond the reach of the Health Insurance Portability and Accountability Act. Use of such a repository (essentially a special-purpose personal health record) can allow individual users to fine-tune sharing and de-identification preferences according to their personal wishes. This may be preferable in many respects to the wholesale de-identification of health data required under HIPAA; the more identifying information is stripped from a patient record, the less useful the record may be for clinical research and as a potential source of insight.

Two surveys fielded in 2012, one by Consumer Reports and one by Patients Like Me, showed near-universal support for open sharing of health data among social media users, but the broader population would likely be interested in the ability to mask some identifiers.