Conversations

What are the biggest challenges and opportunities when it comes to improving patient health?

Contributors Respond

Crawford Clay

Crawford Clay

Patient Advocacy Coord., Colon Cancer Alliance

Read Crawford Clay's bio

Read Crawford Clay's bio

Nine years ago, I was diagnosed with colon cancer, and what followed was one of the most physically and psychologically challenging experiences of my life.

Surviving a health crisis like colon cancer is a complicated, daunting challenge. As with any cancer, it is as much of a mental challenge as a physical disease. I remember my radiation therapist telling me he thought more people died of despair than of the disease. I committed myself to beating the disease for my kids’ sake. Luckily, I did, but it was an incredibly difficult journey.

Unfortunately, my story as a colon cancer survivor is far from unique. Colon cancer is the second-leading cause of cancer-related death in the United States, and more than 140,000 people will be diagnosed with the disease this year. As with many other issues of chronic disease, preventative care is crucial. For people with average risk factors, that means a colonoscopy at age 50 with follow-up visits every 10 years after that. Those with a first-degree relative like a parent or sibling that have colon cancer are two to three times more at risk than the average person.

But diagnosis doesn’t have to be a death sentence. Early detection is key to staging a successful fight against the disease – there is a 90 percent, five+ year survival rate if it is detected at an early stage. Unfortunately, most instances of colon cancer are not detected early enough. Improving access to potentially life-saving cancer screenings for colon and other forms of the disease, and continuing to raise awareness about the risk factors needs to be a top public health priority.

Adam Gilden Tsai

Adam Gilden Tsai

The Obesity Society, Advocacy Chair, MD, MSCE, FACP

Read Adam Gilden Tsai's bio

Read Adam Gilden Tsai's bio 

A major challenge in improving care for patients is ensuring consistent, high-quality care across the healthcare environment. In general, patients are more likely to receive the best care in integrated health systems, where members of the care team work together to ensure the patient’s medical history, medications and prior tests are a part of patient care. This team-oriented environment helps reduce the waste and confusion that often coincides with the silos familiar to our current healthcare environment.

The Affordable Care Act provides incentives for providers and payers to form integrated systems, such as Accountable Care Organizations (ACOs). The ACO model for healthcare delivery is a network of providers and hospitals that shares responsibility for improving patient health. Kaiser Permanente and the Veteran’s Administration (VA) Health System are taking the lead in establishing these systems. Both are prime examples of coordinating medical care with a focus on the long-term, and thus providing an environment where clinicians can focus on keeping patients healthy without facing pressures of over- or under-treating.

When more patients receive care in integrated systems, there will be greater incentives for those systems to deal systematically with health issues that affect large numbers of patients – for example, obesity.

Obesity is an important population health issue, affecting more than one-in-three American adults, and treatment is not consistently reimbursed in many settings. However, in the case of an integrated system, patients can have access to treatment by a team of healthcare professionals, which is often necessary for this complex condition. For obesity, access to a nutritionist, a psychologist and a weight-loss physician can mean the difference between success and failure.  And more, a five to ten percent weight loss alone can have significant benefits for a patient’s overall health, and the cost of future treatment.