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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

If the knee bone is connected to the thigh bone, then why doesn't your primary care doctor know what your orthopedist is doing? One of the problems with American health care today is that it's uncoordinated. And one of the promises made by advocates of health care reform is that in a new system, doctors and hospitals would do a little more communicating.

NPR's Joanne Silberner reports on why most people's health care is disjointed now and how it might come together in the future.

JOANNE SILBERNER: Get a bunch of health policy strategists together and you'll hear the phrase a lot: coordinated care.

Ann O'Malley with the Center for Studying Health System Change.

Dr. ANN O'MALLEY (Center for Studying Health System Change): Coordinated care refers to the integration of health care across all of a patient's needs, conditions, the different clinicians that person sees and the different settings where the patient receives care.

SILBERNER: Seventy-six-year-old Ben Bart(ph) knows what coordinated care means. He's a retired electronics engineer. He likes systems and he likes Kaiser Permanente, where all the doctors and nurses work together and share a computer system. Bart has diabetes, which can cause eye problems, so his primary care doctor sent him to a Kaiser ophthalmologist.

Mr. BEN BART: He sat down, looked at the computer and immediately he had my entire history, as far as the diabetes is concerned and to what degree I had - I am bothered by it.

SILBERNER: Bart doesn't have to labor through his medical history every time he sees a different specialist.

At the Geisinger clinic in Pennsylvania, Connie Guinger's(ph) doctor does the work of some specialists. She doesn't have to go to the hospital for a blood test or a Pap smear.

In a more limited approach to coordinated care, there's disease management programs where if, say, you have diabetes, you see a nutritionist and an educator and a doctor, who all work together. Patients and policymakers love coordinated care. Why isn't there more of it?

Alan Garber, who directs the Center for Health Policy at Stanford University, says it's money.

Dr. ALAN GARBER (Director, Center for Health Policy, Stanford University): The biggest obstacle to establishing coordinated care in routine clinical settings in the U.S. is not so much that doctors and hospitals aren't organized to provide it, although that is certainly a factor, but that very often they have no financial incentive to do so.

SILBERNER: Most doctors don't get paid for talking to one another or to you. They don't get paid for tracking down an X-ray or a biopsy result. They do get paid for doing new ones.

Whether coordinated care would save money is unclear. A recent analysis of 15 Medicare projects showed no significant reductions in hospitalizations, no net savings and little improvement in quality.

But studies of people with congestive heart failure treated by a team, show better care and a 30 percent reduction in costs. Proponents of coordinated care say it's a matter of designing the right kind of program. The current Senate and House health overhaul bills address care coordination obliquely. They would add money for more Medicare pilot programs.

Analyst Ann O'Malley hopes they'd show better results.

Dr. O'MALLEY: So that the left hand knows what the right hand's doing. So that providers are communicating with each other and most importantly with patients, and so that we're not doing unnecessary things to patients or duplicate testing and that we can avoid unnecessary hospitalizations by better primary care.

SILBERNER: If these pilots work, it could prove to private insurance companies that coordinated care is worth the effort. In fact, some are already trying it. And Stanford's Alan Garber says that plans for a central exchange to buy health insurance could promote coordinated care.

Dr. GARBER: If care coordination works as well as we think it does, it will certainly be higher quality and lower cost.

SILBERNER: And people who go to the exchange to buy their insurance would be able to see the effects in the grades that the plans get, and shop for those that will give them a doctor who makes sure they get the care they need: no more and no less.

Joanne Silberner, NPR News.

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