The Silent ADHD Stimulant Non-Responder: A Case For Eliminating Managed

Good question. This is a case currently in progress. Sam’s primary care provider has referred Sam to Dr. Alex Golbin, known to most readers of this medical journal as a preeminent expert in sleep and behavior. Dr. Golbin is currently conducting a comprehensive assessment upon Sam and his results and comments will be published in the next installment of this column. Whether Sam’s silent non-response as detected vis a vis QbTesting is significant might well be addressed by the results of Dr. Golbin’s assessment. Is Sam’s silent non-response an anomaly that can be ignored? Or is it a cause for a revision to his treatment plan? Stay tuned to this column. The answers may surprise us all.

In summary, Sam behaves as we would expect a child with ADHD to behave. He behaves better in response to a common, frontline ADHD medication. Why not proceed with treatment, assume ADHD empirically and move on? The net effect of managed care in recent years would in all other cases force this sort of thinking and assure this result. But is this to be a good medicine? Or a waste of Sam’s
development, physician time and expensive medication? If the results of this case study in progress point to the former, fine. But if to the latter, would not managed care’s interference be properly characterized as disruptive and the cause of waste? If so, eliminating managed care in this case and possibly many others like it would result in better medicine at 20% lower cost (managed care’s average cost burden on healthcare).

Finally, the Verist system has performed well at several levels of cost effectiveness, efficiency and quality. It has united the primary care physician, a highly skilled specialist, mom, dad, two teachers and a school nurse into a closely-knit safety net for Sam leading to:

  • Safety: Sam is surrounded by more focused resources than ever before possible.
  • Transparency: knowledge is shared and information flows freely in a secure, yet transparent virtual space.
  • Cooperation:cooperation between primary care and a sleep and behavior specialist is enabled because of patient need despite the typical interference of managed care that divides and fragments care.
  • Decision making is evidence-based: the evidence includes an impressive digital behavioral rating profile from 5 separate respondents instantly accessible in meaningful, pre-set graphic formats.
  • Sam’s needs are anticipated: it may be that Sam’s case of silent non-response evolves to demonstrate a durable, safe and effective response to stimulants. The QbTesting results may become an unexplained anomaly. On the other hand, closer scrutiny now may lead to avoiding a crisis later. Our goal is anticipatory rather than reactionary.
  • Waste is eliminated: time typically wasted in gathering behavioral data is eliminated. Since the physicians have better data faster and in far more usable, at-a-glance comparative graphs, much less of their time is required and is solely focused to matters that truly demand their expertise.

Thank you for your time in reading this column. The author is quite serious about eliminating managed care by competitive application of traditional, proven process management techniques and measurable aspects of cost and quality under the active, professional guidance of physician leaders. Please send comments to: jtaylor@veristmedical.com.