2010 Summer Marillac Clinic Director's Corner
Steve Hurd, PhD - Marillac Clinic Executive Director
Throughout the extended and heated debate on health care reform, several key elements were highlighted while other important aspects of reform received little attention. Having over 40 million people in our country without health insurance is not a statistic that makes us proud. I’d like to devote this part of the newsletter to discuss the health care challenges facing our country and our community.
ACCESS AND COST
Under the reform legislation, more people will become eligible for health insurance. This is good. However, having insurance (whether through public funding, an insurance exchange or an employer-sponsored plan) does not address two fundamental challenges. Will there be a suﬃcient number of providers to address the increased demand for health care? How will we prevent our costs from increasing at double-digit rates?
There are no simple solutions. The prominent physician and author, Atul Gawande, notes that our classiﬁcation system contains 16,000 diagnosable health conditions and over 6,000 procedures to address them. The challenge to deliver safe, high quality health care while controlling costs is indeed daunting.
Leaders throughout the country are actively discussing how to re-engineer the way we care for people. Fragmentation of our health care system raises costs. Our country’s inclination to treat disease rather than invest in prevention raises costs. Spending an exceptionally high percentage of our resources during the last year of life is being questioned.
Improved information technology has been emphasized as one solution. However, this does not reduce the burden on patients and their families to take time away from work or school to travel to a variety of settings and schedule several appointments to meet their health care needs. We place the burden of navigating an increasingly complex system on patients and their families.
STRENGTHENING PRIMARY CARE AND THE MEDICAL HOME
Historically, Mesa County has beneﬁtted from our high number of primary care providers who coordinate well with specialists. However, Mesa County is now impacted by the same shortage of primary care providers as other areas of the country.
If we aren’t able to improve access to primary care, many of our newly insured patients will seek treatment at the emergency room – further accelerating our cost spiral.
The federal legislation will encourage a higher percentage of medical school graduates to become primary care providers. However, the large inﬂux of people seeking care will occur before these providers enter the workforce.
Much discussion is occurring about the patient-centered medical home model as a way to address access and cost. In this model, health care providers form teams and address the person from a holistic view. New roles are being identiﬁed in the health care team. Care coordinators and patient navigators make outreach contacts to encourage patients to follow through with care plans. Marillac’s model of the medical home brings various types of primary care providers under one roof so that medical, mental health, oral health, vision care, eyeglasses and access to low cost medication can be addressed during a single extended visit. In our primary care model, psychosocial factors impacting health conditions are addressed as well as health conditions themselves.
With the full implementation of a health information exchange, smaller-sized private practices have the opportunity to create virtual medical homes that enable patients to receive the access to coordinated and comprehensive primary care.
CURRENT COMMUNITY EFFORTS
Leaders of Mesa County health care organizations are committed to having a health care system that works for all of us. This principle of collaboration is woven into our community’s culture. Several health care practices throughout the Valley are currently learning medical home concepts and implementing new processes to improve health outcomes.
Quality Health Network has accomplished much in our community to make health data available to a provider when a patient presents for treatment.
Many communities do not focus on the entire population. In several communities, providers compete to serve patients with ﬁnancial resources while ignoring those who are poor and vulnerable.
MARILLAC’S ROLE IN THE FUTURE
Our mission directs us to prioritize the poor and the vulnerable people living among us. Historically, the poor and the vulnerable were represented by the uninsured. After the implementation of state and federal legislation, many of our current patients will have access to Medicaid. Staﬀ are working hard with Rocky Mountain Health Plans and the State of Colorado to start serving the mental health and medical needs of patients with Medicaid.
One challenge to Marillac is that the reimbursement system does not support the model of care in a single extended visit. Medical and mental health providers working simultaneously with patients is not reimbursed; however, while seeing the same patient on diﬀerent days is reimbursable. Group medical visits, a model popular for many Marillac patients who have the same chronic disease, are not reimbursed within the traditional reimbursement model. Thus, Marillac will need to secure supplemental funding to provide the type of care our patients prefer.
YOUR ROLE IN HEALTH CARE
Current data suggest that our country spends approximately 40% of our health care resources on preventable illnesses. How often do we say to ourselves, “I know I shouldn’t be doing/eating this but….”
The University of Wisconsin recently published health statistics for every county in the country. This data is available on an interactive web site:
Evaluation occurred on four factors: Clinical Care, Health Behaviors, Physical Environment and Social and Economic Factors. Mesa County was compared with the other counties in Colorado. We can be proud that our county ranked #1 in Clinical Care. However, Mesa County ranked 41st in Health Behaviors. This means that many of us are making lifestyle decisions that negatively impact our health. The health care debate did include considerable discussion on personal responsibility. Much learning needs to occur regarding ways to encourage wise decision-making for ourselves and our loved ones.
All of us need to understand the important distinction between access to health and access to health care. The community needs a high level of engagement from employers, education, government and lay citizens to improve community health. When disease does occur, health care leaders need to take responsibility to provide eﬃcient and eﬀective care. As a community, we appreciate the interconnection of our lives, and that all of us are impacted by the health and well-being of each one of us.