Gov. Tom Corbett recently made two critical health-care proposals: 1) to expand health insurance coverage to more Pennsylvanians by using private insurance plans for families who otherwise would qualify for expanded Medicaid and 2) to offer more community-based primary care.
The expansion of high--quality primary care is a key element of the governor’s Healthy Pennsylvania plan. To ensure access to good care, the administration has engaged experts to develop better ways of delivering and paying for it, including the use of new technologies like telemedicine and electronic health records and direct funding for more services that can prevent unnecessary, costly health crises.
The timing is right to address both proposals. Massachusetts provides an excellent case study: In 2006, when the state expanded health insurance coverage, primary-care providers experienced an overwhelming demand for care. This required primary-care clinics and practices to consider more efficient methods.
Covering more lives with finite resources challenges a state to more efficiently deliver care and reduce the financial, mental and physical costs of unnecessary hospitalizations, emergency room visits, preventable illness and disability, and visits to multiple specialists.
What does more effective community care look like?
The Jewish Healthcare Foundation recently published “Putting the Prime in Primary Care,” which highlights some of the best national efforts to help patients lead lives that are as pain-free, productive and independent as possible. These “best practices” extend basic health care beyond the walls of a traditional medical practice to provide integrated care that addresses not only medical issues, but also behavioral, environmental and social issues that affect a patient’s ability to comply with treatment plans.
The best models prevent serious illness and disability by recognizing that health is greatly influenced by how and where people live, learn, work and play. Patients become partners in improving their own well-being, collaborating with a primary-care team that might include health educators, pharmacists, social workers, community coordinators, dietitians and exercise physiologists. Together, patients and clinicians identify behavioral, social and economic barriers to good health and create customized plans to break through them. At-risk patients get access to needed services and become better managers of their health so that they don’t end up in the hospital.
The Affordable Care Act seeks to forward this vision by endorsing preventive medicine tailored to particular communities and “accountable-care concepts,” which encourage providers to work together to improve health care quality and lower costs.
A recent report by the Institute of Medicine and the National Research Council found that, even though Americans spend twice as much per capita on health care as citizens of other affluent countries, we live shorter lives in poorer health.
Worse, the U.S. health disadvantage is widening. In Pennsylvania, improving health will mean addressing such non-clinical issues as the fact that one in five adults smoke, one in three is obese, one in four engages in no leisure-time physical activity, and even that half of our restaurants sell fast food.
Consider Warren Warwick, the subject of Atul Gawande’s famous New Yorker article, “The Bell Curve.” As a pediatrician treating cystic-fibrosis patients, Dr. Warwick achieved the best life--expectancy results in the nation. He has no secret remedy; he just views each patient as an individual and applies focus and invention to remove whatever obstacles stand in the way of patients doing what they need to do to manage their disease. Excellence, he believes, comes from doctors and nurses being attentive to each patient’s individual needs on a “wide angle” basis, including lifestyle choices, available support systems and physical environment. His medical team goes beyond traditional treatment guidelines by helping patients become diligent partners in managing their own health.
The savings — in lives, costs and hardship — easily justify the testing of new models for primary care.
Creative implementation of the commonwealth’s new improvement plan through local pilot projects would permit the evaluation of creative approaches. Pennsylvania could be a model for the nation as communities around the United States seek to provide better care, contain costs and reduce America’s health disadvantage.
Karen Wolk Feinstein is president and CEO of the Jewish Healthcare Foundation, where Robert Ferguson is a program manager.