The Comprehensive Primary Care Initiative

I was reading about a provision of the Affordable Care Act (ACA) called the Comprehensive Primary Care Initiative that, among other things, provides funding for Care Coordinators and other incentives to do team-based approaches to delivering healthcare.  One of the main goals is to free the physician from a fee-for-service model to enable them to do a better job of chronic disease management.

Needless to say, I’m very pleased that the ACA is trying to impact a very difficult and costly area of patient care.  I’m also proud to say that Casa de Salud has already been taking this approach for almost two years.  We have an RN Care Coordinator in place who can reach out to patients before, during and after appointments, which improves show rates and compliance.  Her work also affects outcomes, because she can track how a patient is doing over the course of our interventions (whether in our clinic, at a partner organization, through our Home Visits Program, or a combination of the three).  If a particular indicator (maybe an A1C level for a diabetic patient) is going in the wrong direction, the Care Coordinator can reach out to speak with the patient, try to understand what is going on, and take the appropriate action.  We also offer diabetes education free of charge to all of our patients, another aspect of care promoted by the ACA.

We have seen the impact generated by this form of care.  Patients who had highly elevated A1C levels are now at or near normal. Many who were struggling to make lifestyle changes are now implementing them and seeing reduced weight and blood pressure.  Most importantly, our intervention is supporting the patients’ own desire to control their illness and get better.  And all of this achieves significant cost reduction, both for the patient and for the healthcare system itself, which means savings for all of us as the expense of uncompensated care is reduced.

 
That is what Casa has been able to achieve through the vision of our Board of Directors, the collaboration of many partners, and the generosity of our funders. I’m glad to see that the ACA is working to mainstream this type of approach.

A Wedding or a Funeral

I had the good fortune of spending the last weekend of September in Florida for my cousin Bernadette's wedding. The whole family was assembled for the occasion. There was a lot to celebrate.

My cousin has lupus, and that disease has made life very difficult for her. But Bernadette is a fighter with a very supportive fiancée (now husband). So it was that, after countless times in the hospital, myriad medications, and finally a kidney transplant, Bernadette arrived at her wedding day.

That day would not have been possible if she hadn't had access to the best our healthcare system can provide.  We can and will debate about how the costs of care are shared and distributed, and how we manage finite resources in the face of large demands. But that debate should take place in the context of the lives that are at stake.  It's too easy to lose sight of the fact that our political decisions and our policy making are not abstract discussions. They affect real human beings.  For my family, accessible care was the difference between celebrating a wedding and attending a funeral. 

That, I think, is what should ground all our discussions about healthcare.