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In the Adirondacks, a new model of primary care
On a Monday afternoon in December the Moreau Family Health Center, just south of Glens Falls, is packed. The doctor’s seeing patients back-to-back - and so is care coordinator Jessica Casey.
Just as Jessica introduces herself, the phone rings. It's a patient. She helps him figure out his prescriptions. She schedules an eye surgery appointment and arranges the patient’s transportation by coordinating with his sister.
Jessica's job – being a link between doctor, patient, and other services – is part of a new model of primary care in the Adirondacks still in the pilot stages. It’s called a patient centered medical home.
"The idea is to not just have the doctor and patient together, but a whole team of people caring soup to nuts doing the patient coordination, doing most of the care right there in that primary care setting," said Dr. John Rugge, physician and founder of Hudson Headwaters Health Network.
Rugge helped start the medical home pilot 5 years ago. There weren’t enough primary care doctors in the Adirondacks and it was hard for patients to access the basic services they needed.
The hope was to keep doctors in the Adirondacks, improve patient care and reduce health care costs.
Health centers across Warren, Hamilton, Essex, Clinton and Franklin counties decided to participate. Public and private insurers signed up, paying $7 per patient per month. And 3 years ago, the pilot was up and running.
Doctor Tucker Slingerland, the physician at Moreau Family Health Center, says it’s changed his practice.
"Now before I go in the room there’s a team nurse that’s in there, so much of the encounter is happening before I even get in there," Slingerland said. "I try and help the patient make the complicated decisions. It’s forced us to define what we think quality is and what things we think make a difference for patients."
Sherman Hurlbert is one of Dr. Slingerland’s patient. He has chronic diabetes, pancreatitis, and asthma. He’s a retired nurse, and says the medical home program has helped keep him out of the hospital.
"We need the encouragement from their nursing staff and doctors themselves to stay on track. You need to have a pat on the back to say you’re doing the right thing or maybe make suggestions to do things better," Hurlbert said.
It’s not yet clear what impact the medical home pilot has had on costs for patients. But it’s drastically reduced hospital re-admissions and pediatric emergency room visits. And that has affected the business of hospitals.
Glens Falls Hospital, Adirondack Medical Center in Saranac Lake, and CVPH in Plattsburgh have all laid off employees this fall, in part because of lower patient volumes.
"Our cost structure is built on those pediatric ER visits coming in. and they’re not there anymore," said Stephens Mundy, head of CVPH. "We have to figure out how to retool. We shouldn’t have patients just coming to the hospital because we need them to come for financial reasons. That’s a wrong answer. And we want those patients to get care in an outpatient setting and we have to adjust internally."
Medical home advocates like John Rugge say it’s the way forward.
"For this part of the Adirondacks, the medical home is health reform. This is how we’re tackling it," Rugge explained. "Physicians, hospitals, communities have the opportunity to find solutions that work for them. We think this is the kind of approach we need here in the mountains."