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Thursday, June 18, 2009 07:32 pm

Durbin: Everybody needs a medical home

SIU physicians shape reform for low-income patients

Patient-centered medical homes — a modern health care model that connects patients with primary care providers — has emerged as the centerpiece of national health care reform, says Dr. Jerry Kruse, chair of family and community medicine at the Southern Illinois University School of Medicine.

The medical homes approach provides primary care physicians to patients who might otherwise seek treatment from hospital emergency rooms. The approach works to establish a constant, long-term relationship between the physicians and their patients by giving them a wide array of health care services in one location, as well as direct assistance in finding other supplemental services such as mental health.

“It makes for a more efficient health care system,” Kruse says. “The patient-centered medical home will provide the care that will cut down on unnecessary ER visits and better coordinated care for chronic medical conditions.”

As health care reform tops the national agenda, Kruse and other primary care physicians worked with U.S. Sens. Dick Durbin, D-Ill., and Richard Burr, R-N.C., to create the bipartisan Medical Homes Act of 2009. The new legislation provides federal funding and guidelines for three-year medical homes pilot projects in Medicaid and the State Children’s Health Insurance Program in eight states.

On May 20 Durbin introduced the bill to senators and touted its importance:

“Those of us who have a medical home take it for granted. We see the same doctor, in the same setting, for extended periods of time. Our medical history is in one place, and even if we are seeing specialists or different doctors in the same practice, there is continuity in decisions about our health care.

“But many people do not have this luxury. Think about people who move from place to place whose home lives are less than stable, who do not have health insurance, whose medical care is sporadic. For these members of our community, each visit to a clinic or an emergency room means starting over again.”

As part of the Medical Homes Act, primary care physicians sign up to treat qualified, low-income patients on a continual basis. These doctors will maintain their patients’ medical records, conduct follow-up calls and visits and make referrals for other health services. The legislation also sets up local steering and medical management committees comprised of social services, public health, public hospital and community health center professionals to oversee the pilot projects.

States that participate will receive a per member-per month care management fee to reimburse physicians and to pay for extra costs like health information technology and case managers that help coordinate patient care.

Dr. Janet Albers, director of the family medicine residency program at SIU School of Medicine, says extra reimbursement will help physicians do their jobs better and maybe even attract students to family medicine who would have initially gone to higher-paying subspecialty practices.

The eight pilot project sites won’t be chosen until after the bill passes, but Albers hopes Illinois will be on the list. Illinois Health Connect, a two-year-old program at the Illinois Department of Healthcare and Family Services, already uses the patient-centered medical home model to deliver better health care to 1.7 million residents.

Albers, who sits on the steering committee, says Illinois could expand on this program and serve even more families with help from the Medical Homes Act.

“Even people with Medicaid that are underinsured, it’s difficult for them to find a medical home,” Albers says. “There aren’t enough providers. It only makes it worse when you don’t have insurance.”

“A system like this, and at least basic coverage for prevention and screening, would be huge.”

Durbin told the Senate that early analyses of the medical home approach find that providing patients with regular access to primary care yields “earlier and more accurate diagnoses, fewer emergency room visits, fewer hospitalizations, lower costs, better care, and increased patient satisfaction.”

“Many studies conclude that having both health insurance and a medical home leads to improved overall health for the entire population,” he added, “which brings down the cost of care and reduces health care disparities.”

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