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Setting up shop where the sick are

Northgate II in Camden, NJ., a public housing apartment building for 400 seniors, many of whom are chronically ill.

Angie Lara is a medical assistant at the Reliance doctor’s office

Nobody wants to be in the hospital, or the emergency room. And now under the Affordable Care Act, known as Obamacare, hospitals and doctors have a financial incentive to keep their patients out, particularly the chronically ill.

There’s a small doctor’s office in Camden, New Jersey that could play a big role in lowering costs some of those costs, and in improving care for some of the sickest and most expensive patients in the city. Angie Lara is a medical assistant at the Reliance doctor’s office. She remembers a woman coming in one day, really upset.

“She was crying. She said that she was going to the hospital because she didn’t feel good,” says Lara. The woman thought she was about to have a stroke. Lara checked her blood pressure. It wasn’t high. “As soon as I told her, she’s like, ‘oh, o.k..’. Why thank you so much sweetie. Have a good day’,” says Lara.

Problem solved and a potentially expensive visit to the emergency room avoided. That’s precisely why the Reliance doctor’s office was opened two years ago at North Gate II, a public housing apartment building for 400 seniors, many of whom are chronically ill. In six years, residents here ran up more than $80 million in health care costs.

“Having a primary care office where you live breaks down a lot of barriers you run into when you want to go to the doctor here in Camden,” says Nadia Ali, who works at the non-profit Camden Coalition of Healthcare Providers.

Barriers like no reliable transportation, and long waits for an appointment. This office is one way Camden hopes to get out in front of the new health care law and lower costs by keeping chronically ill patients from ending up in the hospital again and again. But even though the clinic is so convenient you could trip over it, most residents won’t go there.

“I’m the first one,” says 63-year-old Elsa Cartegna. She said as soon as it was open, she was there. With high blood pressure, asthma, terrible allergies and 11 different medications. Cartegna saw the value. Her neighbors…not so much.

“I talk to them. They say, ‘oh, I got my doctor for a long, long time.’ Leaving the doctor you’ve known for 20 years isn’t easy for anyone.

Reverend Heyward Wiggins, whose congregation includes Northgate residents, says when you live in the poorest and most violent city in America; it’s hard to trust people.

“For so long agencies have come in, said, ‘We are here to propose this program for you. You need to take advantage of it. And as soon as it didn’t work, they just left,” he says.

Despite modest success lowering hospitals visits, the office loses $150,000 a year. But rather than leaving Northgate, Camden health officials are adding staff to try to get more care to the sickest people in the building. Because -- no matter how well designed the plan -- making basic changes in health care is very hard.  

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

Angie Lara is a medical assistant at the Reliance doctor’s office

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