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Health care reform, New Orleans-style
A patient receives care at the Common Ground Health Clinic, a patient-centered medical home in New Orleans, La.
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Kai Ryssdal: Waters are rising along the southern stretches of the Mississippi River today. Crews are shoring up levees in Baton Rouge and New Orleans. They've got no desire for a repeat of the flooding from five years ago and Hurricane Katrina.
But that storm is still helping re-shape the city of New Orleans. Health care, in this instance. Before Katrina the only way a lot of people saw a doctor was to go to the public hospital emergency room -- with taxpayers often picking up the tab. But when Katrina wrecked all the public hospitals there, the city decided to start over.
Mary Stucky reports on health care reform -- New Orleans-style.
Mary Stucky: It's a typical day at this red-brick clinic near New Orleans' French Quarter. A steady flow of patients comes in for routine tests, counseling and the usual colds and flu.
Doctor: Are you diabetic?
Patient: No, high blood pressure.
What's not so typical is the clinic itself. Or at least it wasn't before Katrina. It's what's known as a medical home -- a place where local, usually poor, residents can get most of the care they need right in the neighborhood. The care is coordinated, so patients see the same doctor every time. A case worker keeps track of medications and appointments. The clinics have extended hours.
Austin Duskin, Sr. is a patient at the clinic near the French Quarter. Duskin says he's relieved to finally have a regular doctor who takes time to discuss his overall health and to explain the chronic pain in his hip.
Austin Duskin: I told him about it and he explained that the cartilage is gone. He talked to me about changing my diet and try to eat more healthier.
Before Hurricane Katrina, Duskin and many other residents of New Orleans went without a regular doctor. They typically got the treatment they needed at the emergency room. But now, using a $100 million federal grant, the city has rebuilt its health care system along the medical home model. There are 93 across New Orleans.
Dr. Karen DeSalvo is New Orleans commissioner of health. She says this "team" model, allows individual staff members to work at what she calls the top of their license. Primary-care doctors, for instance, aren't doubling as social workers at physician's rates.
Karen DeSalvo: It makes the system less doctor heavy. So it makes us work as a team. And then it makes you find those patients to bring them back into the clinic when they don't follow up, so they don't end up the emergency room or an expensive part of the health care system.
New Orleans has some of the highest rates in the nation for obesity, diabetes, heart disease and asthma. All diseases that can best be managed with regular attention. The medical homes have saved taxpayers millions of dollars, according to DeSalvo. Whether patients are healthier is being studied.
But New Orleans Dr. Eboni Price-Haywood thinks they are.
Eboni Price-Haywood: We have a diabetes care management program and I can tell you that within our clinic, patients who have participate in those programs are those who've shown rapid improvement in their disease management.
A Kaiser Family Foundation study found that 20 percent more of the uninsured in New Orleans now have routine medical care. Again, Dr. Price-Haywood.
Price-Haywood: I think with the medical home structure that we've built in New Orleans, that has been the primary focus is not only to treat, but also to prevent.
Price-Haywood thinks New Orleans can be a model for other parts of the country. And, she says, it should not have to take a hurricane.
In New Orleans, I'm Mary Stucky for Marketplace.
The report fails to mention that we in New Orleans are still suffering the nation's worst mental health crisis -- and without Charity Hospital to triage these patients many are ending up in the city's largest psychiatric facility -- at Orleans Parish Prison. Charity had 160 outpatient clinics before Hurricane Katrina -- the current structure of clinics are relying on diverting DSH funding from much needed and still compromised trauma care which these clinics cannot ever hope to provide. Capitalizing on the Katrina disaster belies healthcare "reform."
Unfortunately, the majority of the public has no understanding of how the funding side of healthcare works, especially with regard to people without health insurance. I would love to see more stories covering the economics of hospitals, as well as the economics of healthcare from poor and uninsured people. The background would greatly help put this story into perspective.
It doesn't always take a hurricane. You can look at the state of NC (Community Care of North Carolina) for focusing on the uninsured and underinsured in establishing a medical home. It has been evolving for @ 8years now , currently exists as 14 networks within the system, servicing the state and it's diversity. This program has have not only reconnected people with a medical home, but also links patients with disease management options while tracking and recording preventive measures taken. For some areas it can often be the lack of transportation that keeps this population from attending appointments, as it is easier to call an ambulance, so we work with the local transit company to manage this. Our team of RNs, Social Workers, Pharmacists and administrative staff, reach out to the chronically ill of all ages and assess these patients to determine how we can maximize their health care and results. We also work within our network to connect the unsured with a local program where MDs donate their time to be proactive and preventative in medical care. Throw in some self management tools , directed educational materials, a focused home visit as needed and something as simple as a pillbox,you can see success in healthcare dollar savings with a reported $190 million in 2009 saved In NC with this program. As an RN for many years, this is a great patient oriented , yet cost savings example for the ongoing health reform discussion. Thank you for profiling this story as I believe many "pockets" of organized and effective healthcare exist and consumers and providers alike all benefit from programs like the ones that exist in New Orleans and NC-both in healthcare needs met and cost savings.
