Power-Up Friday | ChangingAging.org - Harvard Closing Primary Care Program

by Al Power

Uproar at Harvard Med! A faculty and student protest has greeted Harvard Medical School’s announcement that they are responding to the economic crunch by closing their primary care program.
A petition was signed by more than 500 students and faculty. All this amid the growing evidence of critical shortages in our nation’s primary care physicians. A 2007 survey showed that 98% of internal medicine residents are choosing specialty fields.
The Harvard program was only receiving $200,000 a year, which according to the protest organizer, is “itself indicative of a problem.” The Harvard dean suggested that she supported spirit of the petition, but that “difficult economic times have forced some difficult decisions.”
Not good enough. Responding to a problem by perpetuating it when times get tough is not the solution. If it was, culture change would never come to nursing homes; in fact, most aspects of life would never improve if we only did the right thing when it was easy.
The dean’s contention that increased scholarship aid and loan forgiveness will inspire people to consider the lower paying primary care fields is also very weak. It’s the essence of “trickle-down” theory. If you honor the practice of primary care, you need to show that, visibly and financially.

Power-Up Friday | ChangingAging.org

Hold The Mayo | The New Republic

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by Harold Pollack

Alec MacGillis had a nice Washington Post piece on the Mayo Clinic’s low provision of care to Medicaid patients and the even more dicey policies of Mayo’s Glendale, Arizona site to stop accepting Medicare primary care patients. If Arizonans want Mayo primary care, they will have to pay an annual $250 fee, plus a pretty stiff $175 to $400 per visit. Mayo will still provide these patients more complex--and lucrative--procedures.

As MacGillis details, 5 percent of Mayo’s Rochester Minnesota patients are on Medicaid. The Medicaid caseload is 29 percent at the other local hospital. Mayo will no longer accept Nebraska or Montana Medicaid patients, though it is arranging for some currently receiving care.

Mayo receives much praise for its high-quality care. Some effusive praise has come from the President of the United States. That praise is well-deserved. So the above paragraphs should give one special pause. Mayo and other flagship institutions provide excellent, sometimes surprisingly cost-effective care. Yet how should we think about these institutions in light of the reality that many choose in varying degrees to channel their services towards a relatively privileged slice of the American population?
Continue Reading to see how this story illustrates two final points

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Health Affairs Blog-Grandparent Corps: New Primary Care Model

by Arthur Garson,Margaret Whitehead,Tracy Buni,Catherine Sommers, and Karen Rheuban.

We propose to change the paradigm of care with the creation of a new model of the health care continuum by establishing teams that begin with the patient. Patients must take greater ownership of their health (for example, reducing smoking and obesity) and also need to understand when visits to physicians are necessary and whether visits with other members of a health care team are appropriate. These teams will also include community health workers, nurses, advanced practice nurses, primary care physicians, and specialists. This model of greater training and greater responsibility leveraging members of a health care team has been articulated by generalist physicians to address shortages in primary care, and in recognition that physicians do not need to provide all care.
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Serving the Needs of Medicaid Enrollees with Integrated Behavioral Health Services in Safety Net Primary Care Settings

Summary A recent trend in health care has been the increasing integration of behavioral health services into primary care settings. This paper discusses the benefits of such integration and the role of safety net primary care providers as behavioral health providers within the Medicaid program. The authors focus on organizational structure and reimbursement models in analyzing how four state programs achieve this integration. Available Files Report PDF (167K, 19 pages)

Transforming Safety Net Clinics into Medical Homes: Call for Proposals

The Commonwealth Fund, together with Qualis Health and the MacColl Institute for Healthcare Innovation, have launched a new initiative to transform 50 primary care safety net clinics into patient-centered medical homes. The goal of the Safety Net Medical Home Initiative is to develop and demonstrate a replicable and sustainable implementation model for medical home transformation. Through a request for proposal process, four regional coordinating centers will be selected to help transform 12 to 15 safety net clinics per region--for a total of 50 clinics--into high-performing medical homes. These regional coordinating centers--which could include professional affiliations of safety net providers/practices, state primary care associations, and state Medicaid agencies, among other entities--will receive expert technical assistance and up to $500,000 over four years to support a Medical Home Facilitator, who will lead the clinics through practice transformation and quality improvement exercises. In addition, regional coordinating centers will partner with both the safety net providers and community stakeholders to advance the medical home in Medicaid and pursue other policy reform efforts in their states. Regional Coordinating Center applications are due on November 3, 2008, and can be downloaded at http://qhmedicalhome.org/safety-net/index.cfm. For more information, please contact RFP@qhmedicalhome.org or Kathryn Phillips, M.P.H., Project Manager, at 206-364-9700 ext. 2007.