PROVIDENCE – In the continuing effort to reform health care in Rhode Island, the Rhode Island Foundation and Lt. Gov. Elizabeth H. Roberts sponsored a forum Thursday morning to discuss how best to implement the patient-centered medical home concept that proponents say is proving successful in an ongoing pilot program.
No decisions were reached. Rather, the foundation and Roberts will sponsor similar forums in the weeks ahead to collect as much information as possible from various sectors, particularly physicians and business leaders. Meanwhile, Roberts noted, legislation is pending or will be drafted to make reform a reality.
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Dr. Paul Grundy, keynote speaker and president of the Patient-Centered Primary Care Collaborative established by IBM Corp., told today’s gathering of about 110 physicians, and health care and business professionals that the state is a leader in health care reform due in large part to the R.I. Chronic Care Sustainability Initiative.
CSI-RI, proposed in 2006 by state Health Insurance Commissioner Christopher F. Koller, has been a pilot program for 19 months at five medical practices, involving approximately 26 doctors and about 26,000 patients. Doctors receive extra money from insurers in exchange for effecting specific improvements in patient care, such as use of electronic records or expanded access with same-day office visits. Grundy said primary care doctors in other states with similar projects earn as much as one-third more.
A key part of CSI-RI is the medical home concept, in which the role of the primary care physician is greatly expanded. He or she becomes a quarterback directing a team of professionals such as nurses and nutritionists, with a tighter focus on providing actual care rather than chasing down supplies or unpaid bills. Providing care in the home rather than a hospital is also a top priority, both to reduce costs and increase patients’ comfort.
The medical home concept stems from extensive research worldwide on what patients want from their doctors, Grundy said. They seek a “real relationship” and “real communication,” Grundy said, with ready access, convenience and responsiveness. In essence, patients want a medical home that will always be there for them, with a doctor they can trust. “End medical homelessness” said the button Grundy wore on his lapel.
When a listener expressed skepticism about Rhode Island’s alleged leading role in health care reform, Grundy cited as proof the leadership of those such as Koller, Roberts, U.S. Sen. Sheldon Whitehouse, D-R.I., and the state health department. “So many forces in Rhode Island are all rowing in the same direction,” he said.
He said he is qualified to judge because he has worked on health care reform in many states and other countries as well. “I have 528,000 reasons to care,” he said, referring to IBM’s international work force, including retirees. A business like IBM has an incentive to promote reform because 60 percent of an employer’s health care costs stem from loss of productivity when workers are ill, Grundy said.
In those states and countries that have fully implemented the medical home concept, such as Iowa, Michigan and Denmark, there have been 40 to 50 percent reductions in hospitalizations, Grundy said. Health care costs in general drop 5 percent to 15 percent, he said. In Denmark, over the last few decades, the number of hospitals has dropped from 155 to 21 today, according to Grundy. “That is the kind of phenomenon that could happen [in Rhode Island],” he said.
Roberts and representatives of the Rhode Island Foundation pointed out the state has taken several steps already toward reforming health care. These include pending legislation that would require every state resident to have what Roberts called a “usual care provider” and a proposal to forgive repayment of tuition loans for medical students who become primary care physicians.
