Dr. Michael Fine is an old-fashioned primary care physician. As physician operating officer of Hillside Avenue Family and Community Medicine in Pawtucket, he has built a practice that embodies his ideals, with multiple professionals collaborating to meet almost all their patients’ needs in-house.
He also has devised alternate models for financing, including a membership program at Hillside that provides unlimited services (with small co-pays) for a monthly fee.
This month, he and James W. Peters, a patient and fellow veteran of the Rhode Island health care system, published a book, “The Nature of Health,” that calls for a wholesale re-examination of what health means and how care is delivered.
PBN: What led you to write this book?
FINE: I started conceptualizing the book about 10 years ago. I gave a talk at the Rhode Island Academy of Family Physicians about the basic ideas in the book, which really have to do with the connection between health and community, and the potential impossibility of health given the breakdown of community. … Then I met Jim, we started talking … and we worked together, meeting weekly, for about three years to do the writing.
Let’s Save Big with Rhode Island Energy Efficiency Programs
Nestled alongside the Blackstone River in Pawtucket, RI, in a historic National Heritage Corridor that…
Learn More
PBN: Explain what you mean by the connection between health and community.
FINE: When you work inside the health care system, it always feels like you’re playing catch-up, like you’re trying to do something for people that might not really be possible, which is give them a sense of connection and balance. … When you’re trying to take care of someone who can’t sleep and has a backache, and you begin to delve into what’s going on … you begin to say, wait a second, what’s really going on here?
PBN: But to what extent is this the health care system’s problem to address?
FINE: I think it is and isn’t. … [we started] … to wonder whether the health care system we’ve designed might be causing part of the problem, and part of that problem might be because we never understood what health is, because health got captured by commercial interests and distorted.
PBN: So how do you envision a better health system?
FINE: It’s actually easy, and it’s cheap. What you do is for every community of 10,000 to 20,000 people, you build a robust primary care center … that takes care of 90 percent of what people need in a way that 90 percent of the people in that place want to use that health center. You can do physical therapy, you can do generic prescribing, you can do mental health, you can do home nursing, all focused around your taking care of people in a community. And it costs something like $300 to $500 per person per year, which is a fraction of what we spend even on health plan administration. The money is there to do it; we just haven’t organized it well.
PBN: What would the economic impact of such a system be?
FINE: You get a couple of immediate up sides. You get a 30- to 40-percent drop in the cost of care globally. And just because you’re building a business community by community, it’s an infrastructure that spends $5 million to $10 million a year in each community.
PETERS: If a substantive amount of the medical process could be returned to the community level, not only would you have an enormous shakeup in the way that things are handled and managed, but you’d also have an enormous benefit in terms of social capital.
PBN: Dr. Fine, you’ve tried some of these concepts at Hillside and with the Scituate plan. How successful have you been?
FINE: I think they’ve been real successful. Hillside has become the largest family practice in the state … We take care of 14,000 to 15,000 people, and we’ve got most of their care now organized under one roof. We’ve integrated mental health, nutrition, physical therapy, lab, all in one place. It really works for lots of people. We’re open from 9 a.m. till usually 7 p.m., we’re open on weekends, we take care of people in the hospital, and our physicians have a really good lifestyle.
PBN: What do you hope to accomplish with this book?
FINE: To change the terms of the discussion. We as a state and as a nation become a little obsessed with insurance and who gets it. Effectively we’re trying to argue about how to pay for it without articulating what it is. The book makes a point about infrastructure, that how you pay for it comes second to how you organize it.
PBN: How does the employer-sponsored health insurance system fit with your vision?
PETERS: I think the payment of health services through the workplace is an aberration, and it’s become such an inculcated part of the American economy. … But if you changed the plumbing, people could afford to buy health care on their own. … A model we’ve suggested is that for a modest price, people would be able to afford a very comprehensive gamut of primary care services, and for very expensive but less common problems, they purchased catastrophic insurance with a high deductible. The entire and enormous expense of health care would be removed from business … and people would be directly connected with [paying for] care. •
Interview: Michael Fine
Position: Physician operating officer, Hillside Avenue Family and Community Medicine; physician in chief, Rhode Island Hospital and The Miriam Hospital Departments of Family and Community Medicine; clinical assistant professor of family medicine, Brown University; author of “The Nature of Health: How America Lost, and Can Regain, a Basic Human Value”
Education: B.A. in philosophy, 1975, Haverford College; M.D., Case Western Reserve University School of Medicine; residency, 1983-1986, Brown University Program in Family Medicine, Memorial Hospital of Rhode Island
Age: 54
Residence: Scituate
James W. Peters
Position: Freelance writer; former director of communications and public affairs, Lifespan, 1994-99, and Rhode Island Hospital, 1992-94; co-author of “The Nature of Health”
Education: B.A. in communication arts, 1969, Fordham University, New York
Age: 60
Residence: Smithfield
