Sunday, October 7, 2012

Health Care Transformation

The Michigan Department of Community Health is working at a feverish pace to transform the way health care is delivered in the state. There is nothing unique about that--it is happening everywhere in American today, as we struggle to reduce the cost of health care, which is making insurance unaffordable and making our businesses uncompetitive.  Michigan is currently calling its health reform initiative “Community Linkages.”

However, many people do not realize that this is going to have big implications for grass-roots community organizations like those that are members of the Montcalm Human Services Coalition, Gratiot County Community Collaborative, and the Building Stronger Communities Council in Clinton County. 

One trouble with our health care system is that there is poor coordination between health care providers and community based services.  The fact is, while doctors can help you a lot when you have some kind of acute health crisis like an infection or injury, they don’t do a great job of preventing you from becoming sick in the first place, and can’t do much if the things that are making you sick have their roots in your home or community.

For example, if a physician is treating a child for asthma whose parents smoke in the home, the physician needs to be able to refer the parents to smoking cessation services. What about someone who keeps landing in the emergency room with symptoms of severe depression whose real problem is that they have been unemployed for three years?  Today doctors are stymied by the many overweight patients they see who are on their way to heart disease and diabetes for whom they seem to be able to do nothing.

The Community Linkages project seeks to transform health care by taking the care of patients in doctor’s offices, and wrapping around it easy, low-cost access to comprehensive community services to address all the needs patients may have. In the jargon of the project they want to create “community hubs” to which health care practices can subscribe to get access to these services.

Now you might ask, “Well we already have 211 and our collaborative councils, so what more do we need to do?” The “hubs” will be special in two ways.  First, they will take advantage of the electronic medical records revolution.  Doctors will be able to refer patients to community services right out of their electronic medical records.  In fact, the systems will even prompt the doctors to make such referrals.  Second, patient outcomes will be monitored to ensure that people actually benefit from the services. Let’s face it, we’ve been doing a lot of prevention work for these many years, but in many cases we can’t show that people actually got better.  Community Linkages will leverage Michigan’s new Health Information Exchange to demonstrate the value (if it is there!) of the community services.  In the examples above: Did the parents referred to smoking cessation stop smoking? Did the man referred for employment counseling have fewer emergency room visits? Did any of the patients referred to weight management lose weight?

This measurement is critical, because the State is still trying to figure out how to make Community Linkages sustainable.  It has to be able to demonstrate value and cost savings so that health care providers, employers, payors and governments will feel justified in supporting it financially.

Right now there are demonstration projects under way in Ingham County, Saginaw and Muskegon.  At the Mid-Michigan District Health Department we are very interested in getting an experiment going here, too.