The Charleston Gazette, November 28, 2005

Commentary: Sarah Chouinard

Systematic changes are needed to improve health care


UNFORTUNATELY, West Virginians are afflicted with myriad illnesses which contribute to our dreary health statistics. Tobacco dependence, obesity, high cholesterol, diabetes and high blood pressure are a few of the conditions burdening West Virginians that result in a poor quality of life. These illnesses are a burden not only on the individuals but also on the health care system. Systematic changes must occur to improve our current method of care delivery.

Many factors contribute to the chronic diseases commonly diagnosed in our population. In a rural setting, problems perpetuating these illnesses often include geographic and economic isolation, a genetic predisposition to these conditions and a lack of health insurance, which limits access to care. In short, our health care system is set up to pay for sick, episodic care instead of chronic disease management. Even those individuals who are fortunate enough to be able to access care are fed into the system of “15-minute health care.”

On the brighter side, we don’t have to accept what we have now as the standard for our future. We can improve the health of West Virginians. I see it as a three-step process:

First, we must insure the uninsured. If patients cannot be seen by providers, disease management will never come to fruition. The challenges of accomplishing this goal are too numerous to describe. However, there is a quick fix that would solve one small but vital piece of the puzzle. This solution is clinic-based retainer health care. The idea is that patients can pay a set monthly fee to enroll in a health center, make it their medical home, and receive preventive services such as “well woman” exams and diabetes screening and treatment. The primary advantage of having primary health care paid by a predetermined monthly fee is that it removes the cost deterrent that prevents some people from seeing their doctors.

Problems such as diabetes, high cholesterol and high blood pressure can be discovered earlier and in the primary care setting rather than in hospitals, where treatment costs are much greater and those illnesses have often progressed without being detected. Although not a total solution, this model would allow some of the uninsured to have a medical home and get a large part of their primary care needs met before they wind up in an emergency room with uncontrolled disease. More West Virginians would be healthier.

Those in the private sector who have tried this model, accompanied by private insurance for catastrophic events, say that they saved almost one-third on their health care costs by using clinic-based retainer health care as part of their solution to barriers that prohibit access to care.

The second step should be to implement a structured quality improvement program with designated care managers. Our clinic, Clay Primary Care Systems, is participating in a Medicaid demonstration project geared toward chronic disease management. The goal is to show benefits of changing from a physician-centered, episodic model of care to a patient-centered, chronic care model. This patient-centric model empowers patients to become better educated and share the responsibility in making choices about their treatment plans.

The third step is implementing an electronic health record system. Digital records improve the delivery of care through better charting, prescribing, data access and care management. The Community Health Network of West Virginia, for which I serve as chief medical advisor, has entered into a partnership with Medsphere Systems Corporation to install an electronic health record system with a specific focus on chronic disease management.

One example of how an electronic record can improve care management is that it would allow a clinic to list all female patients ages 18 to 65 who have not had a “well woman” exam in the past year and send letters urging them to get those exams. In order for the electronic quality improvement system to work, those women would first need a place to receive care and call their medical home.

Some of those women who do not have traditional insurance or who do not qualify for special programs to pay for such exams could benefit from clinic-based retainer health care.

These are the first few steps that could help improve the health status of many West Virginians. Put them all together and we can start the long uphill battle of changing our dreary statistics to encouraging ones.

Dr. Chouinard works at clinics at Clay and Ivydale.