Doctor’s Tip: A local solution for expensive, fragmented health care
Health care in America has become a fragmented, unsustainably expensive system, with too many people still uninsured or underinsured in spite of the Affordable Care Act. Elisabeth Rosenthal, M.D., wrote a book called “American Sickness, How Healthcare Became Big Business and How You Can Take It Back.” In it she talks about “the transformation of American medicine in a little over a quarter century from a caring endeavor to the most profitable industry in the United States — what many experts refer to as a medical-industrial complex.”
Mountain Family Health Centers is a local example of how health care can be less costly, be less fragmented and be available to everyone. Mountain Family came to this area some 40 years ago, with the mission to cover the uninsured and underinsured. According to its CEO, Ross Brooks, its mission is “providing access to care for all, regardless of economic or insurance status, ethnicity or race, as we believe access to affordable health care is a basic human right.” They now have facilities in Rifle, Glenwood, Edwards and Basalt, with a satellite school-based health center in Avon, a Title Ten affordable family planning clinic in Eagle-Avon, and dental services in two schools in Parachute.
Mountain Family serves about 20,600 patients, 83 percent of whom live at or below the federal poverty level. Locals, including many health care providers, have the mistaken impression that MFHC is just for the uninsured, but 18 percent of its patients have private insurance, including Medicare. Another 37 percent have Medicaid, and 36 percent are uninsured.
One of the problems with the U.S. health care system is that we have too many specialists and not enough primary care providers practicing preventative medicine. MFHC employs 40 medical, dental and behavioral health providers. The medical providers are all primary care, and include eight physicians and 13 nurse practitioners/physician assistants. They also employ dentists and mental health providers. These providers are salaried, and work as teams — the teams are rewarded quarterly based on quality outcomes for patients such as control of diabetes and hypertension. They also have employees who manage patient transitions in and out of the hospital, specialist referrals, community care coordination, and helping patients access community resources such as housing, affordable food and legal resources.
MFHC has proven (such as demonstrating significant total cost-of-care savings for Medicaid patients in Western Colorado) that it’s possible to provide affordable, coordinated health care for all. One reason they are able to do this is that they receive Federal grants to provide care for the uninsured and underinsured. Also, they receive cost-based reimbursement for serving Medicaid patients. However, they also bring costs down by keeping patients out of the E.R. and out of the hospital. They do this by emphasizing preventative primary care, coordinated care of chronic diseases, and by “integrated care.” The latter refers to having medical, dental and behavioral services under one roof at their main clinics (Basalt, Glenwood, Rifle and Edwards). Many people who present to doctors have an emotional component to their illness, so easy access to behavioral providers makes sense. And dental disease causes or contributes to many other diseases, such as cardiovascular disease.
In summary, Mountain Family Health Centers offers a model that addresses many of the deficiencies in our broken health care system — which is especially important in this region, where health care is as expensive as anywhere in the country.
Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email email@example.com.
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The idea has been kicked around to make the ban on smoking downtown 24 hours rather than the current daytime hours only until 10 p.m.