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I have said time and again that what we have today is not really a system due in large part to the lack of communication and coordination among various providers. However, there are examples where coordination is happening and solutions are working. One example of these solutions can be found right in WakeMed’s backyard.  In 2006, the Wake County Medical Society, along with WakeMed and other health care providers to the uninsured, worked together to create the Capital Care Collaborative. The Collaborative offers uninsured patients better, more efficient medical care while maximizing limited health care resources that serve this population.

The Capital Care Collaborative is a network of eight health care providers, including WakeMed, Rex Healthcare, Duke Health Raleigh Hospital, Urban Ministries, Wake Health Services, Alliance Medical Ministry and Wake County Human Services, who provide the bulk of medical care for the uninsured in Wake County.  Together, we are working to improve patient care and reduce medical expenses by improving the coordination of care and reducing duplication of services.

One of the program’s key elements is a technology initiative that allows WakeMed and other safety-net providers to quickly determine if patients qualify for Medicaid or other charity care programs.  Between 30–40% of these patients do qualify for assistance and we help them register for the appropriate coverage.

Even more exciting is a new electronic health record program that enables providers to capture and share information regarding a patient’s prior medical history.  This shared clinical data repository will allow all members of the collaborative to share patient encounter, pharmacy, diagnostic and other data electronically through interfaces being built with each of our partner organizations and by utilizing a common patient authorization form.

This will ensure that whoever treats the patient – whether it is WakeMed or another member of the collaborative – can better manage chronic diseases and give the patient the care they need.  The system is scheduled to go online later this year and promises to significantly reduce costs by helping us avoid duplicate tests and other unnecessary procedures.

Our efforts to retool the national health care system must learn from community projects like this and many others that are working well across the country. We must identify the best way to expand successful programs to every patient – insured or uninsured on a national level.

Tomorrow David Coulter, senior vice president and administrator of WakeMed Cary Hospital, is participating in a panel discussion from 7:30-9:30 a.m. at Prince of Peace Episcopal Church. The event, which hosted by the Triangle Business Journal, will focus on roads, water and sewer, power supply, education and health care.

Since opening in February 2008, WakeMed Apex Healthplex has surpassed projected volume by 10-15 percent.  And, ED volume for this fiscal year is 50 percent greater than what we saw last year. David will discuss WakeMed’s plans for the future in Apex.  Other panelist include

-Michael Murphy, Director of Manufacturing Engineering, EMC Corporation

-Brenda Steen, Executive Director, Apex Chamber of Commerce

-Tom Hendrickson, Developer, Lookout VenturesWally Bowman, Division 5 Engineer, North Carolina Department of Transportation

To learn more, see the article in the Apex Herald.

Flu is officially widespread in North Carolina and WakeMed is already seeing more than 80 patients per day across our 5 emergency departments. This flu season it is more important than ever to know how to protect yourself from the flu – both H1N1 and seasonal.  Learn about prevention, signs and symptoms and when to seek health care by visiting WakeMed’s flu resource center.

And, search for the closest seasonal flu clinic to you by visiting Carolinas Center for Medical Excellence’s flu clinic finder. (We’ll make sure to post information on the H1N1 vaccine as it becomes available.)

Finally, watch WakeMed’s experts talk about H1N1 prevention and hospital preparedness on NBC-17 and ABC-11.  Tonight News 14’s evening news will cover our surge planning and feature our disaster preparedness supplies.

Another great local case study that could be held up as a national model is Alliance Medical Ministry.

Alliance Medical Ministry is a faith-based medical ministry that serves uninsured working families in Wake County. For the most part, Alliance operates like any other private doctor’s office. Board certified physicians provide general primary care to patients who pay a set fee up front, however they don’t bill insurance, Medicare or Medicaid. The fee covers time with a physician, any necessary lab work or x-rays, most medications and health education. Alliance links with many community partners to provide the highest quality treatment available. The comprehensive care provided includes acute and chronic medical care, urgent care appointments, preventive and health education, monthly screening eye exams for diabetic patients, all necessary lab work, free or reduced priced medications, monthly ENT and GYN clinics, bilingual services and 24-hour coordination of care including a bilingual after-hours answering service.

Approximately 25% of Alliance patients are direct referrals from local hospital emergency rooms who need follow-up care or a medical home. Over 60% of these referrals have never had health insurance or have been without it for over a year. Ninety seven percent of Alliance patients have an annual household income of less than $25,000; 49% are Latino, 29% are African-American, 4% are Asian-American, and 60% are women. All have a working adult in the household but have no insurance.

A survey of Alliance Medical Ministry patients clearly demonstrates the success of this medical home model:

• Better Care, Better Health: 100 percent of patients experienced an improvement in their overall health. Before being treated at Alliance Medical Ministry, these patients often ignored medical issues due to concerns about high costs. More than two-thirds of those surveyed said they had refused to address medical issues at least three times in the year before becoming a patient.

• Fewer Missed Workdays: 90 percent of employed patients missed fewer days of work due to illness.

• Reduced Medical Costs: 86 percent of patients visited the hospital emergency department less frequently, resulting in 68 percent fewer emergency department visits. This results in significant savings to the patient, as a visit to Alliance Medical Ministry typically costs $10 while a visit to the emergency department frequently bills for $1,800 or more.

Establishing a national network of primary care providers will take significant time and resources, requiring changes in reimbursement for primary care physicians and a renewed commitment to develop a strong pipeline of these important, but often undervalued, physicians.

The Alliance Medical Ministry – and hundreds of other successful models across the country – demonstrates that pursuing the medical home concept is worth the effort.

New census figures released in late August show that fewer Americans are without health insurance.  The number of uninsured dropped from 47 million (15.8 % of Americans) in 2006 to 45.7 million (15.3%) in 2007, partly due to expanded Medicaid roles and better coverage for children.  But the problem of uninsured Americans remains very real in Wake County and beyond.

At WakeMed, we had 211,004 visits from patients without insurance last year.  That represents nearly 600 visits a day — provided by WakeMed at a total cost of at least $59 million in 2008.  Unfortunately, those with insurance ultimately wind up paying for much of these costs.

The number of uninsured patients is extraordinary – the total population of Wake County is only 866,000 – and demonstrates that the need for health insurance reform remains very real despite the slight decline in the overall number of uninsured people.  And remember that much of the country is in worse shape than Wake County because our community has not been hit as hard by the recession.

WakeMed is one of the largest safety-net hospitals in North Carolina, providing more than 80 percent of all charity care in Wake County.  That is why we are so committed to health care reforms that will help those without insurance.  Because every single day, WakeMed cares for those people who are falling through the cracks of the current system.

Our commitment to serve the people in our community – regardless of whether they have the resources to pay for medical care – has been a fundamental part of WakeMed’s mission for nearly 50 years.  And as we look toward the next 50 years, we remain hopeful that we can soon find better ways to help those people in our community who cannot afford health insurance.

America’s Healthy Future Act of 2009
Read the full health care reform proposal submitted by Senator Max Baucus, chairman of the Senate Committee on Finance.

What’s in Baucus’ health care proposal?, CNN.com
CNN summarizes some of the key points of Senator Baucus’ health care reform proposal.

8 Questions About Health-Care Reform, Washington Post

Is There Hope For Health Reform?, Washington Post
The Washington Post asked former lawmakers and political experts if President Obama’s health care reform outline can pass.

Dr. Atkinson was asked to respond to President Obama’s speech to a joint session of Congress on WRAL’s evening news. Watch this video to hear some of his thoughts on health care reform.

Dr. Atkinson was also interviewed by Gerrick Brenner, reporter with WTVD, about the Census Bureau’s newly released numbers on the uninsured. According to the Census, one out of every six people in N.C. are without health insurance.

The U.S. Congress returns to session today to resume the debate over health care reform after a busy August recess that was marked by contentious town hall debates across the country.  It will be interesting to see what sort of direction the legislative proposals take.

Over the weekend, Senator Max Baucus circulated a draft of the long-awaited plan from the Senate Finance Committee. While the Committee’s proposal omits a public insurance option, it expands Medicaid coverage to millions of Americans who are currently ineligible an proposes insurance options offered by non-profit co-operatives. Many people are expecting to hear significant detail from President Obama, including whether or not he will support legislation that doesn’t include a public option, when he addresses a joint session of Congress tomorrow evening.

With the House of Representatives tentatively scheduled to recess for the year at the end of October, the time table leaves me to wonder what legislation will land on the President’s desk to be signed. As I’ve said many times before, our current health care system is in bad need of repair, and it starts with health insurance coverage for all.  There is no shortage of common-sense reforms that everyone agrees can significantly improve patient care and reduce health care expenses. Here’s hoping that President Obama and our Congressional leadership can find a way to build bipartisan support for those measures that we know will have an immediate, positive impact on patient care and our nation’s bottom line.