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Alaska set to test patient-priority 'medical homes'

Eric Christopher Adams

A public health care idea that's caught on in other states will soon be explored in Alaska.

Leaders of Alaska's vast health care system -- responsible for everything from disease awareness and prevention to making sure Alaskans have access to clinics and hospitals -- are betting that bringing all of a patient's many decisions back to a single doctor or nurse will make us happier and healthier, while hopefully cutting skyrocketing costs.

The Department of Health and Social Services will soon ask medical providers to participate in a pilot project called Patient Centered Medical Homes. Don't confuse these new "homes" with nursing homes or long-term care facilities. Instead, think of a patient-centered home as a place where Alaskans can come to coordinate all of their health care needs.

Associations of doctors across the country are on board with the patient centered medical home model. They've been described as places where "each patient has an ongoing relationship with a personal physician to provide first contact, continuous and comprehensive care." One physician would lead "a team of individuals" responsible for your health -- whether it's dealing with chronic aches and pains, occasional flu bugs, diabetes treatment or preventative check-ups and screenings.

Other states that have found varying success with public health medical homes include Oregon, Rhode Island, North Carolina and New York, according to the nonpartisan health care advocacy group Commonwealth Fund.

Medicaid patients who take part in one of the new pilot homes previously had to coordinate all of their individual medical visits with specialists, doctors and therapists -- oftentimes with those experts not communicating. Now, they’ll have one person who takes responsibility for arranging care, discussing options and helping with decision making. It could be a doctor or a physician’s assistant.

Ideally, that single provider will be able to work with his or her patients in a long-term relationship, identifying potential health risks and providing preventative treatments and prevention advice before costly emergency care is needed.

"This idea's been around a long time, and now Alaska will give it a shot," William (Bill) Streur, the commissioner of Alaska's Department of Health and Social Services, told Alaska Dispatch in an interview. "We're hoping it will reduce inappropriate visits to hospitals at the first sign of a fever or non-emergency situation.

"It will give people a choice: instead of going to the (emergency room) with a sick child they can come to the (patient-centered home)," Streur added. "The goal is to take away reasons for people not to go to their primary physician."

Alaska's experiment in bringing medical care back to the single provider model will involve four test homes at first. One will be in a tribal or Alaska Native health care-managed facility. One will be in a "tribal-independent" facility, such as on the North Slope, where there's a high density of Native and non-Native people who need access to medical care, Streur said. A third patient home will be located in rural Alaska. And a fourth will be one of the state's urban centers, perhaps Anchorage.

Once the state sends out its proposals for the project, interested clinics or public health providers will apply. They'll need to explain how they can provide services that a patient-centered home is expected to offer: more patient-physician communication, longer hours of operation, open scheduling and more access for patients to their provider.

The program is focused on Alaskans who receive Medicaid -- a group of residents that's forecast to increase by 40,000 in the next several years, under new rules for who qualifies under the federal health reform law. Many current Medicaid recipients aren't getting the best care -- often they’re "frequent flyers in terms of emergency room visits or doctor hoppers. We'll be working with pilot participants to enroll as many people as we can," Streur said.

Health and Social Services hopes to enroll at least 5,000 people in the first year of the project. Expect the state to pay somewhere around $6 up to $10 per patient, per visit, to each of the four patient homes during the pilot. Streur said if all goes according to plan, the state would have double, maybe even triple enrollment during the second year.

Contact Eric Christopher Adams at eric(at)alaskadispatch.com