Parkland: A Blueprint for Health Reform Implementation

Parkland: A Blueprint for Health Reform Implementation

During my first week as an advocacy intern here at NAPH, I had the opportunity to jump right in and attend the Fifth Annual Medicaid Congress, where I had the privilege of hearing Dr. Ron Anderson, CEO of Parkland Health and Hospital System, give a presentation that was the start of my exposure to health reform.

Dr. Anderson is a supporter of health reform efforts made by the federal government. He has been working towards health reform for a long time and his work and program implementations at Parkland are evidence of this. What Parkland does now is ahead of the curve and is essentially, to me, a model of what more hospitals will look like in the future as health reform implementation gets underway. Although Anderson praised health reform, he also warned of some of the challenges posed by the new reform law including the reductions in Disproportionate Share Hospital (DSH) payments before we know how consumer behavior will change or how low Medicaid payment rates will impact providers. Dr. Anderson mentioned that if Medicaid rates continue to be below cost there will be a continued need for DSH payments to hospitals. He also spoke of about 23 million people who will be left uninsured and the failure of the law to deal with the undocumented population (most of which use safety net hospitals, therefore driving the need for DSH payments) in border or high-impact states like Texas.

Dr. Anderson provided interesting insight into the workings of a safety net hospital and Parkland’s efforts to supply quality health care to low-income, vulnerable patients in need of primary care services. Since 1980, Parkland has seen a fairly steady increase in the hospital’s services except for emergency room services. Anderson attributed the decline in use of ER services to the presence of 11 clinics established out in the community to provide low-income vulnerable patients with access to care in the areas in which they work and live. These community oriented primary health centers (COPC), with an additional eight women’s clinics, increase access to primary care and improve public health by providing early prevention and intervention opportunities. Additionally, Parkland operates its own health plan, Healthplus, which acts as both a bridge to uninsured patients to Medicaid and CHIP, as well as managing their care once they secure coverage.

The need to discuss and establish more integrated delivery models was evident in Dr. Anderson’s presentation as he pointed out the importance of primary care medical homes, care management, the necessity of addressing socioeconomic determinants of health, and addressing disparities adequately. Parkland has already taken steps toward dealing with these issues by, as mentioned, establishing community clinics as well as studying the disparities in health between different members of the populations Parkland serves. He also signaled a shift from volume-driven to value-driven care.

In regard to the safety net’s future, Dr. Anderson indicated that public hospitals will need to redefine the way they operate. The safety net will need to be more adaptable, flexible, and accountable in implementing new payment and delivery models and the use of DSH payments. Dr. Anderson and his work at Parkland should be seen as a blueprint for health reform implementation methods at the local level, and his ideas and experience should no doubt be used as a platform for health reform implementation at other hospitals.

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The issue of undocumented health seekers is a major concern, both in general, and for borderland or susceptible States in particular. the Medicare / Medicaid system is almost certain to come under increasing stress due to pressures on State and Federal spending. The key problem remains the issue of hospital emergency rooms being used for primary health care by un/under insured and undocumented individuals. I cant help thinking there has to be some answer that permits Primary physicians / First Aid or 24 Hour Medic Facilities to treat many of these patients and thus unload the general hospital emergency care system.

gazzer

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7/1/2010 10:43:12 PM