Health Care Reform Finds Even More in the 'Safety-Net'

When Massachusetts implemented statewide health care coverage, many speculated that the number of people who relied on the “safety-net” of care providers — public clinics and hospitals, community health centers, and hospitals in low-income neighborhoods — would decrease. Now that these people had coverage, they reasoned, they’d find a private, primary-care doctor, and the stress on those already-taxed providers would diminish.

But findings released yesterday in the Archives of Internal Medicine show that people who’ve grown used to using the safety net still use it, in fact, they were using it 31 percent more as of 2009 than they were in 2005. Less worried about being able to coverage their medical care costs, they’re returning to net because it’s convenient, it’s affordable, and these centers provide additional services, “offering language assistance, insurance enrollment assistance, transportation, and other services not usually offered by private health care facilities,” the report says.

Massachusetts has long been a crucible for health care reform, and in an editorial accompanying the study, researcher Mitchell H. Katz, M.D., of the Los Angeles County Department of Health Services, points to these findings as a call to action. In order for our system to handle the additional 17 million patients who will be insured when the Affordable Care Act is takes effect in 2014 (not to mention the 24 million who will remain uninsured), we’re not just going to need more primary care providers, he argues. Katz calls for the creation of teams of health care providers who are linked through technology to provide the best care for these safety-net patients:

[A]s internists, we need to focus on diagnosing and treating people with complicated illnesses. We need panel managers to cull through patient registries to identify patients who need screening tests (eg, colon cancer screening, mammography) and preventive treatments (eg, influenza vaccination) and to arrange these interventions through standing orders. We need case managers to teach patients how to manage their illnesses, to motivate patients to make lifestyle changes that will improve their health, to help them adhere to treatments, and to direct them to places other than emergency departments whenthey have nonemergent problems. We need to use our pharmacists to stop filling or supervising the filling of pill bottles, a task best done by machine, but rather to see patients on complicated medication regimens and assess them for adverse effects, drug interactions, and need for simplification in regimen.

“Ironically, safety-net providers have more experience working in teams than most commercial providers because low reimbursement rates have forced them to learn to be more cost-efficient,” he writes. “The challenge will be proving that they can also be a system of choice for their patients, not just in Massachusetts, but across the country.”