A unique University of New Mexico School of Medicine model of health care that seamlessly integrates public and private providers while treating both the symptoms and root causes of illness is being heralded in a special segment ofAnnals of Family Medicineas a role model of what health care could become in the future.
The "Health Commons" model care, created in a joint partnership between UNM School of Medicine Department of Family and Community Medicine physicians and rural and urban community safety-net providers was a response to the increasingly competitive forces acting on medicine during the past decade that have resulted in millions of uninsured Americans being forced to do without adequate medical care.
Traditionally, a commons was an area where people could gather and be served as equals. The idea behind the Health Commons model was to develop a system where community health care planning and service would be shared equally between the university and community stakeholders. In New Mexico , that meant creating two inner-city neighborhood and two rural county locations where uninsured patients could experience "one-stop shopping" for medical, behavioral and social services with local economic development a byproduct of the process.
While the four sites have a single philosophical foundation, each is uniquely organized to reflect the needs of the community it serves. Clustering safety-net providers makes it much easier to address the social determinants of disease and reduce health disparities. For instance, a mother might be able to see her own health care provider, have immunization shots given to her child and be able to access job counseling and food stamp services in one trip on the same day a major health care barrier breakthrough to many families with limited income and access to reliable transportation issues.
Creating a system with community input has resulted in creative solutions to community problems.
For instance, in Albuquerque at the Southeast Heights Health Commons, two family medicine residents explored options for a community-based health improvement project with unemployed Hispanic women enrolled in the clinic. To their surprise, the women's health' priority was finding employment and they created La Mesa Cleaning Cooperative. The residents came to believe that economic development was both a legitimate and effective health intervention addressing the social determinates of illness presenting in their clinic.
The lessons from the Health Care Commons hold great promise for Academic Medical Centers. Although teaching hospitals comprise only six percent of all hospitals nationally, they provide more than one half of all charity care. The problem is exacerbated in states such as New Mexico where the level of employer-based insurance is low and the level of illegal immigration is high, wrote Paul Roth, M.D., UNM vice president of Health Sciences, in an accompanying commentary on his decision to green light the Department of Family and Community Medicine's move into a new model of care.
"The economic forces acting on us during the past decade have clearly threatened our institution mission and harmed our reputation within the community. I felt strongly that we needed to understand our community and regain their trust as a partner on their behalf and to ensure their health while protecting the survivability of our academic health center," Roth wrote. He added that the success of the Commons model has helped fuel new partnerships and initiatives throughout the state.
While quality of care for the uninsured has increased, the sites have demonstrated significant cost decreases due to less duplication of services; reduced visit times and drops in no-show rates responses that maximize the efficient use of expensive clinician time.
"It makes sense that Family and Community Medicine has a special role to play within Academic Health Centers serving on the forefront in creating new models of care," said Arthur Kaufman, M.D., chair of the Department of Family and Community Medicine within the UNM School of Medicine. "Traditionally our physicians have served as a bridge between the university and the community and between the curative and public health systems of care. Our graduates contend with frontline community reality since they are geographically distributed than any other specialty in areas of need. "
The article was written as collaboration between the UNM Department of Family and Community Medicine and its partner safety net providers organizations. These include Robert DeFelice, MBA, MPH of First Choice Community Health Care Inc. in Albuquerque; Leora Jaeger, MRCP and Nicola Baptiste of the Sandoval County Community Health Alliance in Bernalillo and Charles Alfero of the Hidalgo Medical Services in Lordsburg, New Mexico. UNM Health Sciences Center Family and Community Medicine faculty members coauthors include Kaufman, Daniel Derksen, M.D., Angelo Tomeci, M.D., Saverio Sava, M.D. and Wayne Powell, M.A.
Unique Solutions Spawned by the New Mexico Health Commons ModelExperience:
A number of technological innovations were incorporated into the commons:
· Creation of a software based program that allows ER personnel to schedule patient follow-up appointments on a 24-hour basis a procedure that has reduced costly follow-up visits to the ER.
· The creation of the nation's first state-wide public/private Nurse Advice line partnership where patients can call and receive health care triage regardless of whether or not they are insured.
· Information System (IS) Innovations for all Safety-Net Partners. Though most safety-net partners had incompatible medical IF, they now communicate via ExtraNet, which is a HIPAA-compliant, web-based interface. UNM commercialized and marketed the product for the partners with generated monies reinvested to expand health and social services for the uninsured.
Health Commons Locations inNew Mexico
Hidalgo Medical Servicesserves seven southwest New Mexico communities located in a "medical frontier' (<7 persons to a square mile.)Prior to this center opening 1995, the area had been without a physician for more than a decade and had never had a dentist. Today there are four UNM residency trained M.D.s practicing while a wealth of social and family support services are integrated into the primary and behavioral medical care offered at the site.
Sandoval County Health Commons:This Commons is a public/private interagency partnership initiated by the Sandoval County Health Alliance. Bilingual staff provide interdisciplinary, holistic services through unified intake screening and assessment processes. Families are seen as a unit, receiving multiple services during one appointment in one building.
SoutheastHeightsCenterfor Family Health.The oldest Health Commons campus. The site is characterized by high mobility, ethnic diversity, poverty and social stresses including inadequate housing, isolation, violence and substance abuse. It is an entry point for poor migrants and immigrants.
Albuquerque,New Mexico: South Valley Health Commons.Set in a predominately poor, underserved community Albuquerque with High unemployment and high school drop-out rates. Will open in early 2007.
Contact: Cindy Foster, 272-3322