CHESTERTOWN - Health clinics and hospitals in the Adirondack region will be able to offer more attentive primary care when a state pilot program is launched this summer, the state's top medical official said Wednesday.
State Health Commissioner Richard Daines revealed details of the program as he visited the Chester-Horicon Health Center and talked with Dr. John Rugge, founder of the center and 10 similar ones in the Adirondack region.
Rugge helped Daines and other state officials engineer the new Adirondack Region Medical Home Pilot, which is expected to boost primary care and disease prevention while encouraging more attentive care for those with chronic diseases, Daines said Wednesday.
Preliminary studies have indicated such an approach will improve public health while reducing the costs of ever-rising medical expenses paid by the state and health insurance companies.
The state, insurers and health maintenance organizations will all be contributing to the cost of boosted payments for primary care and preventive services to hospitals, clinics and private practices throughout the Adirondacks .
Participating primary care providers include Hudson Headwaters Health Network health centers in Warren and Essex counties, Inter-Lakes Health in Ticonderoga, Smith House Health Care Center in Willsboro, Elizabethtown Community Hospital, Champlain Valley Physicians Hospital and doctors in the Plattsburgh area, and the Adirondack Medical Center based in Saranac Lake .
Participating payers include the state - through Medicaid and its civil service program - and private insurers BlueShield of Northeastern New York, Empire Blue Cross, Excellus, Fidelis Care, MVP Healthcare, and United Healthcare.
The pilot program is expected to strengthen primary care provided by family doctors to keep people healthier and minimize hospital care, Daines said.
Rugge and Daines said that the program was designed to encourage health care that was comprehensive, coordinated and family-centered.
"This state has far too much inpatient cost," Daines said. "We have high rates of preventable hospitalization-it's time we shift our focus to primary preventative care."
The Adirondack Regional Medical Home Pilot Program is scheduled to receive about $9.5 million in state funding over the next fiscal year, which will be divided up between the seven participating facilities.
"We expect to receive an additional $5 or 6 million in reimbursements from six participating insurance companies," HHHN's founder Dr. John Rugge said. "Studies have shown that preventative outpatient care results in reduced overall medical cost and reduced mortality."
Rugge said that death rates for ailments like heart disease and cancer are significantly higher among Adirondack residents than the general population. Long-term, patient-focused preventative health maintenance is the key to boosting public health and minimizing hospital stays, Daines and Rugge said.
The majority of health issues in the Adirondack region, Rugge said, are directly related to such behavior choices as smoking and overeating, and the pilot program would be addressing such issues through both preventive care and public education.
Daines suggested that the Chester-Horicon Health Center and others throughout the Adirondacks were already practicing patient-centered health care, and they provided a model for health care systems across the state.
"The way the doctors here are committed to their community and patients is like nowhere else," Daines said. "Facilities like this are places that can influence or change behavior-that's what we want to do. We must form a model that fits the rural demographic."
Physicians and health care providers through the region have expressed concerns that state and insurance reimbursement rates haven't been high enough to cover the cost of medical care.
Rugge said the boosted reimbursement rates would help health clinics through the Adirondacks to continue providing quality care.
Currently, approximately 15 percent of the patients HHHN treats are uninsured, with Medicaid only making up for 55 percent of the cost of treatment for these individuals.
If adopted, the pilot program would double the funding to outpatient facilities for the treatment of the uninsured from $55 million to $110 million, Daines said.
Pilot participants include 35 medical practices with 101 physicians and 76 physician assistants and nurse practitioners.
For adults, disease management will focus on chronic diseases that account for nearly 80% of health care spending - conditions that include diabetes, hypertension, coronary artery disease, and congestive heart failure. For children, the focus will be providing preventive services and the long-term management of chronic conditions such as obesity and Attention Deficit Hyperactivity Disorder.
HHHN is slated to receive approximately $1.3 million of the initial $9.5 million that has been pledged to the pilot program.