By Richard Asinof
By Richard Asinof
Rhode Island leads the nation in implementing the patient-centered medical home model of health care, with its focus on primary care. One of the leaders in this transition is Coastal Medical, Rhode Islandâ€™s largest private group practice, with more than 85 physicians, nurse practitioners and physicianâ€™s assistants serving some 150,000 patients.
In the future, according to Dr. Michael Fine, director of the R.I. Department of Health, patient-centered medical homes could handle 90 percent of a patientâ€™s health needs â€“ including lab work, imaging, pharmacy and doctorâ€™s visits â€“ and they would be within a few miles of a patientâ€™s home.
Dr. G. Alan Kurose, president and CEO of Coastal Medical, has taken a leadership role in positioning the group practice to be in the forefront in changes to the health care delivery system in Rhode Island.
PBN: How has the patient-centered medical home model at Coastal Medical changed the way that care is delivered?
KUROSE: The new emphasis on a team approach is a major change. Doctors are spending more time doing the things only they can do. Nurse care managers are playing a key role educating patients and guiding them through the system. We donâ€™t wait for patients to come to us anymore. If patients arenâ€™t keeping up with recommended care, weâ€™re calling them.
PBN: What kinds of IT applications has Coastal Medical developed to allow patients and doctors/nurses to communicate in real time?
KUROSE: We have implemented a new patient portal that allows patients to access their test results through the Internet and to request an appointment. This is just the beginning. We hope to have a Skype type of functionality in our electronic medical record by early next year.
PBN: What do you think Rhode Island can do to attract more primary care physicians to practice in the state?
KUROSE: The Rhode Island Foundation helps repay educational loans for primary care physicians who start practice here. The Office of the Health Insurance Commissioner has increased spending on primary care, and this has helped to increase primary care physician incomes in Rhode Island from their historically low levels.
We are No. 1 in the country in patient-centered medical home implementation. Rhode Island is gaining national recognition as a state where primary care is thriving and meaningful reform is underway. Raising our profile further to create more awareness of whatâ€™s happening here is the best thing we can do to attract more primary care physicians.
PBN: In Rhode Island, what are the strengths the state can build upon to improve the health delivery system outcomes?
KUROSE: We have a lot of assets in Rhode Island. The Rhode Island Chronic Care Sustainability Initiative, the all-payer, patient-centered medical home demonstration project, is one of only eight such programs across the country funded by Medicare.
The Rhode Island Quality Institute has garnered significant federal funds over time to support electronic medical record adoption, help transform our delivery system, and build currentcare, our new health information technology network for the state.
Sen. Sheldon Whitehouse is a national leader on healthcare issues.
Commissioner Christopher F. Koller is the only state health insurance commissioner in the nation.
We need a coherent global strategic plan for the health care system in Rhode Island. Fragmentation of our complex health care delivery system is a major challenge. We have to do better bridging the gaps. Technology can help, but by itself, itâ€™s not enough.
PBN: What kinds of workplace wellness programs would you like to see businesses adopt as part of their ongoing workplace operations?
KUROSE: Obesity, sedentary lifestyles, smoking, and lack of appropriate preventive care are just some of the areas where workplace wellness programs can be effective. Medical homes, health insurers and employers should collaborate to improve the health of the Rhode Island workforce.