A better way to provide health care, threatened by budget cuts

CO-OP medical care at risk in supercommittee deliberations

November 16, 2011|By Rachita Sood and Marce Abare

With a potent mix of excitement and idealism, we set out to become physicians serving on the front lines — primary-care doctors who would be the first point of contact for patients we would follow over the course of a lifetime. Yet throughout our training, the ideals of a career in primary care have begun to fade as strong financial, administrative and lifestyle considerations push us steadily toward specialization.

As the United States struggles with a shortage of primary-case physicians, the pressure to veer from general practice represents a systemwide failure to supply the well-trained primary doctors our communities deserve. If we care about retaining physicians with a desire to serve at the front lines, we need to enable a system of health care delivery and financing that supports this work.

In Maryland's own Evergreen Project, a prototype of the nationally known health care CO-OP model, we find an innovative solution that will draw medical school graduates to primary care, improve the health of communities and ultimately lower costs. But as the federal budget-cutting supercommittee nears its Nov. 23 deadline, it is set to cut the funds allocated for low-interest loans that would act as seed funding for these projects. Pre-emptive termination of the Evergreen Project and many more like it across the country would mean the end of a novel, fiscally sound solution to many of the complex issues challenging our health care system today.

Consumer Operated and Oriented Plans (CO-OPs), described in the Affordable Care Act, are nonprofit, consumer-governed health plans that use a variety of delivery and payment methods to lower costs of care. As envisioned in Maryland, CO-OPs involve a network of neighborhood-based health centers staffed by interdisciplinary teams including a nurse practitioner, a primary care physician, medical assistant and part-time social worker, among others, who would deliver both routine and urgent care for members of the CO-OP insurance pool living within a defined neighborhood. Health professionals would be salaried, and empirical evidence would guide available treatments.

From the perspective of future physicians, we would benefit tremendously from a CO-OP medical culture that emphasizes evidence-based decision-making, pays a competitive salary, and maintains a fraction of the patient load of typical primary care offices. Enabling longer patient visits and more efficient use of clinic resources will allow physicians to focus on collaborative management of chronic conditions and timely prevention measures. These are the types of employment perks that will influence career decisions of medical students like us, who value the ability to listen to patients' experiences and build long-standing relationships.

In addition to improving quality of care, CO-OP health care systems will address a key issue: access. Despite the Affordable Care Act's mandate for greatly increased health insurance, private plans will still be out of reach of many working Americans. By offering lower premiums, CO-OP models can fill this gap and bring stable, long-term care to more people. Specifically, the Evergreen Project's use of salaried physician payments and evidence-based treatment is expected to lower premiums by 20 percent to 30 percent.

Our current system fails to successfully address the most pervasive and expensive chronic medical conditions — diabetes, heart disease, obesity — because Americans without insurance and consistent access to health maintenance and preventive care cannot properly manage these problems. When acute complications arise, these Americans find themselves in the emergency room, where expensive care must be provided to treat a problem that could have been avoided. We're hopeful that expanded access created by CO-OP models across the nation will alleviate this vicious cycle and ultimately rein in health care costs.

In addition to the numerous potential benefits of the CO-OP scheme, this model is also budget neutral. Federal government start-up funds have been allocated in the form of a loan rather than a grant. These loans include a repayment schedule based on milestones in the CO-OP's development, so there is no long-term impact on the budget. As we wrestle with the ongoing economic crisis, we must strengthen the systems that work — and stand by our commitment to innovations that improve systems that do not.

The Evergreen Project is poised to open pilot clinics in January. Yet, even with private funding secured from Maryland-based foundations, if government loans are abolished the Evergreen Project won't get off the ground. Considering the strong value this model offers to both future physicians and working-class families seeking health insurance, we urge the supercommittee members to maintain the low-interest loans required for CO-OP health care plans to take root.

Rachita Sood (sood.rachita@gmail.com) is a student at the University of Maryland. Marce Abare (mabare@jhsph.edu) is a student at the Johns Hopkins Bloomberg School of Public Health and the University of Michigan Medical School. Both are members of the American Medical Student Association.

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