Every weekday, nurse Jill Ross telephones some of her sickest patients. On this particular morning, she is asking breast cancer patient Renita Mock when her double mastectomy is scheduled. The conversation quickly veers to Mock’s stress over the operation.
As someone with diabetes, hypertension and a host of other illnesses, Mock, 52, is considered too high-risk for reconstructive surgery, and she’s struggling with the prospect of losing her breasts. She asks for help in finding a therapist.
Ross promises to provide her with names. She also tells Mock that she’ll be calling regularly “to see how you’re doing, if you saw a specialist, if your medication’s changed, kinda seeing what’s going on with you.”
Thank you so much, Mock replies.
“It’s a lot going on, and it’s stressful,” Ross adds. “But you know what? We can get through it.”
These calls to patients are part of a new approach to primary medical care that Maryland is testing across the state. Instead of a doctor seeing patients mostly when they’re sick — and the physician is getting paid for that visit or service — this program gives financial rewards to practices that use a team of doctors, nurses and other staff to treat the whole person on a continuing basis, not just for one illness. The team focuses on patients with chronic conditions, develops individual care plans, and coordinates with specialists. Emphasis is on prevention and comprehensive care.
For a patient, it is like having a doctor’s office that acts like mom — with nags and nudges designed to promote better health.
The state initiative is among dozens of public and private experiments across the country that are trying to fundamentally change the way doctors practice medicine. Federal policymakers are watching closely to see whether the strategy can improve care and reduce costs, one of the pillars of the health-care overhaul law.
Early experiments suggests that definitive results will take substantial time and investment. But, experts say, the concept holds promise for rescuing the country’s historically underfunded and undervalued primary care system.
Primary care doctors will be in even greater demand as the country approaches 2014, when the health-care law is expected to expand insurance coverage to millions more Americans.
For patients such as Mock, the extra support is welcome. She likes the idea of one office being in charge of her health. Especially now.
“When [the surgeon] told me I might have no breasts, well, that threw me for a loop,” Mock said in an interview later. “I was holding back tears, then I just broke down. . . . When you get sick, you think, ‘How do I help myself?’ ”
‘Value, not . . . volume’
Coordinating care is part of Jill Ross’s new duties at MedPeds, an internal medicine, family medicine and pediatrics practice in Laurel. It is one of 52 primary care practices chosen by state health officials from about 200 applications to take part in the Maryland program, which began in May and will run for three years. About 245,000 patients are in the program.
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