In Chicago, a University Initiative Rethinks Health Care
Saturday, July 25, 2009
CHICAGO -- On the sprawling South Side of one of the nation's largest cities, the logic of health care is haphazard, at best. For tens of thousands of the working poor and the unemployed poorer, the concept of a regular doctor and easy access to affordable care is a fantasy.
Clinics are scattered and family doctors few. Too many patients get too little care until small problems become big ones. Others who are not very sick go straight to hospital emergency rooms, where the care is costly and the wait is often long.
To put it simply, there is no health-care system for the 1.1 million residents of Chicago's South Side, said Eric E. Whitaker, a physician and public health specialist who is leading an ambitious and controversial University of Chicago project to remake the delivery of care.
With moral support from close friends in the White House, Whitaker and his Urban Health Initiative team are trying to produce a major expansion of community care that will improve patient health and reduce costs -- goals central to President Obama's health-care reforms.
Obama, who traveled to Ohio last week to tout the Cleveland Clinic as a model of low-cost collaboration between nurses and doctors, hospitals and clinics, is well-versed in the Chicago experiment. Whitaker, a friend since they met at Harvard 20 years ago, is a frequent White House visitor and participated in the early health-care discussions. He told the City Club of Chicago in April: "I need your help. The president needs your help."
Whitaker was lured to his job as executive vice president of the University of Chicago Medical Center by Michelle Obama and by Valerie Jarrett. Obama, who launched the South Side Health Collaborative in 2005, was leading the hospital's outreach program and Jarrett, now a presidential adviser, chaired the medical center board.
On June 29, Michelle Obama announced $851 million in federal stimulus grants to upgrade community health centers, saying their work "has never been more important."
Described by Yale University professor Harlan M. Krumholz as the largest effort of its kind in the country, the Urban Health Initiative seeks to improve health and reduce reliance on emergency rooms by encouraging "medical homes" -- a clinic or doctor's office where patients can turn for routine needs and chronic conditions.
The initiative reinforces local institutions with university doctors and connects people to primary-care physicians and community hospitals. Success will require changes in expectations and behavior from patients and doctors, along with technology and shoe leather to make it happen and test what works -- and what doesn't.
'A System Where People Can Go'
If that sounds similar to the promise and peril of reforms being debated in Congress, it may be because Chicago's quandary is representative of the daunting dysfunction that defines the health industry in many other places.
"We have to create a system where people can go. It doesn't exist and we're trying to build it," said Whitaker, who worked for seven years in a South Side clinic and once ran the Illinois Public Health Department.
Whitaker, who spends much of his time negotiating with doctors, community groups, government officials and university skeptics, calls these the "very early" days in "a decade, two-decade experiment."