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By Dr. Myechia Minter-Jordan
Dr Myechia Minter-Jordan is president and CEO of the Dimock Center, a nationally recognized community health center in Roxbury.
Growing up, I always knew I wanted to be a doctor. I remember being fascinated by all the cool gadgets in the doctor's office, from the cold feeling of the stethoscope on my skin as the doctor listened to my breathing, to the funny feeling as my doctor tapped my knee with the small hammer to test my reflexes. It always felt exciting to me, even when we had to make two or three visits to separate clinics for doctor’s appointments and medical care. As a young child, it seemed like an adventure.
What I didn’t realize was that it was not an adventure for my parents. They often had to take multiple days off of work to go to those appointments and they weren’t happy about it. They ran in circles giving the same information over and over to different nurses and doctors, receiving few helpful results. They often left those appointments more frustrated and perplexed than when we arrived.
Now, as an adult and a doctor reflecting back on those times, I can say with certainty that my family’s primary care provider never spoke with our dentist and eye doctors about our health and wellness. My mother’s OB-GYN never communicated directly to our pediatrician about her care or anticipated my needs as a new infant. Fragmented, clunky and often disempowering, that was our health care system then in many ways. And it still is now.
Why are there not more people knocking at my door to learn from our model of care?
Throughout its history, our health care system became increasingly disjointed, and we are now faced with the reality that we must seek alternate models that are centered on the patient. We must seek models that are streamlined, efficient, less expensive and more empowering for the patient. We need models that enhance communication among providers about the patient and their health care experience. And we need to improve the collective health of our communities.
In other words, we need a model that has existed in our country since 1965: the community health centers.
Here's what community health centers offer:
• Primary care to a defined population
• Public health interventions aimed at improving the social factors in health
• An emphasis on community involvement and empowerment, including control of the center itself
• Epidemiology to identify problems and guide decisions
• Particular improvement in the health and health care of poor people and minorities.
So, from my perspective as a leader of one of Boston’s largest health centers, The Dimock Center, I wonder: Why are there not more people knocking at my door to learn from our model of care?
The reason is that until now, health care has been a business built on transactions. A visit to the Emergency Department or to the doctor generates a fee for that service. The more you do, the more you get paid. Our system has failed to integrate behavioral health and primary care, and to account for the patient’s illness experience.
Quality and cost containment have been given secondary status. In fact, per capita health care spending in Massachusetts is the highest of any state at $9,278 (based on per capita spending in 2009). Hospital utilization for outpatient services (services that could be delivered in much lower cost settings like health centers) are a significant contributor to our exorbitant spending, according to the new Massachusetts Health Policy Commission’s 2013 Cost Trends Report.
Our system is imploding. The stark reality is that the system has priced itself out of its own market.
With health care reform, we now have the opportunity to right a sinking ship. We can design a system that prioritizes the patient, the quality of their care and cost containment. We can reduce inefficiencies and waste and improve patient outcomes. We can redirect care to be in the right time and place and at the lowest cost. We can begin to close the gap between our country’s health outcomes and those of almost every other developed country that have outpaced us for decades.
I and other leaders in community health will gladly help to foster a better understanding of how we have been able to achieve quality measures that surpass local and national standards, while balancing cost efficiency and patient empowerment. I can explain how we integrate behavioral health into primary care while improving patient outcomes and provider and patient satisfaction.
One of the advantages that we have in Massachusetts in particular, is that we have a rich network of community health centers and academic institutions like The Dimock Center and The Center for Primary Care at Harvard Medical School, that are leading the nation in health care reform. Now, if only we would recognize the value of harnessing the expertise from the entire network, perhaps we would be better leaders for our nation and for our world.
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