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SCHENECTADY
McClellan Campus using new concept
Goal of medical home is to improve care
BY SARA FOSS Gazette Reporter

    Earlier this month, Dre-a accompanied a friend with an abscessed tooth to the Ellis Hospital McClellan Campus in Schenectady.
    A shuttle picked the women up at the City Mission of Schenectady and brought them to the campus. A greeter escorted them into the building and guided them to the right office. There was no wait; the entire process took about 20 minutes. And as they left, they were handed bus tokens for the trip home.
    “I’ve been up there plenty of times,” said Dre-a, 40, who lives at the City Mission’s Family Life Center and asked that her last name not be used. “But it’s different now because if you’re low income, they’ll come pick you up.”
    In the past, Dre-a got to what was then St. Clare’s Hospital by bus, taxi, walking or getting someone to give her a ride.
    In 2008, St. Clare’s Hospital merged with Ellis Hospital, which took over its McClellan Street property and turned it into an outpatient facility with a 24-hour emergency room. Now Ellis is in the process of transforming the McClellan campus into something called a medical home. This requires making physical changes but also thinking about health care in a new way.
    In a medical home, the emphasis is on preventive and primary care and the relationship between the patient and the clinician. Routine doctor’s visits are encouraged while non-emergency use of the ER is discouraged. Doctors are expected to be proactive rather than reactive. The idea is to make the health system integrated and user-friendly.
    “When the health care community talks about medical homes, it’s a concept of care,” said Patti Hammond, vice president of operations for Ellis Hospital. “We’re trying to divert people from the emergency department and get them thinking about primary care.”
    The goal is to create a medical home for all patients, regardless of whether they have health insurance.
DECADES-OLD CONCEPT
    The medical home concept has been around since the 1960s, when the American Academy of Pediatrics first coined the term to describe how best to deliver care to children with special health care needs. Over the years, the definition of the term has evolved, and today the medical home is broadly defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective.
    Advocates believe medical homes will be a necessary component of any attempt to overhaul the country’s health system, something that President Barack Obama’s administration has said it plans to do this year. They say the medical home approach to health care will lead to better management of chronic disease, lowered health care costs, improved preventive care and fewer disparities in care.
    A 2008 Commonwealth Fund study found that only 65 percent of adults under 65 have an accessible primary care provider. Only half of the overall group had received all recommended screening and preventive care. Among uninsured adults, only 30 percent had received preventive care. Based in New York City, the Commonwealth Fund is a private foundation that focuses on health care issues.
    “Strengthening primary care is a critical component to achieving higher performance,” said Melinda Barnes, assistant vice president of the Commonwealth Fund’s patient-centered primary care initiative. “The medical home is an important building block to strengthening primary care.”
FACING A SHORTAGE
    One of the biggest issues, Barnes said, is that the reimbursement rate for primary care is lower than the reimbursement rate for other types of services. As a result, the country is faced with a shortage of primary care physicians as more medical students opt to go into higher paying fields. New York recently launched a program, called Doctors Across New York, which aims to address this problem by helping young doctors who agree to work in medically underserved areas with money to repay their student loans.
    Barnes said that the payment structure for primary care needs to be changed. “Primary care providers make half of what specialists make,” she said. “Less than 2 percent of students are choosing careers in primary care.”
    At the Ellis Hospital McClellan Campus, the transition to a medical home is ongoing.
    After the merger, officials began meeting with community groups to get a better sense of what patients need. They then began developing plans for shifting services to more accessible locations and making the facility more open and easier to navigate.
    The pediatric health center has moved from the facility’s basement to the second floor. The outpatient adolescent mental health unit, which had been at Ellis Hospital’s Nott Street campus, also moved to McClellan’s second floor, and both departments have doubled their capacity.
    “We can see patients in a timely fashion,” explained Dr. Kevin Karpowicz, head of pediatrics at Ellis Hospital. “Before we only had three exam rooms. Now we have seven. And these rooms are better equipped.”
    Christine Waghorn, operations manager for psychiatry, said the extra space for adolescent mental health will allow for the addition of a full-time social worker and a fulltime nurse practitioner. Patient visits will jump from 1,000 to 5,000 a year, she said......>>>>..............>>>>...........http://www.dailygazette.net/De.....amp;EntityId=Ar00103