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SCHENECTADY
‘Navigators’ help poor get care Medical home offers ounces of prevention
BY SARA FOSS Gazette Reporter

    When the van arrives at the entrance to the Ellis Health Center, two nurses approach the vehicle, clipboards in hand.
    They open the door to the vehicle and help a woman who is complaining that her head hurts. She’s unsteady on her feet and looks like she’s in pain. The nurses make a quick decision: This woman belongs in the emergency room. They help the woman back into the van and accompany her to the nearby ER.
    For more than a year, Deb Eaton and Margaret Rogers-Meagher have greeted this van every weekday, introducing themselves to passengers and escorting them to the proper medical services. They give patients bus tokens so that they can get home and make follow-up calls to see how they’re doing. They hand patients their business cards and tell them to call if they have any questions.
    Eaton and Rogers-Meagher are “nurse navigators” for the medical home at Ellis Health Center on Mc-Clellan Street, part of a new initiative that aims to provide comprehensive primary care services and make health care easier to access and navigate. The idea is to divert people from the emergency room and connect them with doctors and specialists and to get them to think about preventive care and wellness.
    “We want to provide primary care,” said Eaton. “We want to make sure people have their own doctors. We want it to be friendly, and we want people to accept that we’re here to help them.”
    The medical home — formally known as the Cushing Center for Family Medicine at Ellis Health Center — is designed to be friendly and welcoming, with a registration area that resembles a hotel lobby. The family health center is based here, as well as the pediatric health center, dental health center and child and adolescent treatment center. Outpatient services, such as day surgery, nutrition counseling and swallowing and speech therapy, are also available. If necessary, the nurse navigators can send patients to practices and services in the community.
    “The idea is to be able to walk patients from service to service,” said Rogers-Meagher.
FOCUS ON THE POOR
    The medical home is open to all, but it is of particular use to the poor.
    “A lot of people don’t even realize what primary care means,” said Kellie Valenti, assistant vice president of Ellis Medicine.
    Many people lack health insurance and don’t have a doctor when they first arrive at the medical home; many of them haven’t seen a primary care physician in years and only seek medical attention when it’s urgent.
    Such people are directed to Rogers-Meagher and Eaton, who make followup appointments for them with a primary care physician based at the family health center and work to enroll them in a low-cost insurance program such as Fidelis Care, which has an office at the facility, or in Medicaid. More than one-third of patients keep their followup appointments; since October 2009, the nurse navigators have connected 163 people with primary care physicians. Overall, they’ve worked with close to 900 patients.
    One of those patients is 38-yearold Dekida Hamler. She fi rst learned about the medical home when she visited the emergency room with her 2-year-old daughter, Journey, who is allergic to mosquitoes and needed an epinephrine shot. Hamler applied for Medicaid; when that process was complete, she made doctors’ appointments for herself and Journey at the family health center.
    Hamler took the Ellis shuttle to the family health center for her fi rst appointment, and Eaton greeted her at the door. This personal touch was extremely helpful, she said, because the center “is kind of intimidating. You don’t know where to go. The building is humongous.”
    One of the first things Hamler did was see the dentist. Her face was swollen and sore, and the dentist informed her that she had an impacted wisdom tooth and three broken teeth, which he took care of. Hamler also received a prescription for blood pressure medication from her new doctor, and she learned that the pain in her leg and resulting limp was caused by an old accident and she would need a hip replacement. That procedure is pending.
    What impressed her most about the medical home, Hamler said, “was the caring and people wanting me to care about things. … I felt like I was supported. If it wasn’t for the nurse navigators, I wouldn’t have come back. I had always used the ER for medical care. That’s the poverty way of thinking.”
    A recovering drug addict, Hamler works at the City Mission of Schenectady and lives in the organization’s transitional housing.
MEDICAL HOMES
    The idea of medical homes has been around since the 1960s, when the American Academy of Pediatrics first coined the term to describe the best system for delivering health care to children with special needs. Over the years, the definition of the term has evolved, and today the medical home is broadly defi ned as primary care that is accessible, continuous, comprehensive, familycentered, coordinated, compassionate and culturally effective.
    Advocates believe medical homes can be a tool for reducing health care costs. Emergency room care is expensive, and the hope is that emphasizing preventive and primary care will eventually lead to savings.
    The medical home at Ellis Health Center has attracted the attention of other hospitals. In March, Valenti will speak at the National Medical Home Summit in Philadelphia.
    The nurse navigators work closely with social service agencies such as the Schenectady Community Action Project and the City Mission. A community services navigator, employed by SCAP, is based at the medical home and can help patients with needs such as housing and food. A Schenectady City School District registration offi ce is based at Ellis Health Center, and staff frequently direct parents and their children to the medical home for immunizations and other services. ...................>>>>......................>>>>................http://www.dailygazette.net/De.....r00103&AppName=1