Collaboration, quality to be key under health reform

From left, Drs. Carl Haisch, Charles Willson and Kathleen Previll of the Brody School of Medicine talk during a break at the health care reform symposium held Friday, Jan. 13. Photo by Cliff Hollis

Health care professionals and organizations will have to work together, coordinate care and improve quality like never before to survive after 2014, when the national health care reform law starts to take effect. 

That was the message of speakers at a health care reform symposium Friday organized by East Carolina University, the Eastern Area Health Education Center and University Health Systems of Eastern Carolina. It was held at the East Carolina Heart Institute at ECU.

“These groups are going to have to interact in a whole different way,” said Dr. Thomas G. Irons, a professor of pediatrics and associate vice chancellor for health sciences at ECU, referring to hospitals, medical schools, health departments, health centers, physicians and many others who make up the health care system. “We have to engage. It’s not about coming to a meeting and talking. We will fail if we do not do this together.”

The federal Patient Protection and Affordable Care Act, signed into law in 2010, is intended, in part, to reform aspects of the health insurance industry, increase coverage of pre-existing conditions, expand access to insurance, reduce projected Medicare expenditures. 

Coordination of care will also take on increased importance as Medicare focuses on reducing hospital readmissions, said Dr. Samuel Cykert, a professor at the University of North Carolina at Chapel Hill School of Medicine. Patient-centered medical homes, led by primary care physicians, will play a lead role in coordinating care.

“Those of us in primary care have to say, ‘The buck stops here,'” he said, referring to the need to direct care coordination. He cited organized efforts to improve the health of diabetes patients as an example. Diabetes patients whose care is not well-managed have a significant risk of developing complications, such as blindness, limb amputation and kidney disease. 

The health care system will also have to deal with an influx of new people who will be seeking care. 

“Health care reform was passed at a time when state budgets were crumbling” and employers were cutting back and dropping health benefits for their workers, said Allen Feezor, senior policy advisor for the N.C. Department of Health and Human Services and a former executive at Pitt County Memorial Hospital. “There are going to be about a million new folks who will have access to health care financing than before.”

Many of these will seek to purchase health insurance coverage from the new insurance exchange North Carolina is in the process of setting up, Feezor said. About 250,000 who have coverage now will switch to the exchange, he predicted, and he encouraged providers to develop strategies for treating these new patients.

Improved oral health will also be a key to improving overall health status and reducing costs, said Dr. Gregory Chadwick, interim dean of the ECU School of Dental Medicine. Four North Carolina counties, all in the east, have no dentists, and three eastern counties have only one dentist. 

Studies have shown oral health to be connected to other diseases, such as cardiovascular disease, according to the National Institute of Dental and Craniofacial Research. 

Ahoskie, where ECU will open its first dental community service learning center this spring, has a sufficient number of dentists, but they range in age from 57 to 92, Chadwick said, underscoring the need to educate new dentists who want to practice in rural areas.

“Most of the problems we deal with are preventable,” he said. “There is no way we are going to drill and fill our way out of the oral health challenges we face, especially in the eastern part of the state.”

Chadwick said construction could start as soon as next week on a second service learning center in Elizabeth City.