In Southwest New Mexico, a public health clinic offers a model for rural care
Only when Resendiz ended up in the emergency room without vision in one eye, her left arm numb, did she pay attention to her own health. "I thought it was an aneurysm," Resendiz said. "But it was stress and diabetes."
A similar fate befell
Both women credit their survival to
Financing public health care poses another problem: Although the state's
Although the group has grown since, it hasn't wavered from its long-term goal: providing a better health care system focused on patients' needs.
So what makes it revolutionary? The clinic's model has four main components: It builds a health care team for each patient, expands the number of medical residencies offered at the clinic, shares an electronic record program among all providers and promotes health care careers to young people.
"Our vision is fundamentally about changing health care delivery across the state and the nation, not just in
Teaming up for care
Resendiz and Marquez monitor their diabetes daily, and they will have to do so for the rest of their lives. It can be overwhelming to track their blood sugar levels, diets, work and doctor appointments.
Fortunately, they each have a team to help.
Five years ago,
The cooperative approach helps share the load of a managed care system now heavy with paperwork and performance requirements under the federal Affordable Care Act.
"The whole pay per performance under the federal requirements? You can't do it on your own," said Dr.
"Having an integrated model is going to make that possible," Troxler said.
Central to the integrated teams are community health workers, trusted locals trained to educate people about basic health care, diabetes and nutrition. Community health workers have been around for years, but "they were never really accepted into the house of medicine," said Dr.
Community health workers address the "social determinants" of health, such as transportation, food, home life and insurance. They are the front line, identifying all the issues that can prevent a patient from making appointments or following up on treatments. If the client needs a dental checkup, food stamps, housing, a job or help obtaining home care, the community health worker is there to coordinate.
"We provide a lot of support and encouragement for people who find themselves stuck with a lot of problems," said
Rippetoe helped Marquez obtain insurance quickly and qualify for a sliding-scale fee. Rippetoe also helped Marquez acquire a machine for testing her blood sugar, and she even attended a diabetes education class with her. "I don't know what I would have done without her," Marquez said.
Resendiz worked with
"Chronic diseases often come with depression," Quimby said. "If they are depressed, they can't get past that. Once we address the depression, it's a lot easier for them to apply the diabetes education we give them. Bea was able to move on and help herself."
Thanks in part to the team behind them, Marquez and Resendiz have cut their blood sugar levels in half, a critical step in treating diabetes.
And they're hardly the only patients who have benefited from the team approach. Quimby and Rippetoe estimate they each have contact, by phone or face to face, with about 200 clients a month. That frequent contact also reduces hospital and emergency room visits. "About 70 percent of the reason people go to health care providers is socially related," Alfero said. "Our system relies heavily on the medical center to address social issues."
Designing delivery
On the clinic's bottom floor, doctors review cases alongside medical assistants and nurses. Two doors down the hall sit their community health workers who focus on family support services. "Having a physician, medical assistant and nurse sitting side by side makes the work much more efficient," Troxler said.
The clinic houses a digital radiography machine, a bone density meter, a small pharmacy and a urology lab. A small, private lactation room is available to both clients and staff. Everything is housed to maximize communication, team building and efficiency. Instead of sending a patient with a sprained ankle to the nearest hospital for an X-ray and then awaiting the results, doctors at sites in
"From a business perspective, an integrated health model can definitely make health care more efficient and provides the stability to provide more timely care," said Otero, who grew up in
A federal capital improvement grant and state funds have helped
Drawing the next generation of providers
Like many Western states,
Making matters worse is that many of
What's more, all doctors must complete medical residencies before they begin practicing on their own. Those residencies are funded through
Because doctors are likely to practice within 100 miles of where they complete their training, shifting some of the limited medical residencies from major teaching hospitals to rural areas is key to attracting and retaining providers in remote settings.
Kaufman's group at UNM and clinics such as
The first two residents in the program just finished their three-year terms at
"The best solution to solving the rural primary care provider services is to train people from and in rural areas," said Nelson, son of a miner from a small
Physician assistants, nurse practitioners, nurse midwives and nursing students also complete training at the clinic. Alfero is also negotiating an agreement to set aside some dental slots for qualified
"There's a lot of grass-roots encouragement," Troxler said. "We're exposing people to the work that we do, hoping to grow and inspire the next generation that will come and fill the ranks as we all age and move on."
Coming full circle
A 2013 New Mexico Legislative Finance Committee report called
It has become more competitive than ever in a time when many rural places are losing their primary care providers. Alfero said the Affordable Care Act's emphasis on preventive care and outcome-based payments has generated a renewed interest in primary care and family medicine. UNM once had to scramble to find enough medical school students to fill the family medicine spots. Last year,
While rural health care has evolved from the country doctor hanging a shingle outside an office, it still centers around providing the best care possible to patients in remote areas. "The HMS mission is focused on quality and comprehensive care," said Nelson, not the bottom line. "It allows us to truly put the patient at the center of what we are doing."
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