By Ronald C. Rak, J.D., President and CEO, St. Peter’s Health Care System
Saint Peter’s Healthcare System recently developed and launched a “patient-centered medical home” for high-need uninsured and underinsured adults with diabetes mellitus and hypertension who reside in central New Jersey.
The “patient-centered medical home” is a way of organizing primary care that emphasizes care coordination and communication. Such a model enables us to transform primary care into ‘what patients want it to be.’ Medical homes in turn can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.”
A $20.5 million state grant to be distributed over five years (2012-2017) is funding the project, which, as of July 1, has expanded to providing education and preventive care for patients in the program. Although funding comes to Saint Peter’s in the form of a state grant, the initiative is supported by federal funds and made possible through the Affordable Care Act.
The Saint Peter’s effort to educate the public about diabetes and hypertension, while coupling those lessons with preventive care, is the way of the future in medicine. The health care of yesterday was too often about treating advanced disease symptoms in a hospital setting. Tomorrow is about nipping disease in the bud before it can cost us both dollars and lives.
Patients are referred into the Saint Peter’s program via outpatient services, the emergency department, inpatient services, same-day service locations, and community health screenings conducted by our clinical staff. The program includes the use of multi-therapeutic outpatient evidenced-based management, lifestyle modification, nutritional consultation, intensive hospital discharge planning, a dedicated patient navigation system, and improved social services.
Diabetes – especially if left untreated – can lead to heart disease, kidney disease, blindness, and nerve damage in the feet. Hypertension or high blood pressure, also known as “the silent killer,” is as an important risk factor for stroke but also contributes to the development and acceleration of many complications of diabetes. Those conditions include diabetic eye diseases and kidney disease. Most people with diabetes will develop hypertension during their lives.
It is estimated that nearly 800,000 New Jersey residents are affected by diabetes and that nearly one-third of those people have no idea they have this very serious condition. The preventive model of care we now can provide will result in larger numbers of those people living longer and healthier lives, while it will lower hospital admissions and emergency room visits, improve the processes surrounding delivery of care, and result in a long-term reduction of healthcare costs.