Hurricane Katrina devastated the medical infrastructure along the Gulf Coast. Now, as they rebuild the hurricane-ravaged region, policymakers would do well to finish that destruction, according to Karen DeSalvo, M.D., M.P.H., chief of general internal medicine and geriatrics at Tulane University School of Medicine, New Orleans.
Graham Center Forum
Hurricane Katrina's Aftermath Creates Opportunities
By Leslie Champlin
1/4/2006
Rather than attempting to recreate the old system, DeSalvo said that policymakers should build a health care system that focuses on primary care as its foundation. "Never before have we had the chance to build a health care system from scratch," she said during a Dec. 20 forum here. The forum, "After Katrina: Healthcare Infrastructure in the Gulf," was co-sponsored by the Robert Graham Center.
"We should promote primary care as the centerpiece of a new health care system (in Gulf Coast states)," DeSalvo said. "The data are very strong that primary care drives the system. It is more efficient (and) has better outcomes and fewer health disparities."
The forum drew 48 congressional and HHS staff members, news reporters and others, who heard presentations by family physician J. Edward Hill, M.D., of Tupelo, Miss., president of the AMA; David C. Kibbe, M.D., director of the Academy's Center for Health Information Technology; and Linda Magno, director of the Medicare Demonstrations Program Guide.
Hurricane Katrina wrecked the medical infrastructure along the Gulf Coast, according to Hill. Some 6,000 physician practices were affected, 4,500 of which were in three Louisiana parishes, he said. The average practice loss was $363,000 after insurance coverage.
DeSalvo called for a health care system that mirrors the model of care espoused in the Future of Family Medicine report. New Orleans' pre-Katrina health system was the antithesis of that model, she said, adding that the FFM model will best serve patients, conserve resources and improve outcomes.
"Patients in the system experienced fragmented care delivered in clinics located inconveniently downtown and open during hours convenient to the physicians and trainees," she said of that pre-Katrina health care. "Other care in the city was generally provider-centric, not supported by interoperable information technology or by health policies that financially supported primary care."
Worse, the system perpetuated itself by training physicians who expected to work in a subspecialty-focused, hospital-based, provider-centered practice.
"In re-engineering the health system of New Orleans, planners propose to shift the paradigm away from this … model," DeSalvo said. "Our ultimate vision for the post-Katrina health system is one in which every citizen has a 'medical home' that provides high-value care that is responsive to their needs and perspectives."
Planners want a network of primary care practices that would be housed in community centers and that also would offer exercise facilities, child care and Internet access for patients, said DeSalvo. These health care clinics would offer group visits for chronic conditions, open-access scheduling, multidisciplinary teams and electronic health records. The clinics also would train residents and medical students "so that they are exposed to a patient-centric model of primary care," she said.
One clinic -- the Covenant House -- already is implementing the tenets of the planners' vision. The facility provides socioeconomic, recreational and health care services for residents from the surrounding neighborhood. Plans call for a multidisciplinary team that includes a social worker and counselor and a training program to expose students and residents to patient-centric care, said DeSalvo.
"We should promote primary care as the centerpiece of a new health care system (in Gulf Coast states)," DeSalvo said. "The data are very strong that primary care drives the system. It is more efficient (and) has better outcomes and fewer health disparities."
The forum drew 48 congressional and HHS staff members, news reporters and others, who heard presentations by family physician J. Edward Hill, M.D., of Tupelo, Miss., president of the AMA; David C. Kibbe, M.D., director of the Academy's Center for Health Information Technology; and Linda Magno, director of the Medicare Demonstrations Program Guide.
Hurricane Katrina wrecked the medical infrastructure along the Gulf Coast, according to Hill. Some 6,000 physician practices were affected, 4,500 of which were in three Louisiana parishes, he said. The average practice loss was $363,000 after insurance coverage.
DeSalvo called for a health care system that mirrors the model of care espoused in the Future of Family Medicine report. New Orleans' pre-Katrina health system was the antithesis of that model, she said, adding that the FFM model will best serve patients, conserve resources and improve outcomes.
"Patients in the system experienced fragmented care delivered in clinics located inconveniently downtown and open during hours convenient to the physicians and trainees," she said of that pre-Katrina health care. "Other care in the city was generally provider-centric, not supported by interoperable information technology or by health policies that financially supported primary care."
Worse, the system perpetuated itself by training physicians who expected to work in a subspecialty-focused, hospital-based, provider-centered practice.
"In re-engineering the health system of New Orleans, planners propose to shift the paradigm away from this … model," DeSalvo said. "Our ultimate vision for the post-Katrina health system is one in which every citizen has a 'medical home' that provides high-value care that is responsive to their needs and perspectives."
Planners want a network of primary care practices that would be housed in community centers and that also would offer exercise facilities, child care and Internet access for patients, said DeSalvo. These health care clinics would offer group visits for chronic conditions, open-access scheduling, multidisciplinary teams and electronic health records. The clinics also would train residents and medical students "so that they are exposed to a patient-centric model of primary care," she said.
One clinic -- the Covenant House -- already is implementing the tenets of the planners' vision. The facility provides socioeconomic, recreational and health care services for residents from the surrounding neighborhood. Plans call for a multidisciplinary team that includes a social worker and counselor and a training program to expose students and residents to patient-centric care, said DeSalvo.
