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| Tulane is involved in a state task force on healthcare redesign, including Paul Whelton, senior vice president of health sciences at Tulane. Whelton is shown outside the court building where he delivered testimony before a Congressional committee on a related topic earlier this year. (Photo by Aaron Martin) |
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As destructive as Hurricane Katrina was, it also left opportunity in its wake. Tulane physicians have been actively involved in realizing one of those opportunities: the chance to redesign the way in which health care is provided to low-income and uninsured families in Louisiana. In July, Michael Leavitt, secretary of the U.S. Department of Health and Human Services, challenged the state to provide a new plan for the delivery of health care.
The Louisiana legislature named 40 people to the Louisiana Healthcare Redesign Collaborative, including Paul Whelton, senior vice president for health sciences. Whelton brought in Tulane physicians Karen DeSalvo, Richard Streiffer, Tom Farley and Alan Miller, as well as public health researcher Claudia Campbell, to work on the final plan for the New Orleans area, which was presented by Gov. Kathleen Blanco to Leavitt on Oct. 20.
Whelton identifies the key priorities as, "Moving from a two-tiered system, where indigent care was provided by the Charity system and private care by all other providers, to a single-tier system where money follows the patient. We also are dedicated to preserving the quality of graduate medical education training programs."
The dean of the Tulane University School of Medicine, Whelton also has served on the Louisiana Recovery Authority Public Health and Health Care Committee and the Bring Back New Orleans Public Health and Social Services Task Force (co-chair of the Public Health Task Force).
"Our vision is for neighborhood-based, decentralized clinics to give people a 'medical home' that they can keep coming back to for continued care," says Streiffer, a professor in the Tulane Department of Family and Community Medicine. Streiffer took a year's leave of absence as chair of the department to work with the Louisiana Department of Health and Hospitals in managing the development and implementation of the plan.
The Tulane University Community Health Center at Covenant House, directed by DeSalvo, is an example of the way in which a neighborhood clinic might create a medical home for patients.
"I hope we create a health system designed to care for people, not just treat them," says DeSalvo. "Working on the collaborative has helped me understand the urgent needs on the ground by patients and providers alike."
According to Streiffer, shifting the financing from a focus on emergency care and big hospitals to covering individual care at the clinic level is a challenge. The final result, including criteria for participating providers and electronic medical records available at all locations, will look more like a health insurance plan for qualifying individuals than the current system.
Streiffer also is concerned with developing recommendations for providing medical education in the new system. Once students graduate from medical school, they typically go through post-graduate training known as a residency. Usually, those residencies are affiliated with hospitals but in the proposed system there would be more clinical training opportunities at the community-clinic level, Streiffer says.
"We have to figure out how medical education is optimally incorporated into the system and into the future so that we don't harm medical education long term and can continue to produce the work force needed for the state," Streiffer adds. The Medical Center of Louisiana at New Orleans, also known as Charity Hospital, has historically been the primary teaching hospital for Tulane and Louisiana State University medical students, but damage from Katrina has prevented the building from reopening in downtown New Orleans.
Of the Oct. 20 deadline for the group's proposal, Streiffer says, "Really, that was the beginning, not the end. It's going to be a change of major proportions that will take a number of years to negotiate and implement. But when your state is often 50th in health measures, as we were, anything has to be an improvement."
