Helping patients help selves

Asthma attacks and problems with diabetes used to send Diane L. Gass to a hospital emergency room four or five times a month.

It wasn't until 1995, when Temple University nurses opened a health clinic in North Philadelphia, that the mother of three gained control of the chronic illnesses.

"I haven't been in the hospital in God knows how long on account of the clinic being over there," Gass said. "You can have all the medicines in the world, but if you don't have control over your sickness it does no good."

Today, a chronic care commission appointed by Gov. Rendell will issue its plan to transform how such care is delivered in Pennsylvania. The idea is similar to the one used at the health clinic where Gass is treated: Help patients manage their conditions before problems get out of control.

Under the plan, family doctors and other clinicians will be trained and get financial support to redesign their practices. They'll be encouraged to develop a more team-oriented system aimed at changing patient behaviors, from providing basic education to calling people who miss appointments for key tests.

Patient registries that electronically track the delivery of care and alert doctors to patient needs for treatments will be developed and provided free of charge to primary-care practitioners.

The multiyear rollout of the plan, developed by the Chronic Care Management, Reimbursement and Cost Reduction Commission, is expected to begin in May when 50 to 100 caregivers in the Philadelphia area gather for an intensive "learning collaborative" to teach them the new format.

Rendell hopes that over time people with chronic illnesses will become healthier, avoid hospitalizations, and live longer.

And that will save money, too.

Health-care costs will drop, Rendell says, freeing money to provide coverage to many of the state's 800,000 uninsured adults.

In Philadelphia and its Pennsylvania suburbs, potentially preventable complications of high blood pressure, asthma and diabetes led to nearly 23,000 hospital admissions in 2006 and generated bills of more than $1 billion.

Statewide chronic disease accounts for 80 percent of health-care costs and four out of five hospitalizations, according to the chronic care commission.

Under the plan, experienced "practice-coaches" will provide the first wave of doctors with ongoing technical assistance. Insurers will help pay for the new staff needed to move toward a more patient-centered system.

The idea is to fundamentally change the focus of the health-care system: Instead of reacting to acute illness, prevent it.

Richard Snyder, senior vice president of health services at Blue Cross, said the chronic-care model would promote a holistic approach for patients.

"We need to keep people from suffering from the ravages of their chronic condition," Snyder said, "and in so doing we will keep health care affordable for them."

Snyder, a primary-care doctor who practiced this chronic-care model before joining Blue Cross, said doctors would get more professional satisfaction this way.

And as their patients do better, doctors would be rewarded with pay-for-performance payments.

Norristown internist Charles Cutler began to change his approach two years ago.

He now tracks patients who have chronic illnesses to make sure they get the tests and treatments they need - when they need them. His team approach includes a dietician and a nurse practitioner who work with and educate patients on how best to manage their conditions.

That frees Cutler to make sure the overall care is on target and effective.

"Every time we pick up a patient who might have fallen through the cracks before, that in and of itself is rewarding," Cutler said.

Nancy Rothman, a nursing professor at Temple University, said sometimes simple things have the biggest impact.

Rothman, who has diabetes, remembers her doctor suggesting she attend a class on managing her condition when she was first diagnosed.

At clinics and doctors' offices that follow the new chronic-care model, patients such as Rothman would get that education from the members of their health-care team, a so-called medical home.

That's exactly what Gass learned from her health center.

Gass now knows what to do when she gets the dizzy feeling that indicates her blood sugar is too low: She drinks orange juice or eats a piece of candy.

She also knows to avoid asthma triggers such as bleach or too much perfume - and to keep her inhaler handy.

It's not that difficult, but it makes a big difference.

"That clinic saved my life," Gass said.