Pilot program creates job to coordinate care

Are you young, idealistic, energetic, computer savvy and looking for a job with benefits? Then Dr. Dick Adair at the ANGMA Medical clinic in Minneapolis might have the just the job for you -- care guide.

Never heard of it? That's because it's a new kind of job altogether, part of an experiment in creating a different way of caring for patients with complex, chronic diseases.

Adair, an internist at Abbott Northwestern Hospital is using a $6 million grant to find out whether a strategy that combines electronic medical records, contracts between patients and doctors, and the skills of care guides can improve health and reduce costs for the hundreds of poor, chronically ill patients who walk through his doors every month.

It's a new wrinkle in the movement to provide "medical homes" for patients. This one aims to prove that coordinating care and solving problems before they occur will save money -- enough to convince health insurers that it's worth the cost.

Adair hopes that care guides can make the whole experiment hang together. They won't need to have medical know-how. He's looking for people with good communication and research skills who can develop relationships with patients, their families and their doctors. "There is so much untapped idealism in the world," he said.

To understand Adair's challenge, consider David, a 67-year-old patient on Medicare with chronic heart disease.

One of his many doctors started him on an expensive heart drug because he got free samples provided by the drug's manufacturer. When those ran out David quickly burned through his Medicare drug benefit. Then he stopped taking the drug, in part because he was too embarrassed to admit he was too poor to pay for it. He ended up in the hospital with a serious condition.

"There are so many things that are easily preventable," he said. Only 14 percent of people with diabetes, for example, manage their blood sugar properly. A third of people with high blood pressure succeed in keeping it in check, which can be done with appropriate medications.

But the health care system is fragmented and uncoordinated, and patients fall through the cracks, Adair said.

"Patients are bewildered. There are so many voices talking at them," he said.

Health insurance, however, doesn't typically pay for coordinating care, preventing problems or educating patients. What it pays for, he said, waving at Abbott's new, $90 million heart hospital outside his window, is hospitalization, medications, procedures and devices.

"We have this perverse reimbursement system," said Dr. Penny Wheeler, Allina's medical director. "I always say, we get paid more for amputating a diabetic's leg than we do preventing the problem in the first place."

Abbott is one of four organizations named as primary recipients of the foundation's grants because both Binger and his wife received treatment there. The goal is to fund programs that fundamentally change people's lives, said Dr. Gordon Aamoth, president of the foundation. The $6 million medical home proposal is the first Allina project funded by Robina. The people who stand to benefit from it are some of the often poor, elderly patients with chronic illnesses who live in the south Minneapolis neighborhoods around Abbott. About of a fourth of the patients who come to his clinic have little or no English, Adair said.

The idea is to use a special electronic medical record that includes each patient's contract and goals. That could be anything from taking an aspirin a day and regular walking, to achieving a certain blood pressure or blood sugar levels. If it works as a pilot project, it will be expanded to more Allina clinics.

The care team will consist of the patient, a designated friend or family member, the care guide, and the primary care doctor and any specialty doctors who care for the patient. The care guide's job is to check up on the patient, explain the medical guidelines, communicate with the family and the doctors, and talk to patients about their goals for upcoming medical appointments. They can also tell patients how to get cheaper drugs, or where to get information about their condition. Their job, in part, is to teach patients how to take care of themselves.

"They cannot encourage dependency," Adair said. "They must say: 'You do it.'"

And for that, Allina will pay about $30,000 per year, plus benefits.