• Affiliate with local hospitals to orchestrate pragmatic changes that help them under the Maryland Waiver

  • Form a committe that works with Med Chi to help with its legislative agenda.

  • Ally with Maryland politicians who support a reduction of health care cost

  • Find a voice by appearing on local radio, writing op-eds, and giving talks.

 

 

 

 

 

 

.GOALS OF PRIMARY CARE DIRECTED REFORM IN MARYLAND

OPPORTUNITIES FOR REFORM IN MARYLAND:

  • Several legislators have expressed interest in sponsoring to speak to the legislature in Annapolis and demonstrate what can be done locally to decrease health care cost and improve overall quality.Upon that podium we would focus on a few points (regulations in long term care, working with hospitals to get more money for home care, the impact of local rules regarding primary care) and derive feasible solutions.This could be a terrific opportunity.

  • Tom Cronwell is a physician in Illinois who has established a viable home care network for elders and indigent people that, with some state financing, has saved the state millions of dollars by decreasing ER visits and hospitalizations.(www.hccinstitute.org).He is part of Lown, and he is willing to work with us to construct a similar home centered care network in Maryland.Using a team approach, and relying primarily on nurse practitioners, home based care could revolutionize how we practice medicine in the state, especially if we partner with IV companies, tele-medicine companies, and comprehensive home based services.

  • To that end, once we have data and a firm plan, we should present our proposal for home based care to both the legislature in Annapolis and to several targeted hospitals.Under the current waiver, hospitals will make more money if they can decrease admissions, and thus they have a financial incentive to promote and even support vigorous home based care.We can also apply for a grant through the Medicare Innovation Center.

  • Currently assisted living facilities are among the most egregious hot-spots of hospitalization in the state.Under existing regulatory and payment realities, assisted livings have more incentive to send their residents to the hospital than to care for them at home.We will need to compile data from hospitals regarding the admission rate (such data exists in Howard County), organize a group of Assisted Living directors/nurses into a working committee, and devise a pragmatic plan to curb the flow of dangerous hospital trips among frail elders.All of us, and everyone who works in assisted living, would prefer to treat people in the facility.With grant money, state funds, and perhaps money from hospitals, we can devise a program that is similar to home centered care that would provide resources and incentives for AL facilities to treat people in house.We would also need to appeal to the state to alter certain regulations so to enable facilities to avert hospital transfers.This could become a national model if it succeeds.

  • We will work with existing state and federal agencies to enhance care coordination at home (many ACOs and hospitals provide this service), establish transportation and social services when needed, and promote end-of-life/MOLST discussions.

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