Greg Allen, NPR News, Author at ��ϳԹ�� News

How A Florida Medical School Cares For Communities In Need

Greg Allen, NPR News — Wed, 15 May 2013 13:31:00 +0000

This story comes from our partner ‘s Shots blog.

If it’s a Monday, you can usually find parked next to a lake in Miami, spending the day inside a 36-foot-long RV. He’s not on vacation.

Brown is chief of family medicine at Florida International University’s . The RV is the school’s mobile health clinic.

With community-based health care a central part of its curriculum, Florida International University’s medical school turned an RV into a mobile health clinic so that students could treat families in neighborhoods where medical care is scare (Photo by Greg Allen/NPR).

Every Monday it’s parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. “It’s a beautiful place right here,” he says. “But this is not a wealthy community.”

Brown helps direct FIU’s . It’s part of the school’s curriculum that connects medical students with families in neighborhoods where medical care is scarce.

Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. “We’re able to bring free basic primary care to our households relatively close to their community,” Brown says.

In one of the RV’s exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school’s faculty, Alvarez has been treating her since January.

Flores says with Alvarez’s encouragement, she’s begun exercising more and has improved her diet. And, thanks to FIU’s doctors, she’s begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she’s seen a big improvement. “The high blood pressure and the diabetes together is what you worry about,” Alvarez says. “And now, her diabetes is well-controlled and her hypertension is well-controlled as well.”

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors.

When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there’s a — one that’s expected to worsen as millions more Americans get access to health care under the Affordable Care Act.

��ܳ��, the medical school’s dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care.

Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

In Miami, that includes places like Miami Gardens, where med student Danny Castellanos got to know a family that has 10 members, including a great-grandmother and five children.

Castellanos saw the family as part of a team that included a faculty advisor, a nursing student and a social worker. One of the first things they did was get all of the children qualified for Medicaid, which paid for their coverage.

Over the three years, Castellanos became involved in the healthcare of the entire family, including most recently the great-grandmother. She’s now taking part in a telemedicine pilot program.

Castellanos says the school installed an electronic unit in the household. “It has a screen,” he says. “It has a camera. It has a blood pressure cuff on it, a stethoscope which allows us to hear the heart sounds. We just ask her to place it in certain areas on her chest, ask her to put the blood pressure cuff on. And we get those kind of readings electronically.”

The telemedicine pilot will be evaluated for its cost-effectiveness.

But, overall, FIU’s Rock says the school’s focus on improving the health of targeted communities already is a success.

And for families in the program, the benefits are even more tangible. They’re much more likely now to receive regular checkups and less likely to use emergency rooms. “We also have increased health literacy, so they have a keen understanding of what some of the issues are,” Rock says.

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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To Cap Medicaid, Florida Looks To Managed Care

Greg Allen, NPR News — Tue, 08 Mar 2011 13:29:00 +0000

This story comes from our partner

In Tallahassee, Florida’s Legislature has one overriding goal this session: to close a $4.5 billion budget shortfall. And one of the key programs it is targeting for cuts is Medicaid.

In Florida and every other state, the program, which provides health insurance for the needy, makes up a big chunk of the annual budget. In reforming the program, Florida hopes to save $1 billion in what it spends on Medicaid.

When he introduced a plan recently to overhaul Medicaid, the head of Florida’s Senate, Republican Mike Haridopolos, said that his first two goals were improving the quality of care and improving the access to care.

“Then and only then,” he said, “we start looking at costs.”

But in fact, there is really one thing driving elected officials in Florida and elsewhere to take a hard look at Medicaid – and that’s the price tag. Ten years ago in Florida, Medicaid cost $9 billion. By last year, it had risen to more than $22 billion.

More than half of that cost is picked up by the federal government. Even so, Florida’s share still amounts to nearly one-third of the state’s budget.

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Using Contracts To Cap Costs

To bring down that cost, Florida’s Legislature is planning to dramatically revamp the way the state delivers health care to those on Medicaid. State Sen. Joe Negron has put together a plan that changes the state’s relationship with Medicaid recipients and Medicaid health care providers.

“We want to get out of the check-writing business and into the contract-compliance business,” he says.

Negron wants to scrap the old fee-for-service model and replace it with managed care. He proposes negotiating contracts with health care providers, which would agree to deliver care to the state’s 3 million Medicaid recipients for a predetermined fee.

Negron says it would give the Legislature a way to effectively cap what it spends each year on Medicaid.

“We’re going to decide how much we want to spend on Medicaid,” he says. Of the state agencies charged with overseeing the program, he says, “They do not have the authority to spend beyond what we appropriate.”

From a budgeting standpoint, it’s an attractive idea. It passes off the responsibility for controlling costs, and the risk of busting the health care budget, to private contractors.

But it also means that Medicaid recipients may start seeing fewer benefits. At a time of tight budgets, Republican State Sen. Steve Oelrich said that Florida has few options.

“Like the triage nurse separates the sore throat from the stroke and the heart attack,” he says, “what we’ve had to do here is take our limited resources, and apply them where they’re most effective.”

Republicans control the governor’s mansion and both chambers of the state Legislature, so it’s clear some version of Medicaid reform is likely to pass.

That doesn’t mean Democrats are going along quietly.

Poor Reviews For Managed Care Experiment

At a recent workshop in Hollywood, Democratic State Rep. Joe Gibbons said he was tired of hearing the Republican refrain that balancing the state budget is like balancing the family checkbook.

Gibbons says that the analogy doesn’t justify cutting health care for many who desperately need it. He said, “If my family checkbook at home is short, you know what I do? I get a second job. I don’t just eat three days instead of seven. … What they’re telling us we got to do is, you got to eat three days.”

It will be weeks until the Legislature finalizes its plans to overhaul Medicaid. But for many Republicans, the future can be found in Hollywood, Fort Lauderdale and other communities in Broward County.

For the past five years, nearly all Medicaid recipients in the county have been part of a pilot program that puts them in privately run managed care plans. Many in the Legislature now want to expand that program statewide.

At the workshop in Hollywood, a succession of doctors, care providers, advocates and Medicaid patients all had the same message: Managed care has been a disaster.

Richard Stein, a retired lifeguard, came to speak on behalf of a friend, Cynthia Bowersox, who, he said, has had four HMO plans in four years. Stein said Bowersox is homeless and was recently diagnosed with throat cancer.

“It has taken four months to get a biopsy on a throat cancer,” he said, “due to the impediments placed by the HMOs for authorizations.”

A Push For Managed Care

Moving more Medicaid recipients into managed care is something that’s been happening not just in Florida, but in almost every state in the country.

In Broward County, critics say the experiment with privately run managed care often reduces access and benefits for those on Medicaid. Those charges will be considered by the Obama administration when it looks at whatever new Medicaid plan Florida comes up with.

If the administration doesn’t approve, some Republicans in the Legislature say Florida should drop out of Medicaid. They say the state would then provide care for some 3 million of its poorest residents with whatever resources are available.

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