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Embracing reform key to Obamacare success, Longview health care official says

By Glenn Evans
Nov. 23, 2012 at 10 p.m.

A local health care provider said this week that Obamacare does not have to fail as long as medical providers across the spectrum coordinate a response.

Health care reform will ask medical providers and their patients to abandon decades of reacting to crises and embrace new models of delivery, said WellnessPointe Chief Executive Director Carl Walters II.

"This really depends, quite frankly, on how the health care community mobilizes and comes together to support healthcare reform," the head of Longview's Federally Qualified Health Center said in his office at the East Marshall Avenue medical center. WellnessPointe provides primary care, prenatal and other services for under-served residents of Gregg, Harrison, Upshur and surrounding counties.

Walters took in comments earlier in the week by U.S. Rep. Louie Gohmert, R-Tyler, who told officials at Good Shepherd Medical Center that the Patient Portability and Affordable Care Act - commonly called Obamacare - is designed to fail.

The act, Gohmert said, is filled with structural flaws that will make it financially unsupportable - to employers, hospitals and insurers.

"I understand they've got to make money," Walters said. "No margin, no mission - I get that. If you take care of people for the right reasons, the money will take care of itself."

If that sounds Pollyannish, Walters describes a new model of health care delivery adding new, "financially viable platforms" to today's system.

"This law, without proper healthcare systems integration - yeah, it's going to struggle with that," he said.

Much of the integration Walters touts is driven by the financial benefit of primary care.

No one disputes that regular medical attention is less expensive than emergency room care or that it identifies health problems before they become chronic or fatal conditions.

"The single most important thing we can do as a nation to lower cost is get people under the care of a primary care clinician and to stay in their preventative care regime," he said. "The law, in effect, will help to insure millions of Americans who otherwise can't afford insurance. When people have insurance, they are more likely to get the preventative care that they need."

Gohmert and Walters anticipate a larger role for mid-level medical providers, such as nurse practitioners and physicians assistants, in response to newly insured patients joining the primary care market.

The congressman worried that phenomenon is a "dumbing down" of care providers.

But Walters said mid-level providers already play a pivotal role in the country's health care.

"The reality is, we as a nation are not producing physicians fast enough to meet our health care needs," he said. "Just like physicians have certificates to distinguish their clinical expertise, mid-levels do as well."

Those professionals often practice under the auspices of a medical doctor and are subject to peer review to ensure they provide "evidence-based medicine," he said.

"Evidence-based medicine" refers to a shift, under Obamacare, to basing provider reimbursements on outcomes rather encounters with a provider, such as a visit, test or procedure. That element is seen as a potentially significant money saver for insurers - and patients.

Outcome-based medicine also is the standard for Patient-Centered Medical Homes, a relatively unknown primary care provider for which WellnessPointe is seeking recognition. Patient-Centered Medical Homes are required to implement electronic medical record keeping and maintain so many spots for walk-in patients.

"The Patient-Centered Medical Home fundamentally changes and transforms the way patient care is provided in this country," Walters said.

Getting people into those primary care environments is going to require an attitude adjustment on the part of some patients, Walters added.

Members of the political right wing complain people on the low end of the economic strata want government handouts - but that's not what Walters sees.

"Whether Medicare or Medicaid or (private) health insurance, all of that is for naught if the patient is not willing to routinely seek the services that are designed to keep them healthy and identify chronic diseases before they turn into chronic diseases," he said. "That's part of the reason you're seeing this explosion of diabetes and cardiovascular disease. ... We've got to create a comfortable environment where people feel more comfortable and (start) talking about why they don't use services. Sometimes, those people feel like they're 'less than' when they shouldn't.

"This is why you're seeing this explosion of chronic diseases across this country. They sit out there, and they're feeling chest pains and they call 911. ... Whether you're Democrat or Republican, that doesn't change the fact these are our community families that need services."



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