Primary Care

In a bid to boost beleaguered primary-care doctors and encourage more preventive care for the public, Independence Blue Cross announced a plan Thursday to pay physicians more if their patients' health improves. Independence, the region's largest health insurer, will spend an extra $47 million a year to increase base pay and double incentive programs that already encourage primary-care doctors to deliver higher quality and less costly care. Starting July 1, a doctor with 850 Keystone HMO patients could earn up to $150,000 more a year, said Steven Udvarhelyi, executive vice president of health services at Independence.

Much of the discussion about the health-care reform legislation just signed into law has focused on the uninsured and the problems of private insurance. But what about a large group of Americans who face none of these issues - namely, those covered by Medicare? While much of the reform will not impact them, there are three areas in which older adults definitely will be affected: prescription drug coverage, managed care, and access to primary-care providers. The impact on those facets of their health care is likely to be good, bad, and potentially ugly.

The top two executives at Abington Memorial Hospital called the health-care bill that passed the House yesterday a necessary first step to improving the well-being of all Americans, though the hospital's chief financial officer was more pessimistic, fearing the bill would not do what legislators hope. All three hospital officials said it was too early to tell exactly how the legislation, which the House passed last night, would affect the large community hospital in Montgomery County and its bottom line, especially since the legislation would take effect over a period of years.

Throughout the past year's health-care reform debate, all eyes have been fixed on Washington. But examples of innovative, cost-saving health-care initiatives can be found right here in New Jersey. The Camden Coalition of Health-Care Providers - made up of providers throughout the city - posits that a broken primary-care delivery system is responsible for the fragmented, inefficient, and often redundant care that is straining the health system and the economy. As a result of this broken system, Camden residents use emergency rooms at twice the national rate, with all the accompanying costs.

Nuns tossed Marque Allen out of grade school for misbehavior, and high school teachers told him he wasn't "college material. " But Glassboro State College biology professor Richard Meagher saw something else: a future doctor. "He saw something in me at the time when I did not," said Allen, now the foot and ankle physician for the NBA's San Antonio Spurs. "His vision and the opportunities he presented to me changed my future. " Yesterday, Allen, 43, who grew up in Lindenwold, donated $100,000 to start a scholarship in Meagher's name at the new Cooper Medical School of Rowan University.

Emily Duffy, a licensed social worker, was walking down the hall of her North Philadelphia clinic last month when she heard crying in Exam Room 3. She opened the door and met Patricia Stone, 26, and her children ages 5, 3, and 2. What happened next illustrates a paradigm shift in mental health care - seamlessly integrating what is known as behavioral health into a primary practice - that is gaining traction nationwide. While the children underwent routine physicals, Duffy learned that the 3-year-old's father had died violently three weeks earlier.

Compared with the swath of health-care businesses spread out on either side of Interstate 95 from New York to Washington, tiny Danville and Riverside, Pa., at first glance don't seem to have much to offer that industry. But the two hamlets, across the Susquehanna River from each other about 150 miles northwest of Philadelphia, are homes to organizations trying to spark a boom in health-care innovation in rural Pennsylvania. One is Danville's Geisinger Health System, which has attracted national attention for providing quality patient care at relatively low costs.

As the newly elected president of the Pennsylvania Academy of Family Physicians, I will spend much of the next year advocating for health-care reform on the state and national levels. I will be arguing that less can sometimes mean more: Less testing, fewer lawsuits, and fewer visits to specialists can mean a healthier public and more affordable, sustainable health care. Universal health insurance can be a step toward reform, but it is not the answer to all our woes. The more than 4,000 family physicians across the commonwealth are one small but important piece of the enormous puzzle.

A local congresswoman, six hospital executives, and another dozen area health professionals rallied at City Hall yesterday to push hard for health-care reform, reaching a critical stage now in Washington. "We're at a moment that is potentially transformative," said Rep. Allyson Y. Schwartz, a Democrat representing parts of Philadelphia and Montgomery Counties in Congress. "I think there are real challenges ahead. It's not about being pessimistic or optimistic. It's about getting this done.

After a year, the first 32 medical practices to sign up for the Rendell administration's chronic-care initiative reported that their diabetic patients were doing better. Forty-four percent of the 15,000 diabetic patients in the program gained ideal control of their blood sugar, up from 33 percent a year ago. Participants say the program works because it gives incentives for caregivers to track patients better and to hire more staff. Over time, proponents hope to see broad health improvements and big savings from fewer hospitalizations and ER visits.