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Health Care Plan

The relatively poor performance of the United States on major health indicators, despite per capita health care expenditures that are much higher than those of any other country, is a pressing concern for policymakers, the business community (which has, historically, paid for much of the health insurance in the country), and, ultimately, taxpayers. Efforts to improve the system to achieve better health at lower cost are rapidly becoming imperative.  A greater emphasis on primary care can be expected to lower the costs of care, improve health through access to more appropriate services, and reduce the inequities in the population's health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/

 

I am the only gubernatorial candidate who has the academic preparation and 20 years health care executive experience to get quality, low-cost, and accessible where it is needed.

The objectives of my health care plan are the following:

  1. Improve the quality of health care in Maine
  2. Better access to health care providers
  3. Allow more people to remain home 
  4. Reduce the cost of institutionalization
  5. Elimination of primary health care insurance premiums
  6. Reduce the cost of paperwork and insurance deductibles

If elected Governor of Maine, I will organize an alliance of legislators, health care providers, consumers of health care services, actuaries, and health care educators to design and implement the components of my plan:  

  1. Expanded Home Health Care
    • https://en.wikipedia.org/wiki/Home_care
    •  
  2. Direct Primary Care Health Clubs

 

Expanded Home Health Care

https://en.wikipedia.org/wiki/Home_care

Traditional differences in home care services are changing as the average age of the population has risen. Individuals typically desire to remain independent and use home care services to maintain their existing lifestyle. Government and Insurance providers are beginning to fund this level of care as an alternative to facility care. In-Home Care is often a lower cost solution to long-term care . 

Among steps to be taken for an expanded home health care plan :

  • The state would invest in hiring, training, and licensing Maine citizens as uniformed home health aides who would visit up to 15 sick or disabled Maine new-borns, children or adults to help them avoid or postpone hospital or nursing home placement at a savings of $60,000 plus per year.  
  • Home Health Services would range from skilled nursing to light housekeeping, meal preparation, shopping, blood pressures, supervision of medications, bathing, temperatures, case management, and help with activities of daily living in-support of pre-natal care, disabled children and adults along with referral services under the supervision of the nurse.  In other words, they would serve as the eyes and ears of the physician in the home.  They would be uniformed and paid on a scale of police officer with full benefits.  They would chart their visit and forward to the primary physician.  In other words, they would serve as the eyes and ears of the physician in the home. 
  • The home health aides would work under the direct supervision of public health nurses and/or visiting nurse organization.
  • Where internet services and software are available nurses and home health aides in the field would communicate with physicians through services such as Telehealth or Skype software.

Direct Primary Health Care Clubs  (DPC) 

“An estimated 7000 physicians in half of the states have already adopted this model — and as the name implies, most are primary care physicians (sometimes known as general practitioners), the front line caregivers who handle an estimated 85 percent of the most common conditions.”

http://www.aarp.org/health/health-insurance/info-08-2013/direct-primary-care.html#quest1

The direct primary care (DPC) model gives family physicians a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies.

Direct primary care benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians.

http://www.aafp.org/practice-management/payment/dpc.html

Components of My Direct Primary Care (DPC) include the following:

  • Fixed-fee physician/advance registered nursing groups
  • Enables patients and doctors to re-take Control
  • Eliminates the need for primary care health insurance
  • Do not rely on insurance billing for revenue
  • Does require specialty, hospital or nursing home insurance
  • No patient care deductibles
  • Monthly dues paid by patients
  • Pre-set fees of $70 or $80 month billed periodically
  • Doctors limit patient volume to spend more time with each
  • Sub-specialty referrals and hospital encounters tend to go down among DPC patients
  • DPC patients receive longer appointments, more timely access, and often a greater focus on preventive care
  • Medicaid/Medicare Funding 

http://www.insideindianabusiness.com/story/36133054/direct-primary-care-a-growing-trend

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How Would Home Health/Direct Primary Care Be Funded?

  • The program can be funded from the savings of postponing or completely avoiding the $66,000/year in Medicaid-funded hospital or nursing home care.  If only 2 of the 15 patients the aides saved from institutional care, they could easily be paid $20/hour and the state would save tens of thousands of dollars more.
  • The initial investment to train and accredit home health aides and setup small health clubs in each town or city would come from a combined allocation from towns, counties, state, and federal grants as proposed by the state plan developed by my health care task force.
  • Medicaid and Medicare Funding  Maine Care (Medicaid) already allows such payment method under the Private Health Insurance Payment program (PHIP) and Child Health Insurance Program (CHIP) thus qualifying low-income children and adults could be served
  • Monthly membership fees could depend on the age of the patient and range from $10 to $90/ month.  Following a care model like that of the one at the Zenith Clinics in Florida  http://www.zdirect.care/
  • Charitable or foundation giving where the health clubs are registered-non-profits.
  • Employer health care membership fees paid as benefit and incentives for employees.
  • Sliding fees for those who cannot afford periodic dues

 

In summary, my direct primary care proposal should be considered a framework in which we can improve the access and affordability of health care in Maine.  It should remain a work in progress until every citizen has access to the level of care he or she requires.

Just like any plan it should not just be one person’s idea to get the best outcome.  Thus, I invite one and all to send me an email with comments and recommendations to pat@theopcenter.com

Health care is a need all Mainers need regardless of age, gender, or political persuasion.  

I have a plan to fill that need and creating new, good-paying jobs in the process and will implement it if you elect me the next governor of Maine.

 

 

 


Committee to Elect Patrick "Ike" Eisenhart
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