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Tuesday, March 24, 2015

Happy Anniversary!: Affordable Care Act at the five-year mark

March 23 marked five years since Pres. Obama signed the Affordable Care Act into law.  Ten million more people now have insurance coverage.  As the ACA has only been in effect for a little more than a year, though, to ascertain its other likely effects, it is more useful to consider the first five years of the universal health coverage law in Massachusetts, the model for the ACA.

In Massachusetts, universal coverage became law in April 2006 as Chapter 58.  The most widely cited study of its effects over the first five years describes an improvement in the self-assessed health status of non-elderly Massachusetts adults.  That's the gold standard for whether the whole law was worth it:  do people feel healthier?  Before the law, 60% rated their health as very good or excellent; afterward, 65% rated it that way. Far more people were insured, and got medical care, according to the article by Sharon K. Long, Karen Stockley and Heather Dahlen in Health Affairs in January 2012, "Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs."

Read a story about the likely effects of universal health insurance on women's health.

Wednesday, March 11, 2015

House calls by nurses: With their eye right up to the screen

Retrace Health provides primary care for families through home visits by nurses and video consultations.  Here’s the story of how they’ve been helping one family:

Ms. B’s story:
I was having some back pain.  They’re very flexible, and have lots of availability, so I was able to call the next day, when the kids were napping.  Otherwise, I would’ve had to figure out childcare for my kids.  They’re age 5, 4, and 3.

The nurse was really helpful in giving me other options, and a referral to a clinic that deals with back pain.  She gave me some suggestions, and made sure there wasn’t anything more serious going on, as I was in a serious amount of pain.  She followed up by sending me exercises I could do and some information for the referral.  A couple of weeks later, she followed up again, asking me how things were going, whether I’d found relief for the pain, and whether I’d tried the referral.  I was seeing a physical therapist.

For my kids, we usually start with a video conference.  If it’s about their eye, we’ll have their eye right up to the video screen.  The nurses are fantastic with the kids, and really make them feel at ease, because at first it would be a little strange for them to be on a computer screen.  They ask nice questions to get the kid to warm up.  There’s often a kid in the background, because this is our house, so it’s not always uninterrupted!  It’s so convenient!  If I have a concern, I can set up an appointment.  They’ll be very thorough, and will do all they can to make sure they get what the kid needs. 

They also have nurse practitioners who can come to our home and look at my kid.  Once they did that for a strep throat, and once for an earache, because you can’t really see that on a video screen, so they’ll come out and run the test here, or look in their ears.

That’s great, so I don’t have to take the kids into a clinic with a bunch of other sick kids, so my kid comes back with something.  They’re really thoughtful in how they ask questions of the kid.  They don’t talk over the kid; instead, they’ll ask them, What are your symptoms?  Then I can add something in if I need to.  They pay attention to the kid, and get them comfortable first to get them to say what’s going on.  We usually use ReTrace Health for things that come up between well-child checks, like a cold, earache, or a rash, where you need to decide whether to bring them to a doctor. 

Thanks to Thompson Aderinkomi of Retrace Health for the connection, and to Ms. B. for our interview.  Read a different story about an innovation in primary care.