State Sen. Aguilar to introduce bill to study health care reform

Colorado’s newest Senator, Irene Aguilar, D-Denver, is completing draft legislation for a bill that could lead to health care insurance for all Colorado residents.

She said that the bill would create a commission to study both the implementation and funding of a program she calls the Colorado Health Care Cooperative.

“The idea is to do self-sign-up health insurance through state-based, integrated health care systems and medical homes. So that every person in the state would belong to an integrated medical system and medical home that would track and ensure their health.”

The bill was not unexpected. Aguilar, a long time advocate for health care programs and reform, served as the president of Health Care for All Colorado for the last two years before resigning to take her seat as a state senator. Health Care for All Colorado’s website notes that in resigning her seat she promised to introduce health care reform legislation.

Integrated health care systems like Kaiser Permanente have been lauded by some politicians in recent years as a method of providing health care while managing costs. The overall goal of such systems is to coordinate resources when handling patient care. The concept of medical homes, originally developed by the American Academy of Pediatrics in 1967, has been growing more popular lately. Medical homes essentially allow a patient to choose a doctor that provides primary care, and a host of other medical professionals, in house, to treat a patient’s needs.

Medical homes are based on a philosophy of team-based, preventive and comprehensive health care.

From a recent article at about medical homes:

Imagine a place where your doctor doesn’t keep you waiting, does keep you healthy, and works with a whole team of other health care professionals. Oh, and imagine that place makes the doctor’s life easier and health care cheaper.

In a nutshell, that’s the idea behind what’s called the “patient-centered medical home.” It’s an idea that’s spreading around the nation.

“I don’t mean to sound in any way demeaning to physicians, but think of the care your dog gets,” says Lisa Letourneau, a primary care doctor who heads a nonprofit regional health care collaborative in Maine that’s trying to build medical homes in the state. “Vets are very good at delivering patient-centered care. They know when the shots are due. They call you ahead of time. They greet you warmly when you arrive. They coordinate your needs.”

Aguilar said that people would be allowed to get their health care outside of the system if they chose to do so.

She said some legislators have already expressed interest in her proposal though they as well as stake holders, including the Colorado Medical Society, COPIC, and Health Care for Colorado, have yet to see a copy of her legislation.

“I will hopefully unveil it on Feb. 14, Valentines day.” Aguilar said. Though she noted that she would be providing informational packets in order to sell her idea to both stake holders and other legislators.

Asked what the need for a program like this in Colorado was, Aguilar said that there are currently 700,000 people in Colorado that do not have health insurance, her plan would ensure every resident in Colorado had access to health care.

Aguilar said that she was unsure of the fiscal costs of the program as her bill was just setting up a commission. “We need to try and get grants for the project to start.”

There have been national studies of the concept, and this report from Dr. Pauline W. Chen, in The New York Times indicates that the concept could be picking up steam.

Now, as dozens of pilot projects across the country are transforming traditional doctors’ offices into medical homes and putting this theory of practice to the test, one thing has become apparent: even this most promising of reforms is unlikely to take hold without the active involvement of patients.

The need to get patients involved was made startlingly clear last month when the American Academy of Family Physicians, a national medical society devoted to primary care, and TransforMED, a nonprofit consulting firm created by the society to help physicians turn their practices into medical homes, published the first report on their national demonstration project. Beginning in 2006, 36 traditional primary care offices began adopting the hallmarks of patient-centered medical home practices. They installed electronic medical record systems and reorganized deeply entrenched scheduling routines. Teams made up of nurses, medical managers, physician assistants and doctors, rather than a single physician authority figure, began working with patients. And care was focused not on single acute episodes of illness but on the patients’ comprehensive and ongoing management.

As the study progressed, the researchers found that the vast majority of doctors’ offices could successfully incorporate most of the changes into their practice, and early signs of the model’s success were promising. Quality of care and preventive health ratings revealed small improvements. Office staff became more streamlined, efficient and satisfied. Most notably, physicians were more content than ever before with their work, despite still having to deal with an unchanged fee-for-service or managed care reimbursement system. The doctors’ enthusiasm persisted even after the study closed, with many maintaining contact with one another through a listserv and twice-yearly self-organized meetings.

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