Here is some local news with potential for a ripple effect across the U.S.:
North Carolina will become a healthcare reform test bed  through a new public-private partnership that aims to see if a Medicaid management program that has saved more than $1 billion can also bring savings and efficiencies when applied to the private sector.
First in Health is being rolled out to employees of GlaxoSmithKline, SAS Institute, Kerr Drugs, Blue Cross Blue Shield of NC, and the State of North Carolina. First in Health has been adapted from a care-coordination program used with recipients of Medicare and S-CHIP. It does not replace employees' existing health plans, but is a voluntary add-on.
The program will be administered by Community Care of North Carolina (CCNC) , which is widely recognized as an innovator in population health and care coordination. CCNC features top information technology as well as "high touch" professionals who manage and coordinate care for their clients. CCNC reminds me a little bit of the United Methodist Church in the way they provide service: CCNC coordinators may work with a single large medical office, but in rural areas they may be on a "multi-point charge," serving several medical practices.
CCNC is founded on the concept of "medical home," an increasingly prominent term in discussions of health care reform. It refers to a central clearinghouse of health data for each patient that is fed and drawn upon by various specialists when providing care. But it’s also a mindset: proponents of "medical home" also call on physicians to employ a different set of values and ways of thinking. The emphasis is on:
- Being proactive and preventive
- Using evidence-based medicine
- Being accountable for health outcomes and the client's holistic wellness
- Being available by phone or email
- Being savvy about the Internet and mobile communications
- Being less a "gatekeeper" who takes away options, than a lifestyle coach who suggests new options
This all sounds pretty close to the job description of the wellness advocates  that our Spirited Life participants work with during their two years of wellness services.
First In Health is a pilot program. Its results are yet to be seen, and whatever the results are, they will be spun a variety of ways by policy makers. (Some commentators dispute the dollar value of the Medicare add-on that precedes this private sector effort.) But this start-up builds on ideas and approaches that the Duke Clergy Health Initiative shares, so we will be watching the progress of First in Health with great hopes.
John James, M.A.
Research Analyst, Clergy Health Initiative