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in 2007 (the year before PCMH implementation) to 13 in 2009 (the year after implementation). Oklahoma saw a decline in expenses of $29 per patient per year from 2008 to 2010.


• Inpatient hospital admissions for aged, blind, and disabled Medicaid beneficiaries participating in Community Care of North Carolina decreased 2 percent between 2007 and the middle of fiscal year 2010. Inpatient hospital admissions for the unenrolled beneficiaries increased 31 percent over the same time period. Overall, Community Care of North Carolina saved nearly $1.5 billion in costs between 2007 and 2009.


Promote physician-led team care


Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients — particularly in primary care medical homes — will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.


Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.


The physician is the highest-trained team member. It therefore falls to the physician — as both provider of care and manager of services delivered by others on the team — to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.


Integrating the talents of a diverse medical team September 2012 TEXAS MEDICINE 65


under physician leadership will be one of the key challenges in the coming decade. Without physician direction, supervision, and management (or if the system evolves to accommodate teams led by practitioners with lesser training), medical care will trend toward even more fractured care, higher-than- necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications


A PHYSICIAN’S STORY


Andres Enriquez, MD El Paso


Health Care System Is Frustrating


“The whole system has gotten so frustrating. My dad was just denied his insulin because of Medicare Part D that he’s on. He’s in the ‘donut hole,’ and they wouldn’t fill his prescription. I had a hard time convincing the pharmacy that that was the right medication — that he needed the medication. My parents don’t speak English. Luckily, I’m educated and I can help them out. I can just imagine all the other people who don’t speak English and who have nobody to advocate for them. That’s why I’m into medicine, that’s why I love practicing medicine. I figure at some point, somebody has to say something.”


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