In Central Florida, a Rare Commercial Clinic Focuses on Medicaid Patients
August 13, 2013 | WMFE - At the heart of the Affordable Care Act is an expansion of Medicaid. It's how the Obama administration aims to make health care available to more Americans. But there are problems. Patients can have a hard time finding doctors who accept Medicaid's lower payments. Some anticipate a doctor shortage. In Orlando one clinic is facing these problems head-on. Family Physicians of Rosemont is a rare commercial clinic focused on Medicaid patients.
63-year-old Lucinda Williams rides 30 minutes from Apopka to Pine Hills on her Harley to see the doctors like Betty Agbede at Family Physicians of Rosemont.
Williams is an avid biker who wears motorcycle boots and a leather jacket filled with pins from all the place's she's been on her bike, from Daytona Beach to the Florida Keys. She's also a Medicaid patient with high blood pressure, and she says the doctors here keep her well enough to ride.
Nearly a quarter of the patients here like Williams are on Medicaid, and that number is growing. Anjali Vyas says it's a business model that works.
"We kind of pride ourselves on kind of being one step ahead of the game."
Vyas is chief medical officer of Family Physicians Group, which owns the clinic. She says the clinic is at the forefront of what the Affordable Care Act aims to do – keep patients like Williams healthy without a lot of unnecessary tests and treatments.
"If we do this well, and if we do it in a methodology that is good for the patient, keeps them out of the hospital, improves their quality of life then those dollars will follow us as our care management platform is the best."
Family Physicians Group is an Accountable Care Organization, one of about 450 groups nationwide. Physicians, hospitals or other providers join to avoid duplicate care and share in the savings. It's a model promoted by the Obama administration's health reforms, and it's aimed at replacing the fee-for-service model familiar to most Americans.
"The ACO is the platform of the future."
Paul Keckley is executive director of the Deloitte Center for Health Solutions, a research firm. He says eventually most doctors will practice under the model.
"We envision that Accountable Care models will be the standard of care in every community in five years."
But he says most ACOs focus on Medicare and commercially insured patients, not Medicaid patients.
"Medicaid is for a state the biggest single health cost challenge, and I think the fact that a clinic is looking at an opportunity to manage a Medicaid population, we're going to see more of it."
Already Medicaid is the nation's largest health plan with 60 million enrolled, and it's going to grow in the next three years. In Florida the Legislature voted this past spring against expanding Medicaid for about 1 million uninsured.
Family Physicians of Rosemont is moving ahead with its Medicaid-focused business model anyway. Patient care is closely monitored. Case managers weed out unnecessary tests and make sure patients have access to healthy food and transportation.
Dr. Tonya Young Henley gets a scorecard every few months telling her how her patients are doing.
"I guess some of the older physicians may feel like that the government stepping in is a negative thing. But the way I look at it, it's just a different model and we're definitely able to take care of patients more effectively."
The clinic's Medicaid focus is unique. Lucinda Williams says finding doctors willing to treat her is a challenge.
"Well, I had one of the receptionists in here trying to get a hold of a heart doctor that would take my Medicaid. Because we couldn't find anybody in town. Now I got to go all the way to Kissimmee."
That's nearly an hour's ride for Williams on her Harley.
After her visit with Agbede, Williams stopped by the front desk and scheduled a follow-up. Then she climbed on her Harley and headed home.