Many of you probably saw the recent Sunday New York Times Magazine story about home- and community-based health care, called “What Can Mississippi Learn From Iran.” Basically, it describes a still rudimentary and not fully funded vision of creating “health homes” using community health workers to reach the medically underserved in the Mississippi Delta, particularly those with chronic diseases. The idea is based on a similar program in Iran.
There’s a lot I liked in this article by Suzy Hansen. The author is an American living in Turkey and she’s not a health care writer. She came to the subject – and to the Mississippi Delta – with fresh perspective. I liked her focus on chronic disease, disparities (black/white, rich/poor, rural/urban), prevention and wellness, the need for more and better primary care, the lack of care coordination and the rationale for more integrated delivery systems with primary care at its core. She did that well. Hansen also did include some context (I would have preferred a bit more) about some of the other delivery system changes unfolding through the Affordable Care Act, changes in the delivery of health care that my posts here often urge you to report on.
So the points I raise below aren’t because I think the article was bad – as I said, I liked it. Rather it’s because I wanted to draw out a few points that will help you as health journalists read it a little more critically and then think a little harder about what’s going on in your own states or communities.
Hansen said in an interview that she first got intrigued about the Mississippi initiative after seeing an earlier report on it in 2010 AARP Bulletin. When I went back and read the 2010 article, and then re-read the Times piece several times I wasn’t really clear on how much the “health homes” had achieved in the two intervening years. I emailed her and she said, “It’s all moving slowly. They have implemented the HealthConnect program, they have trained community health workers, they have designed the health worker certificate program at Jackson State, and opened clinics in some of the schools. They are trying to demonstrate various aspects of the model in order to convince people to fund them.” But the to-do list is still long.
Given all the attention right now on changing health care to achieve precisely the goals that the Mississippi group is trying to achieve (wellness not sickness, better care coordination, fewer hospitalizations, reducing disparities, etc). I was left wondering what’s stuck here – why isn’t this program accomplishing more. (It might have to do with Mississippi and local politics and personalities – not purely “health.”) Continue reading