Health Justice Town Hall – Some Remarks From Dr. Manohar

This past Tuesday, CHC took part in the Health Justice Town Hall, which brought people involved in health care across the state of Connecticut together to discuss current disparities and how to improve our state system moving forwards. We live-streamed the Town Hall at our sites in Middletown and New London, and CHC’s very own Dr. Manohar shared his thoughts with us following the event’s completion.

Dear Friends,

I am very glad CHC decided to help host this important meeting and I am happy to be able to participate in this experience. It was nice to meet all of you again and sit with Martha Trevey, an APRN who was a resident and rotated through my service during her training. We were both of the same mindset about health care advocacy. The meeting also brought forth some important individuals including Rev Dr. Shelley Best, Theanvy Kuoch – who spoke from the floor – and leaders of other key organizations. My friend, Ms. Sue Greeno, also came to participate in Middletown. We worked together during the past few years with the Connecticut Multicultural Health Partnership. Ms. Kuoch also served on the Connecticut Multi-Cultural Health Partnership and she runs a great organization called KHA (Khmer Health Partnership). I was glad to see Dr. Jewel Mullen, the Commissioner of the Department of Public Health, on the panel as well.

The presentations of the panel members helped provide a glimpse of the lay of the land and a greater appreciation for the challenges that confront all of us in health care.

These are some of the responses:

  1. Disparities in Health care:  A) We must fund the efforts to help health care entities meet and excel CLAS standards. B) We need to make sure the use of Medical Interpreters is well resourced to help our friends and neighbors with Limited English proficiency (LEP) to engage effectively in the process of identifying and addressing key health care concerns. C) Use of the Ask Me 3 process to empower our patients to accrue the best outcomes. D) Even without an LEP barrier that hurts effective health care access and participation in health promoting and disease management processes it is clear that health literacy is a very important factor that is being addressed by individual providers, practices and health care systems. One of the key points that was made is “health care doesn’t begin or end with the health care providers.”
  2. Zip Code is destiny: A) It became clear that the great blessing of the affluence of  our state as a whole and the brilliance of the Medical School faculties and the staff of top ranking health care facilities are not received equally by all of us: address, gender, age, race, and LEP appear to have seriously distorted health care spending and outcomes. Sir Michael Marmot definitively documented the importance of social determinants of health including occupation, social standing, address, income, race, and gender. B) Housing is also critical. I am very strongly convinced that address is critical to the outcomes accrued to my patients, especially my female patients. It is important that this one goal is focused on in addition to transportation, health care coverage with the help of out care managers of CHC and/or appropriate legal representation. C) The Camden Coalition, established over five years ago in New Jersey, has demonstrated clear advantages of planning and implementing comprehensive continuous non duplicative, safe and effective treatment to high risk, high health care-utilization patients living in apartment complexes. This successful health care reform initiative required Hospitals and other providers of higher intensity interventions to collaborate with ambulatory care providers. D) Additionally, it is important to develop Targeted Areas funding programs that can relocate physicians and medical providers including psychiatrists to areas that meet specific criteria.
  3. Uneven, unfair, duplicative, fragmented, excessive and expensive  care must be addressed.  This is a major problem; it is the 800 pound Gorilla in the living room. A) ACOs, quality based contracting and changing the reimbursement mechanisms from paying for individual services provided and paid for in an a la carte manner to a more effective, productive and efficient method based on outcomes for a system of health care even if (especially if) it consists of disparate health care entities as it applies in Middletown, with three major systems. Those being CHC, DMHAS and Middlesex Health Care System and Hospital. B) We need to address Anti-Trust laws that can have a serious adverse effect on plans to develop Quality of Outcomes and processes based contracting among a group of health care providers. B) Family Medical Home system with “pod” based teams and integrated comprehensive Electronic Health Record can predictably generate effective, efficient, and satisfying care that also addresses the major problem of ameliorating and erasing health care disparities from the very first instance/contact and determine the quality and safety of the interventions recommended and implemented for health promotion and disease management. Based on evidence-based guidelines and expectations.
  4. Tort reform: This critical factor affects cost and delivery of a health care system. Certificates of Merit must be safeguarded and not diluted to prevent frivolous law suits. In SustiNet’s initial iteration when we, all stakeholders including provider associations, clergy, unions and others, worked to override Governor Rell’s veto, contained great components including the frameworks for reducing the impact of legal liability and tort costs. These useful components have been lost because of the sorry fate of SustiNet which went into devolution when the all-in approach was eliminated and costs appeared to be prohibitive and ObamaCare could achieve many of its goals.
  5. PPA-ACA (ObamaCare). The role of exchanges is a very key part of keeping the dream some of us have harbored 12-15 alive of providing sustainable safe and effective as well as efficient health care which bends the curve of such costs. The health care exchange organized by the Connecticut State Medical Society is moving to be in an advantageous position to meet the needs of our neighbors and friends in Connecticut.  I am a member of the CSMS and of the legislative/advocacy committee myself.
  6. I hope meetings like these can lead to draft legislation that can be brought up in key committees of the Connecticut Legislature and be supported by specific departments of the executive branch and the OMB. We need to make the most of the input from these meetings.

 Thank you friends, I am appreciative of your support and friendship.

 Velandy Manohar, MD

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