Managing the Uninsured With a Community Network

Roth’s article, “Managing the Uninsured With a Community Network” (that accompanies the article by Kaufman, et. al The Health Commons and Care of New Mexico’s Uninsured Ann Fam Med 2006 4: S22-S27) describes the complimentary view by the University of New Mexico’s Dean, Dr. Paul B. Roth. His story starts with an account of UNM’s of the evolution away from the historic role noted above – a microcosm story for many of today’s AHCs, but in the stark relief provided by the fact that UNM is the only AHC in the state and served as the clear focal point for statewide discussions regarding the state’s responsibility to care for all of its people.

The solution that developed is a truly heartwarming (to an academic FP!) story of a creative win-win relationship that was forged between the hugely innovative and historically committed Department of Family and Community Medicine under the direction of its veteran Chair, Dr. Arthur Kaufman and an equally visionary Dean Roth who saw the need – yea requirement – for the UNM University Hospital to return to its historic AHC mission. Dr. Roth crafted a set of solutions that make eminent sense and are being replicated across the country by other equally innovative health care leaders (see To Lower Costs, Hospitals Try Free Basic Care for Uninsured - New York Times Page 4 of 5 http://www.nytimes.com/2006/10/25/health/25insure.html?_r=1&adxnnl=1&oref=slogin... 10/25/2006). These included an intensive program (Care One) for high users of care, expansion of Medicaid through the waiver program, and the creation of an Office of Community Affairs with a community advisory board. Another move was to promote creative collaboration between the community health centers (CHCs) and the UNM Medical School and the Dept. of Family and Community Medicine. The school worked with the CHCs to make them service-learning sites for students and residents – and worked to jointly recruit physicians who would both provide care and teach, thus increasing retention and quality. He also promoted a working relationship between the CHCs and the Dept. of Family and Community Medicine’s inpatient service. This allowed coordination between inpatient and outpatient care that will clearly serve to rationalize the use of both. Larry Culpepper has done the same thing with the community health centers and the new Boston City Medical Center, and this concept is simply outstanding.

But the actions that impressed me the most were the commitments Dean Roth made on medical student admissions and curriculum. He made the commitment, advised now by the AAMC, to increase the class size of the UNM Medical School. But he did this in a way that is clearly and boldly aimed at fixing the maldistribution problems for physicians in the state rather than leaving to chance and choice the unlikely trickle down outcomes of a simple increase in graduates who might elect to fill such gaps. While one cannot guarantee where any graduate will go, the chances of newly minted doctors who are recruited from rural and ethnic minority communities returning to serve there are a lot higher. In a situation where the usual response is to avoid such directed action – this is a brave and courageous move. And to top it off, he has committed the entire school to guaranteeing that all graduates will be uniformly trained in the principles of population health, so they understand their responsibilities and those of the entire health profession in fulfilling their social compact with the people of New Mexico. Dean Roth is walking the walk and has set the bar at a high but replicable level for other AHCs – if they have the courage to act.

Competing interests:   None declared