Al Karcheski discovered in February that he has diabetes.
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Since then, the 64-year-old retired high school teacher has had to learn how to eat fewer carbohydrates, stay on top of his blood sugar levels, increase his exercise and get his feet and eyes regularly checked .
It's a lot to absorb.
But his doctor's office, Strasburg Family Health Center, is helping the Lancaster resident by adopting a new way of caring for patients with chronic diseases such as diabetes.
The Strasburg practice and Lincoln Family Medicine are the two first practices in Lancaster County to adopt the "medical home" method of care.
The two practices are doing it under a pilot program of Gov. Ed Rendell's "Prescription for Pennsylvania" health care reform plan.
The goal is that by better managing common chronic diseases, doctors at these practices can keep patients out of the hospital and hold down health care costs.
The program focuses on education and monitoring.
Patients get a regular "report card" with test results and follow-up recommendations. They may take part in group visits, where they hear about topics such as exercise and diet, and individually talk to a doctor. Doctors and a team of nurses monitor patients with a monthly report that shows who needs to be seen or tested.
"Rather than deal with complications as they arise, we want to try to prevent those complications," says Dr. Curtis Hershey of the Lincoln practice.
Says Dr. Christopher Lupold of the Strasburg practice, "What this allows you to do is to track their care better, to make sure they are getting all the care they need."
When Lupold meets with a diabetic patient, he has a specific checklist of things to go over: Did you get a flu shot? A pneumonia shot? Have you been to see your eye doctor recently? What is your cholesterol level? Your blood sugar? Are you exercising? Do you need to have any medicines refilled?
For their part, patients get the support that helps them to take better care of themselves.
"It's important to have a group of people you can be familiar with, so when you walk out of the office, you're not alone," Karcheski says. "What you choose to do, when you're driving past a McDonald's, you might make a bad choice. ...If you're having a problem, it's nice to be able to call someone about how to deal with this, or is there a substitute for, say, ice cream. There's a whole lot of education that goes on."
The Strasburg and Lincoln groups are in the second wave of practices in the state to participate in the program. their participation began early this year.
By this summer, the state hopes that more than 400 primary care doctors will be caring for more than 750,000 patients in this way. Eventually, the goal is to provide similar care for patients with other chronic conditions, such as asthma, heart disease and lung disease.
Six insurance companies are helping to financially support the program, if the practices meet certain goals. Eventually, the companies may provide a higher reimbursement to practices that adopt this type of care.
In turn, they expect substantial health care cost savings.
About half of all Pennsylvania residents have a chronic disease, according to a state report on chronic care management. These patients account for 80 percent of all health care costs and hospitalizations.
In 2007, it was projected that avoidable hospitalizations for chronic disease patients could top $4 billion in charges, not counting emergency room visits. Pennsylvania residents with heart disease are admitted unnecessarily to hospitals more than two and a half times as often as residents of the best-performing states, the report said.
Initial results of the program show promise, state officials say.
Earlier this month, Rendell said the first wave of the pilot program increased the number of patients with acceptable cholesterol and blood pressure levels.
Hershey and Lupold don't have results yet, but they are hopeful that they can provide better care through the medical home program.
Hershey says his practice already is finding patients who might have fallen through the cracks and were not getting adequate follow-up, sending letters and calling them to ask them to come in for a visit.
Says Lupold: "People are leaving with a much better understanding of what is going on with their diabetes and what they need to be doing."
Staff writer Cindy Stauffer can be reached at cstauffer@LNPnews.com or 481-6024.
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