The disaster that New York City faces in the upcoming months as a potential 1.2 million people on Medicaid and Obamacare lose their health insurance will first be felt in emergency rooms. Even those who have secure insurance for now, in a medical crisis will have to use the same emergency rooms which the displaced and low-income will more and more crowd for basically all their care.
Several city hospitals already have their worst wait times in years for “on boarding,” or the transfer of patients from emergency rooms to hospital beds and waits for ambulances are steadily increasing.
Facing this giant emergency is an absolute priority for the city and state. Here is where the astounding — and decades long — failure of the state and city to address chronic disease, with its many opportunities to improve health while slashing emergency visits and hospital stays, screams for attention.
We know full well that, for chronic disease, proven and engaging self-management education is over and over a fast and effective way to slash emergencies.
Consider one project Health People, an organization I founded in the Bronx, undertook. When we engaged 201 men and women living with diabetes in Bronx homeless shelters in a six-session course known as the Diabetes Self-management Program (DSMP) evaluation by the New York City Department of Health showed stunning results — emergency visits fell by 45% and hospitalizations by 74% in six months! Most important, this is a program that communities can deliver themselves using local peer educators and community health workers.
There are many well evaluated courses that reduce emergencies and hospitalizations for a range of chronic diseases that can also be delivered by trained local peer educators; for kids with asthma, education not just in the community, but brought right to their homes, will slash emergency visits in half.
But our massive sickness industry has had little interest in assuring that patients understand the good self-care that keeps them out of hospitals.
These courses and workshops are especially unavailable to low-income and Medicaid patients. That must change.
New York State has to take the lead for change because it moderates what Medicaid pays for. To its shame, the state has never sought a federal waiver to, for example, include the DSMP, delivered by community groups as part of its reimbursed Medicaid services. The city, to its own shame, has never pushed the state to obtain federal approval for community education like this, which can vastly improve the health of high risk New Yorkers.
Self-management education saves so much money that the state and federal government, which pay for some 90% of Medicaid costs (with cities and counties paying the rest) would both reap literal billions in saved dollars by finally addressing New York’s chronic disease epidemic by assuring that those at highest risk for unnecessary illness have a clear opportunity to understand and improve their self-care.
The New York City health commissioner, Dr. Alister Martin, is by background an emergency room physician, and surely knows what’s coming. As an overriding approach to health, he recently stated that, “The community is the cure.” That may sound like wishful thinking in an era of fast technology, AI and GLP-1.
Much to the contrary, in this emergency, the only way to go forward rapidly is for the city and state to support community groups to be the cure and launch widespread efforts to teach local residents in the grip of chronic disease that they can feel — and be — better indeed.
Norwood is the founder of Health People in the Bronx.