Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, April 10, 1994 TAG: 9404100020
SECTION: VIRGINIA PAGE: D10 EDITION: METRO
SOURCE: Associated Press
DATELINE: LYNCHBURG LENGTH: Medium
Medallion is an alternative to traditional state and federal Medicaid coverage for patients who often have problems navigating the health-care system. Patients are assigned to a primary doctor, who keeps their records.
"Not only do they have a designated primary care physician who is theirs,which many have not had before, but also they have a physician available to them, 24 hours a day, seven days a week," said Bruce Kozlowski, who oversees Medicaid for the state.
Central Virginia's startup makes 14 Medallion plans in the state since the managed-care program began about two years ago. Other states have implemented similar systems.
Keeping the patient on track with one physician makes economic sense, according to Dr. Thomas Eppes Jr., a family practice physician in Forest.
Medicaid recipients visit emergency rooms frequently, he said. Medallion steers patients toward using their physician during office hours.
Studies have shown that "walk-in care is more expensive by a factor of two. Care in the emergency room is more expensive by a factor of four," Eppes said.
Medallion, he said, " . . . will help patient flow, and help the state in the long run . . . it is a worthwhile step."
While the program now works with women and children, "we are not doing Medallion for the aged, blind and disabled population - we'll get into that in a year," Kozlowski said. "We're focusing on all communities with at least 2,000 or more Medicaid clients within that service area."
Women and children offered Medallion also are eligible for Aid for Families with Dependent Children. Medallion, which has its own Richmond office and staff, pays $3 a month per patient to the doctor. Medicaid is the insurer.
Although the per-patient fee is not enough to make physicians jump on board, "it is enough to say, `this is a reasonable thing to do,' " Eppes said.
In Grundy, Medallion has been in place for a month, said Dr. Ragnikant Patel, who has about 800 patients on the plan.
"I think it is working," Patel said. "A lot of patients like to shop around for a different doctor, a type of medicine. This way, we're able to manage better our resources."
In Hampton, which has 2,300 Medallion patients, the Health Department's two full-time pediatricians are the Medallion providers, and the program works with Sentara Hampton General Hospital.
"The patients have access to care through our system, they know we're here to provide care, we're established as a medical home base," said Nurse Manager Mary Elizabeth Smith White.
Some health officials see a few drawbacks, however.
"We're still on the fence," said Dr. Joanna Harris, director of the Central Virginia Health District.
One of the snags Harris sees is the 24-hour requirement for doctors' availability. The health departments' office hours are generally from 8 a.m. to 5 p.m.
by CNB