Sitting in a small clinic at North Miami Beach Senior High School, Nick Contreras, a 15-year-old student, waited in front of a closed-circuit, high-definition television camera while a dermatologist examined his forehead, chest and back on a screen in her office — 13 miles away.
“It’s pretty cool,” Contreras said later, after the doctor’s remote examination, from the University of Miami Hospital, to check his response to acne medication. Without access to a car, he said, seeing a doctor via computer screen was a “really practical” alternative.
The Skype-like system, which connects nine schools in North Miami Beach, North Miami and Overtown and is known as telemedicine, has been in use for almost five years for remote appointments in dermatology and endocrinology.
Now the system is being expanded with a $4 million award to the University of Miami from an Affordable Care Act grant program for “innovative” programs. With the money, which is being paid out over a three-year period, the program is also addressing needs in mental health, nutrition and dentistry in the school clinics, which normally handle the everyday medical concerns of students. The ACA money also means that for the first time, the children’s parents and other adults are becoming patients, too.
The grant to UM — part of $1.9 billion being given to private healthcare groups around the country to help fund new approaches and thinking in medical care — is one of several allocated to Florida institutions, including the Children’s Home Society of Florida and the Florida Association of Healthy Start Coalitions.
Administered by the Centers for Medicare and Medicaid Services, money from the grants will keep coming only if recipient programs can show that they are improving the quality of patient care and “health outcomes” while simultaneously reducing spending. The UM program, which received its first installment in July 2012, aims to prove that over the three-year period of the grant it will have saved $5.6 million in costs that would have been incurred had the program not been in place.
Ultimately, the goal is to “assure that programs deemed to be successful represent high-value investments of taxpayer dollars,” according to a CMS description of the grant program. “Each awardee is responsible for monitoring and reporting to CMS on the progress and impact of its model.”
The UM grant, officially called a Health Care Innovation Award, is the only one in the country that supports telemedicine, a system that appears to be particularly useful in low-income communities where transportation options and jobs are often in short supply.
“It’s decreased travel time for the providers, the patients and the parents,” said Dr. Joycelyn Lawrence, an assistant professor at UM who directs the school clinics program. “If parents needed to take time off from work to take their children to the doctor, it was often with a loss of pay.”
In August, parents began to benefit from the grant in other respects. The funds have enabled Lawrence’s team to offer medical care to adults during evening and weekend clinics. Most are relatives of students in the nine schools, as well as other grown-ups referred by the Center for Haitian Studies in Miami.
“We have a patient population that probably would never set foot in your traditional doctor’s office,” said Lawrence, who estimated that the community served by the schools is 60 percent black, most of them Haitian. “They would be more trusting of the school their child attends.”
Including parents in the children’s care serves the dual purpose of tending not only to unmet medical needs among the grown-ups but of ensuring that families learn to lead healthy lives together.
“If we can teach our kids and their parents the importance of receiving annual physical examinations that aim for prevention and early diagnosis, then we will have made a huge impact on the future of healthcare delivery from a health and economic perspective,” Lawrence said.
One of the grant’s primary aims is to focus on children and adolescents with chronic illnesses, which if left uncontrolled might end up prompting expensive emergency-room visits and hospital admissions. For example, Lawrence and her team have identified all the asthmatic students in the nine schools and have reached out to them and their parents to make sure they get the care they need.
“They are able to be seen within our clinics for acute management, medication refills and pulmonary function testing,” Lawrence said. Parents also have access to a 24-hour call system.
“By keeping an asthmatic child free of symptoms we save approximately $2,700 in emergency-room costs,” Lawrence said.
Additional savings are expected by stepping up immunizations. Lawrence and her crew are also diagnosing and providing on-site treatment for sexually transmitted diseases.
The new dental program also envisages staving off future costs. By providing a dental sealant to a child, for instance, “we save approximately $357 down the line from having to fill a cavity,” Lawrence said as she showed a visitor four new, reclining dental chairs in a room at John F. Kennedy Middle School in North Miami Beach. “We also save on missed school days due to poor oral health.”
The program in nutrition addresses the pervasiveness of obesity and diabetes. “We’ve had children who are borderline diabetics and we’ve been able to pull them back,” Lawrence said. “But the whole family has to be involved.”
Kenneth E. Thorpe, a professor in the Rollins School of Public Health at Emory University, said such initiatives are vitally important, given the “major problem” that obesity has become.
“It’s not just children — it’s seniors, it’s middle-aged workers,” said Thorpe, an authority on diabetes and obesity who is not involved in the UM program. He said that 34 percent of adults in the United States are considered obese, double the amount estimated in the 1980s, “and you’re seeing similar trends in children.”
Parents need to understand nutrition, he said: “They’re the ones doing the cooking, so getting them educated is critical.”
Using the ACA grant, Lawrence and her colleagues also hired six community health workers to, among other things, reach out to what she called the area’s “very high uninsured population.” Over the three-year period of the grant, the UM program will train about 60 workers and create 25 jobs. The new workforce will also include dental hygienists, physicians and nurse practitioners.
“We’re like the liaisons between the school and the community,” said Zekia Idris, one of the newly hired community health workers, who was previously a medical assistant. She and her colleagues identify which students lack health insurance and help them apply to Medicaid or Florida Kid Care.
“If they’re undocumented, we refer them to other clinics that might be able to help them with care,” Idris said. “Every family is a different situation.”
Affordable Care Act awards in Florida
The University of Miami’s program, which is partly funded by the Dr. John T. Macdonald Foundation School Health Initiative, addresses students’ medical care in four elementary schools — Arch Creek, Fulford, Greynolds Park and Sabal Palm — plus two middle schools, John F. Kennedy and North Miami, and three senior high schools, North Miami Beach, North Miami and Booker T. Washington.
The Children’s Home Society of Florida is receiving an award for slightly more than $2 million to establish a medical home for students, families and teachers at Maynard Evans High School in Orlando. The aims include reducing emergency-room visits and hospitalizations, increasing awareness of sexually transmitted diseases, and addressing “food insecurities” and stress.
The Florida Association of Healthy Start Coalitions is receiving a $1.2 million grant to improve maternity care in Tampa, St. Petersburg and Lakeland. The aim is to reduce preterm births and improve health outcomes for newborns and pregnant women.