When Pennsylvania Governor Edward Rendell took office in 2003, one-twelfth of the state’s 12 million residents had no access to health care, 80 percent of health care expenditures went to treating chronic illnesses, and $3 billion was spent annually on avoidable hospitalizations of chronically ill patients. Pennsylvanians were 11 percent more likely than all other Americans to use the emergency room (ER).
On his first day in office, Governor Rendell established the Office of Health Care Reform to begin to address residents’ access to affordable, high-quality health care. In January 2007 he announced a major new blueprint for that reform, Prescription for Pennsylvania (known as Rx for PA, www.rxforpa.com), which would promote access to care for all Pennsylvanians and reduce the state’s skyrocketing health care expenses.
In the 3-plus years since, many initiatives have been undertaken, including:
- expanding health insurance coverage for the uninsured;
- improving access to electronic health information through the Pennsylvania Health Information Exchange;
- establishing a chronic illness commission, which in 2008 recommended, among other proposals, the patient-centered medical home;
- addressing workforce shortages through the Pennsylvania Center for Health Careers;
- establishing seven “learning collaboratives” that involve about 800 providers and 1 million patients and teach a variety of providers to collaborate on primary care teams; and
- expanding the legal scope of practice for physician assistants, advanced practice registered nurses (APRNs), clinical nurse specialists, certified nurse midwives, and dental hygienists (although legislation is still needed to allow APRNs to prescribe medications independently).
This last strategy has had an impact on access to care, particularly for the uninsured and underinsured. There are now 51 retail clinics that use APRNs in urban, suburban, and rural areas, and they provide care to 60 percent of the state’s uninsured, said Ann S. Torregrossa, Esq., who in 2005 was named deputy director and in 2009 director of the Office of Health Care Reform. Ms. Torregrossa said that of 300,000 visits to such clinics, about half would have been ER visits. Retail clinics have been shown to reduce costs and improve access to care (Mehrotra et al., 2009).
Other outcome data after the first year of Rx for PA show an increase in the number of people with diabetes receiving eye and foot examinations and a doubling of the number of children with asthma who have a plan in place for controlling exacerbations (Pennsylvania Governor’s Office, 2009). There are about 250 nurse-managed health centers nationwide and 27 in Pennsylvania; many are affiliated with schools of nursing and provide care at a 10 percent lower cost than other models—including a 15 percent reduction in ER use and a 25 percent reduction in prescription drug costs (according to unpublished data from the National Nursing Centers Consortium [NNCC]).
Tine Hansen-Turton, MGA, JD, CEO of the NNCC and vice president of the Public Health Management Corporation, a nonprofit institute, said that nurses involved in Rx for PA have a great deal to teach clinicians and leaders in other states as they grapple with health care reform (Hansen-Turton et al., 2009). The nurse-managed health centers in particular offer a preventive care model that improves access to care. And Pennsylvanians have given high marks to the care they have received from APRNs, Ms. Hansen-Turton said, adding, “It’s all about access.”