For years, we have read and heard about emergency room overcrowding and the non-emergent use of emergency departments by the uninsured and underinsured with nowhere else to go.

The people living in the Near East Side of Detroit, within the service area of Detroit Riverview Hospital, faced that dilemma on a large scale last year when the hospital was closed. 70,000 residents were left to decide where to go for their medical care.

During the past year, a collaboration of hospital, health center, and community organizations, known as the East Side Planning Team, has developed a way of filling the void left by Detroit Riverview’s closure and through a new approach to care – a medical home. In a sense, many people in our society are medically homeless – they don’t have a place to go for medical care so they use the emergency department. About 15,000 of the residents of the Near East Side don’t have physicians and are likely to use hospital emergency facilities for primary or chronic care. And too often, they will wait until the need is urgent.

Using the definition developed by the Commonwealth Fund, a medical home is a physician’s office or health center that provides a range of “patient-centered” comprehensive health care. These are places committed to the individual’s total well-being, emphasizing preventive care and total care for chronic conditions. Diagnostic tests and other health services such as dental and mental health services are provided in a central location, still close to the medical home.

For the largely African American, lower-income population of the Near East Side, the medical home also offers an opportunity to alleviate racial disparities in access and quality, when compared with white, suburban population, according to the Commonwealth Fund. In addition to preventive care, people with chronic conditions who have medical homes are better prepared to manage their health and not use the emergency department.

The East Side Planning Team also announced five other recommendations for the Near East Side:

• Strengthen existing health care safety net providers.
• Expand primary care capacity to include at least 20 new providers at existing health centers and in new ones.
• Organize the system of care into a “hub and spoke” model of service delivery that would ensure comprehensive primary and urgent care services are available in the hub location while primary medical care in the medical home is accessible in spoke locations. The St. John Riverview campus will become the “hub” for the integrated system of care.
• Implement an emergency facility diversion strategy.  With the help of hospitals and public service advertising, people will be encouraged to call the United Way 2-1-1 to secure a primary care provider rather than go to an emergency room.
• Create connectivity within the hub and spoke system through technology. Funding will be secured to ensure that all safety net providers have electronic health records and other records to track, manage, and support patient care, including e-prescribing.

We believe that within five years, we will have a system of care on the Near East Side, with its foundation being a medical home. It will diminish the costly inappropriate use of hospital emergency rooms, improve the health status of chronically ill people, and will help everyone take better care of themselves.