HealthyCal.org

One of the most common arguments in favor of the federal health reform law that the Supreme Court is weighing this week is that people without insurance overuse emergency rooms because they lack access to basic care.

But new research released today suggests that people without insurance use the ER no more than those who have health coverage. In fact, people who were without coverage and obtain it use the ER more than people who have steady coverage or no coverage at all. People who lose their coverage also use ERs more, the study finds, so it seems to be a change in health insurance status, more than anything, that leads to an increased use of the emergency room.

The study, published today in the Archives of Internal Medicine, was authored by researchers at the University of Colorado and the Oregon Health and Science University.

The study analyzed 159,934 adults who took part in the National Health Interview Survey between 2004 and 2009. The survey respondents were divided into categories of newly insured, continuously insured, , newly uninsured or continuously uninsured. The newly insured or uninsured were placed in those categories if their status had changed during the previous 12 months.

The researchers found that overall, about the same proportion — around 20 percent — of insured and uninsured people had visited an emergency room in the prior year. But almost 30 percent of newly insured adults had done so, compared to 20.2 percent of continuously insured people. And about 26 percent of newly uninsured people had been to the ER, compared to about 19 percent of continuously uninsured people.

Among newly insured adults, the connection between their insurance status and their visits to an ER was strongest for people who were newly on Medicaid, the government-subsidized health insurance program for the poor.

“As policy changes and economic forces create disruptions in health insurance status,” the authors conclude, “new surges in (emergency department) use should be anticipated.”

The results could mean new, unanticipated hurdles for the implementation of the federal Affordable Care Act if it survives legal and political challenges.

While it has been anticipated that the expansion of insurance coverage might lead to more visits to an already over-burdened primary care system, many policymakers seem to have counted on a reduction in emergency room visits. This would mean a savings not only for hospitals and the government but for the private insurance market as well, since hospitals are known to shift the uncompensated cost of caring for the uninsured to their insured customers through higher fees. But if covering more people leads to even more visits to emergency rooms, then those anticipated savings may not materialize.

–Daniel Weintraub

Insurance companies seek intimate health details before deciding whether to sell him a policy

By Herbert A. Sample

Call me crazy. I’m a few months from losing my health insurance coverage – the “COBRA” plan you can buy after you leave a job that initially provided the benefit. So I figured I should start planning now to find an individual policy to replace my current plan before I lose it.

This shouldn’t be too difficult, right? After all, the federal Affordable Care Act – colloquially known as “Obamacare” – was signed into law two years ago. Its mandate that all American citizens obtain coverage of some sort, coupled with a prohibition on insurers denying applicants because of pre-existing health conditions – takes effect in less than two years, assuming the U.S. Supreme Court doesn’t strike it down after hearings this week.

It couldn’t be all that tough, I thought to myself, to find an affordable health plan.

I was wrong.

Advocates of President Obama’s health reform say I am a case study in how untold numbers of Americans have been caught in a no-man’s land waiting for the new federal law to take full effect.

I am a healthy 51-year-old freelance writer. I’ve never had a major illness or disease (knock on wood). The only broken bone I’ve ever suffered was a fractured jaw, and that was almost three decades ago. I have minor, not-so-unusual conditions for an African American male of my age – borderline high cholesterol and high blood pressure, which have been controlled by one medication each for years, and a hormonal issue for which I also take medication. I’m not overweight. I don’t smoke, and my drinking habits are somewhere between light and moderate.

But three insurance companies – Blue Shield of California, Kaiser Permanente and Aetna – all refused to cover me, at any price. Anthem Blue Cross said yes – but only if I accepted a plan that would cost more than three times as much as the plan for which I applied, or $1,350 a month. The justification cited by all four insurers: Pre-existing conditions.

This is the state of American health insurance, California-style, circa 2012.

My situation is not rare, reports Michael Russo, who follows health insurance issues for the California Public Interest Research Group, or CalPIRG. “I don’t think it’s really uncommon at all, sadly,” he said. Large numbers of individual applicants are denied or steered to more expensive plans. “It’s a ridiculously high percentage.”

I thought it might be instructive to peer behind the curtains of the four health insurers to which I applied to see how they concluded I was just too much of a risk. Alas, these wizards said nope, no, no way. They did not want to share any insights into the application process, or at least what happened to my application.

“I’ve been told we generally decline these types of requests,” Darrell Ng, a Blue Cross spokesman, stated in an email.

Aetna’s spokeswoman, Anjie Coplin, had me sign a release so she could discuss my situation, then told me what was already obvious: I was denied because of my pre-existing conditions. She never addressed my request for a further explanation of what made my ailments actuarially scary.

Angenette Lau of Blue Shield emailed, “We do not comment on any specific application.” Am I to understand that Blue Shield will not comment to me about its denial of my own application? “Correct,” she replied.

Kaiser’s policy was similar: There’d be no discussion of my application’s denial, said spokesman Won Ha.

But here’s what I can tell you:

On all four applications, I stated what I know of my medical condition: slightly elevated blood pressure and cholesterol, as well as lower than normal testosterone and infrequent but minor ear infections. I also mentioned that in 2009 and 2010, I saw a therapist every two weeks or so for counseling for mild depression tied to a divorce and the death of my parents, and that there was no medication or hospitalization involved. And I noted my long-simmering but minor athlete’s foot that was resolved last year through a 90-day course of medication, with no side effects or subsequent treatment.

Representatives of Aetna and Blue Cross called with further questions, which I answered.

In its denial letter, Aetna listed blood pressure, cholesterol, ear infections and low testosterone as its reasons. It also cited “parathyroid disorder,” an ailment I’ve never had and which I did not list on my application. In fact, the questionnaire asked whether I suffered in the last five years from ailments such as diabetes, thyroid disorders or lupus. I answered no. But since Aetna isn’t talking, I guess I’ll never know how it divined that I indeed do suffer from parathyroid disorder.

Kaiser cited the cholesterol, blood pressure, testosterone and ear infections, but also threw in the athlete’s foot and my “depression.”

Blue Shield pointed to the blood pressure, cholesterol, and testosterone issues, and said its “other concerns are history of depression treated with counseling.”

Blue Cross apparently didn’t care about my alleged “history of depression.” But it did cite the blood pressure, cholesterol and testosterone ailments, and “erectile dysfunction – treated with Cialis and Viagra.”

During the phone interview with a Blue Cross representative, I was asked if I have an undescended testicle or a malignancy in or near one; have used a penile implant; or plan testicular surgery, infertility treatments or related procedures. I answered no to all of those queries. What was the “underlying cause” of the erectile dysfunction? According to the specialist who first diagnosed the condition eight or nine years ago, I replied, the cause was low testosterone. I also told the interviewer that the doctor prescribed both a daily testosterone supplement and the use of Cialis or Viagra. My subsequent physicians have continued that treatment, I said.

But that was too much for Blue Cross. I’d love to ask why it was so concerned about the sex-related aspects of my medical history, but as Ng said, the company does not discuss the reasons behind its inquiries.

Since the insurers were no help, I posed some general questions to Patrick Johnston, a former Democratic state legislator and currently the director of the California Association of Health Plans, a coalition of 40 health insurers. I asked him to explain the insurance industry business model that leads companies to refuse to sell their product to anyone they think might actually need it some day.

He helpfully talked about how insurance actuaries usually conclude that younger adults are cheaper to insure than older ones, and how they find it difficult to assess risk on individual applicants.

“When you’re dealing with an individual … the actuary has no one else to pool (him or her) with except other people in that age group living in that area, and then has to apply the factor of how likely is this person going to need health care services,” Johnston said. “So the (application) questionnaire that indicates health status is a way to standardize that risk.”

Of course, he and others noted, the world will change on Jan. 1, 2014, when the federal health reform’s main components – the prohibition on pre-existing conditions being used to deny applicants or to charge higher rates, and the requirement that everyone obtain insurance – take effect. Individual consumers then will be able to seek coverage directly from insurers or through the state’s Health Benefit Exchange, an online bazaar of sorts that is intended to ease the chore of comparing and buying policies. Sliding-scale subsidies will help low- and moderate-income buyers afford the coverage.

“Could it have been done sooner? Yea,” said Anthony Wright, executive director of Health Access California, a health care consumer advocacy coalition. “But there actually was a need to have some time built in, to both put the infrastructure in place and also to give time for the market to transition because we are going from the wild, wild west here in California to hopefully a transparent, consumer-friendly market.”

Still, 2014 is 21 months away, and the end of my COBRA coverage this August is fast approaching. Yes, there is the state’s Pre-Existing Condition Insurance Plan, its Major Risk Medical Insurance Program, or provisions of the federal Health Insurance Portability and Accountability Act. But each has its own significant drawbacks, such as requiring an applicant to go without insurance for six months, a temporary ban on coverage of pre-existing conditions, or haziness about the scope and cost of coverage.

So for now I sit and wait, facing the prospect of going without insurance until Obamacare kicks in – or paying more than $16,000 a year for the only policy one of these companies will sell me. Neither of those is a very pleasant option.

Herbert A. Sample is a freelance writer based in Los Angeles. He can be reached at hasample@mac.com

Unless the Supreme Court strikes it down, most of the Affordable Care Act is likely here to stay

By Daniel Weintraub
California Health Report

Today marks the second anniversary of President Obama’s signing of the federal health reform law. Supporters have been celebrating all week. On Monday, opponents of the law will go before the United States Supreme Court to ask that the law be struck down as unconstitutional.

But while its future may seem uncertain, the Affordable Care Act is already affecting the lives of millions of Californians — expanding access to insurance, and care, for people who had been falling through the cracks.

The most controversial piece of the law – its mandate requiring most Americans to obtain insurance coverage – does not take effect until Jan. 1, 2014. The mandate is at the heart of the legal challenge, and supporters say that the Act cannot survive without it.

That may be true. But the mandate, no matter how important, is just one part of the law, and most of the pieces that have taken effect so far are much more popular.

One is a requirement that insurance companies let families keep their adult children on their policies until age 26. Before the law was passed, adult children who were not in college were typically knocked off their parents’ family coverage, and many then went without insurance. It’s estimated that more than 350,000 young California adults are taking advantage of this provision to keep their coverage.

Another major change is a provision prohibiting insurance companies from denying coverage to children with pre-existing medical conditions. Once this rule took effect, some insurers doing business in California said they would simply stop selling kids’ coverage. But a new state law now requires them to sell those policies if they want to sell any insurance here. So families with sick kids now find it easier to get coverage for them.

Adults with pre-existing conditions can still be denied private coverage, until 2014. But in the meantime, California, using new federal money, has expanded a high-risk pool for people who have been shut out of the private insurance market. Nearly 9,000 people who were without coverage before have been accepted into that program.

Every Californian with private coverage is also benefiting from other parts of the law. One provision prohibits insurance companies from imposing lifetime limits on the costs that people can have covered. Another phases out the annual limits on costs that many insurers have included as part of their policies. Still another piece of the law requires insurance companies to provide preventive care without out-of-pocket costs.

And there is more. A major goal of the Act is the expansion of coverage for low-income Americans who have not received coverage through work, could not afford to buy it on their own but did not qualify for public programs designed for the very poor.

With new federal money, California counties are creating or expanding what are known as Low-Income Health Plans, similar to the Medi-Cal program, but for people with higher incomes or who do not have children. So far, more than 300,000 people in 47 counties have been enrolled in these programs. In 2014, they will become part of Medi-Cal, and the federal government will continue to pick up the cost of their care.

California has also begun implementing what could become the most important piece of the new health care system: the creation of a Health Benefit Exchange. This will be an online marketplace where businesses and individuals can shop for coverage. The plans will be standardized and grouped into levels of coverage – gold, silver, bronze – so that consumers can see clearly what benefits are available and how much each plan would cost, including deductibles and co-payments. Subsidies will be available for consumers with incomes up to four times the federal poverty level, or nearly $90,000 a year for a family of four.

The Exchange is expected to facilitate coverage for several million Californians who don’t have insurance now. Others will move to the Exchange if they lose employer-based coverage. Health insurance experts expect some employers to drop their coverage once the Exchange becomes a viable alternative for their workers, despite financial penalties for doing so. Eventually, the state-run marketplace could become the biggest seller of insurance in California.

All of this has been done without the mandate on individuals that will be the subject of next week’s Supreme Court hearings.

The court is expected to rule on the case in June, and unless the justices strike it down completely, the issue will probably be a big part of the presidential campaign later this year. Republicans have vowed to repeal the law if they get the chance, even though their likely nominee, Mitt Romney, signed a very similar plan when he was governor of Massachusetts.

But even if Romney or another Republican is elected president and the Republicans take control of the US Senate, it’s unlikely they will follow through with their threat to repeal the entire law.

Many pieces of the Act are popular even with Republican voters and the business community, and the parts expanding coverage for the poor are really more about the safety net than insurance.

So unless the Supreme Court invalidates the entire law, the Affordable Care Act, or most of it anyway, is probably here to stay.

Kids living near some small airports have higher levels of lead in blood

Unlike other vehicles, piston-engined planes and helicopters are allowed under federal law to use fuel that contains lead additives to achieve the high octane the aircraft engines require. Photo: Donnaphoto/Flickr

By Chris Richard

A growing body of science has confirmed that dirty freeway air undermines the health of those living nearby, and regulators are studying mitigation measures. But activists say a more pervasive danger has received too little attention: lead in the exhaust of propeller-driven aircraft that routinely fly in and out of small regional airports.

Charles Collins, who lives under the flight path about 500 feet east of Santa Monica Airport, said he and his wife are increasingly worried about how the pollution might be effecting their young daughter.

“When you call people, they give you a real brush-off, like, ‘Well, you knew the airport was there when you bought your house,’” he said.

“Nowhere were we given any information that these planes are using leaded fuel, that lead is being deposited in our neighborhood regularly.”

Unlike other vehicles, piston-engined planes and helicopters are allowed under federal law to use fuel that contains lead additives to achieve the high octane the aircraft engines require.

According to Kim Hoang, air toxics risk coordinator at the Environmental Protection Agency’s San Francisco office, atmospheric lead emissions nationwide totaled 990 tons in 2008, the most recent year for which figures are available. Of that, piston aircraft gave off 551 tons, and half of that around airports.

Testing on how that effects surrounding neighborhoods is relatively new. Two of the first investigations — conducted by the Southern California Air Quality Management District at the Santa Monica and Van Nuys airports in the spring of 2006 and winter of 2007 – found lead concentrations near the runways that were five to 10 times higher than the Los Angeles Basin average. In the neighborhood just east of Santa Monica Airport, concentrations continued to exceed background levels for more than half a mile downwind of the runway.

AQMD spokesman Sam Atwood noted that the pollution never rose above the national safety cutoff, 0.15 micrograms of lead per cubic meter of air. The Los Angeles basin average during the test period was 0.0086 microgram, In Van Nuys, the highest level recorded was 0.0261 and in Santa Monica, 0.096.

Testifying in November at a hearing of the state Senate Select Committee on Air Quality, Hoang said a 2010 study by the EPA found similar results. Soil and dust samples taken on Santa Monica Airport property and at local parks did not show lead levels above the local norm, she said.

Likewise Robert Freeman, environmental manager for Los Angeles World Airports, which runs Van Nuys – the nation’s busiest general-aviation airport – said “We have not seen anything that really alarms us.”

But John Froines, professor emeritus at the UCLA School of Public Health, said there is cause for concern.

At the Select Committee hearing, Froines acknowledged that the Centers for Disease Control sets the safety limit at 10 micrograms per deciliter of blood.

Research shows children can suffer a significant cognitive decline at levels between 1 and 5 micrograms, he said.

In July, Duke University researchers correlated state records on children in six North Carolina counties whose blood had been tested for lead with how close they lived to regional airports serving piston-powered aircraft. They found that children aged seven and younger who lived within six tenths of a mile of one of these airports had blood lead up to 2 percent higher than others living farther away. Children who lived within three tenths of a mile of an airfield exceeded the norm by up to 4 percent, the researchers found.

The eastern edge of Santa Monica Airport is within 250 feet of the closest home. State Sen. Ted Lieu (D-Torrance) chair of the Select Committee, said he’s called on state health agencies to conduct blood tests in that neighborhood. No agency has yet been assigned the task and no schedule has been set, Lieu said.

Los Angeles air quality activist Martin Rubin wonders whether Santa Monica’s six flight schools could be concentrating a toxic threat.

“The pattern practice flights circle over and over the same area,” he said. “They’re not that high and there’s a lot of them. So there’s a specific area that is being rained on.”

In a recent interview, Froines said he’d like to see broader soils testing. As for blood tests, airport workers should be included as well, he said.

Some pilots dismissed any thought of a health menace.

“If the EPA had found unsafe levels of lead at the airport, pattern flying would be an issue,” said flight school operator Joe Justice. “They have not.”

Mark Smith, a solar energy entrepreneur who regularly flies his single-engine Mooney 231 on business from Santa Monica Airport, said it’s absurd to blame planes for the region’s environmental woes.

“Obviously, aviation gasoline has got lead in it. Over the years they have reduced the amount of lead and eventually they will eliminate lead,” he said. “There are many other contaminants in Southern California that are produced by cars that are equally as unhealthy as lead if not more so.”

But environmental organizations are keeping up the pressure. Last May, the Oakland-based Center for Environmental Health filed suit against ExxonMobil, Chevron, BP, Shell, AvFuel Corporation and 38 airport-based suppliers of lead-containing aviation fuel under Proposition 65, which regulates public exposure to toxic substances. CEH says the defendants have polluted drinking water and air around twenty-five airports throughout California. Under Propositon 65, pollution of drinking water sources above state standards would require the companies to cease sales of their leaded gas.

The National Air Transportation Assn. is leading defense efforts. Association vice president Eric Byer did not respond to interview requests.

Charles Margulis, a spokesman for the Center for Environmental Health, said the lawsuit is in settlement negotiations.

“The goal is to clean up the problem,” he said. “Ideally that would be through industry reformulating, so they no longer needed leaded gas.”

By Matt Perry
California Health Report

The rapidly-spreading Village Movement is helping older adults age gracefully by offering the best of two colliding worlds: “aging in place” to avoid institutional living while creating tight community bonds to foster better health and social connections.

But these villages are not retirement communities with fixed geographic boundaries. They are collections of individuals living in their own homes across traditional neighborhoods, communities, even entire cities or regions, with the members of each community connected by a network that offers them essential services allowing them to remain independent.

In a typical Village Movement “community,” a phone call to a central number connects residents to a vast array of services: transportation, home repair, yoga classes, business recommendations, even life coaches.

“All the amenities of living in a retirement community without having to leave your own home,” explains Lisa Hendrickson, president and CEO of Avenidas, which operates Avenidas Village for ten communities surrounding its Palo Alto headquarters.

An aging nation is jumping on the Village bandwagon. The Arlington, Virginia-based Village to Village Network, which helps establish and manage villages, reports that there are now 70 villages nationwide, with 115 more in development. Though most are located along the northeast Atlantic coast, California is swiftly gaining momentum, with 13 existing villages – six in the Bay Area – and a whopping 25 more in the planning stages.

In rural Plumas County north of Lake Tahoe, Nance Reed had knee replacement surgery two years ago and received an endless stream of help from Community Connections while she recuperated: overnight home supervision, food, library books, and car rides to physical therapy.

Reed was even transported 90 minutes each way to the hospital for surgery while other village members cared for her cats.

“Our program’s wonderful,” says Reed gratefully of the all-volunteer organization. “People took care of me.”

“They’re almost always grass roots organizations because members of the community want them for themselves and their friends,” says Hendrickson, who is on the advisory council of the Village to Village Network. She says villages succeed when they stay “small and very familiar.”

While Villages have their own distinct personalities, they share several common principles: they are self-governing, offer services for older adults, foster social connections, have local business ties, adopt a holistic approach, and often assist with healthcare needs.

In some villages, there’s even 24-hour phone assistance for safety and medical needs.

Since 90% of village members are 65 and over, the greatest needs are for transportation and home maintenance.

In 2002, Beacon Hill Village in Boston pioneered the village concept with the help of wealthy, educated neighbors who could afford the pricey membership fee. In many communities today, these can range up to $1,000 or more annually.

In California, these fees an vary dramatically. Avenidas Village charges $825 per person, or $1,050 per couple. By contrast, annual membership in Plumas County is $25, with a lifetime renewal of just $25.

Annual fees entitle members to a range of free services. Others may be fee-based. In San Francisco Village, for example, additional costs apply for meal preparation, computer repair, financial planning, and various other services.

This year the Archstone Foundation, located in Long Beach, offered grants to nine California villages to help spread the village philosophy by improving marketing efforts to keep memberships affordable in underserved communities.

“We’re trying to look at areas where there isn’t much money,” says Joseph Prevratil, Archstone’s president and CEO. “The big key is sustainability.”

San Diego’s Tierrasanta neighborhood is an isolated, hilly area bordered by freeways, a military base, and park. With few local businesses or bus routes, it’s largely a bedroom community inhospitable to aging adults.

“Within 15 miles radius you can find all the services you need, but you can’t get to them,” says Pam Chapman, executive director of Tierrasanta Village. “It’s very common for you not to know anyone who lives in your neighborhood.”

Opened in 2008 with just 27 members, Tierrasanta Village provides traditional transportation and home repairs, but also offers a vast array of social programs that include exercise classes, sing-alongs, bridge, educational lunches, lectures, movies, potlucks, writing retreats, and even a personal life coach.

Chapman hopes to expand Village membership beyond the current tally of 173 by marketing to the neighborhood’s 6,000 adults aged 50 and over – the minimum age needed for membership.

Disappointed by a local community center that didn’t cater to seniors, Maureen Geyer researched Tierrasanta Village at length before signing up with her mother.

When the mother-daughter roommates went to their first village monthly meeting, Geyer knew she’d found the right place.

“Seeing her face light up was well worth everything,” says Geyer, who also worries about her own aging process.

Geyer is thrilled to have others to talk to about aging while gaining an additional support system for her mom.

“It feels like someone took a burden off my shoulder,” she says, with relief. “I feel like they’ve got my back.”

“Psychologically, there’s a tremendous amount of improvement in people being safer, well-cared for, connected,” says Chapman. “They are amazingly less isolated.”

Tierrasanta is a “hub” model that works in smaller, self-contained neighborhoods – one of three traditional village models.

The “hub and spoke” model features a central administrative office orbited by satellite neighborhoods – some several miles away.

The third model – and one with the least expensive membership fee – is the “time bank” model. Members volunteer services and receive equal volunteer time in return.

One time bank example is Plumas County. With its rural setting, mountainous terrain, and tiny population of mostly low-income citizens, these factors produced a village far different from its well-heeled Beacon Hill origins.

“It didn’t have anything to do with money,” says Leslie Wall, program coordinator for Community Connections, which administers the village.

For Wall, the village concept turned the traditional social services model upside down to “tap into people’s strengths instead of their needs.”

Membership dues are virtually non-existent. The only staff needed to administer the program is paid by Wall’s employer – the non-profit Plumas Rural Services – which operates several other programs.

Of the village’s four core values, Wall says the first is the most important: “The real wealth of a community is its people.”

While most village models cater to older adults, tiny Plumas County emphasizes a generational mix. Of its 266 members, 25% are 18 and under. The oldest member is 91, and the youngest only six. Older adults often receive technology assistance from their younger counterparts.

And in this mountain community, the greatest needs are far different than their urban or suburban neighbors; cutting wood, stacking it, and shoveling snow are in high demand.

The time bank model “has much more potential in under-resourced communities where people have time available but not the financial resources,” says Andrew Scharlach, director of the Center for the Advanced Study of Aging Services.

In the Bay Area, San Francisco Village shares offices with the Institute on Aging in the city’s Inner Richmond district, but its 145 members span the entire city – a “hub and spoke.”

New executive director Kate Hoepke hopes to expand membership to 400 in the next three years, targeting the city’s progressive neighborhoods.

Scharlach says the expansion of village memberships depends on overcoming two major barriers: proving the value of village services, and overcoming the stigma of aging.

Many older adults have belonged to churches or clubs that provided social connection, and want to know what else the village can provide. Scharlach says seniors also don’t like to be affiliated with “all those old people.”

“It’s not so much a question of affordability,” says Scharlach, a Kleiner Professor of Aging at the University of California Berkeley. “It’s a question of perceived value.”

Villages are therefore responding to growing member requests for healthcare assistance.

San Francisco Village will launch its “Transition to Home” initiative this spring to help returning hospital patients get settled after hospital stays. Services include buying food, helping with home care referrals, filling prescriptions, and transporting patients to their first follow-up visits.

Scharlach says virtually no data exists yet to indicate that villages improve health, but he cited Avenidas as an example of one that is creating progressive healthcare partnerships.

While Avenidas already offers robust services to transition hospital patients back home, the village also trains members as “Med-Pals” who accompany patients to appointments, take notes, and ask questions.

“It’s the kind of thing your daughter might do if she were in town,” says Hendrickson.

Partners inside Stanford Hospital will check on village members and provide health advocacy, then assist with discharge planning.

Avenidas is also using its Archstone grant to develop a partnership with the Palo Alto Medical Foundation – a large area group practice – to improve care for its members. Villagers are specially tagged so that group doctors and nurses know they have additional support outside their immediate family.

Is the village concept a return to the good old days when neighbors cared for neighbors?

“That’s the idea,” says Scharlach. “It provides a protection against social isolation… There’s certainly tremendous health benefits in that.”