David Garr, MD Executive Director South Carolina Area Health Education Consortium Associate Dean for Community Medicine Medical University of South Carolina

 Patient-Centered Medical Homes  Use of Electronic Health Records  Accountable Care Organizations  Increasing emphasis on population health- shifting from numerator to denominator health care 2

Engaged leadership A quality improvement strategy Emphasis on continuity of care Patients’ involvement in decision-making about their own care Enhanced access by patients to health care and to their clinical information after hours Care coordination to reduce duplication of services 3

Certified EHR systems capable of interoperability Ability to e-prescribe Ability to monitor the health of the population Higher reimbursement for meaningful use of the EHR 4

 Workforce changes with an integral role for primary care and IP teams  Focus on quality of care and the provision of preventive services for populations  Reimbursement changes from volume-based to value-based care, i.e. pay-for- performance 5

 Incentives for collaboration between hospitals, ambulatory care facilities/PCMHs, long term care facilities, home health agencies, pharmacies, and others  Incentives for avoidance of readmissions, preventable complications and duplicative services 6

Expectation to focus on the health of all patients registered in practices, not just on those who come for appointments No longer acceptable to label some people as “bad patients” Attention to the social determinants of health 7

 Provision of evidence-based care  Use of templates to guide clinical decision- making  Reimbursement tied to providing evidence of quality care 8

The clinician can’t do it all Re-engineer the system of care in the practice Use the EHR to share responsibility for care among the members of the team 9

Continuing education for the entire healthcare team, not just for individuals on the team based on their professional disciplines Outreach by the practice to their patients- patient reminders, role for community health workers Increased job satisfaction of the members of the team 10

 Providing excellent clinical experiences for students in sites that are practicing the health care of the future  Building and sustaining relationships with clinical practices that will serve as premier learning laboratories for students 11

 Maintain an ongoing relationship with IP teams in precepting practices so they remain aware of the critical role they play in educating students about ICP  Provide incentives and rewards for clinical practices that will encourage their participation as model teaching sites 12

 Conducted an assessment of the readiness of clinical practices to serve as models for health care delivery (EHR use, PCMH status, ICP) – a survey followed by on-site interviews done by AHEC Health Professions Coordinators  Established the Institute for Primary Care Education and Practice for students, faculty and community-based preceptors  Funding from The Duke Endowment with matching funds from the five participating colleges 13

 47 first year MUSC and USC advanced practice nursing, medical, and physician assistant students have joined the Institute along with 22 preceptors  Monthly seminar series and mentoring opportunities for students  Creating an outreach program for practices interested in examining the effectiveness of their IP care and ways to improve the quality of care for the populations they serve  Value of using a self-assessment instrument for IP practice 14

 Health care is changing in significant ways  The next generation of clinicians need to be prepared for these changes  ICP, quality improvement and population health are becoming increasingly important  Students need to have the opportunity to work in settings where the health care of the future is being delivered  Academic faculty and AHEC programs can work together to identify and support these clinical practices 15