DANIEL SPOGEN, MD CHAIRMAN, DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF NEVADA, SCHOOL OF MEDICINE, RENO

TO IMPROVE HEALTH CARE NEED TO INCREASE THE NUMBER OF PRIMARY CARE PROVIDERS NEED TO INCREASE THE MEDICAL STUDENT INTEREST IN FAMILY MEDICINE IMPROVE THE FAMILY PHYSICIAN “ROLE MODEL” INCREASE THE TRAINING OF PHYSICIANS IN PRIMARY CARE

DECREASE IN STUDENT INTEREST DECREASED (COMPARED TO SPECIALISTS) COMPENSATION POORLY FUNDED PROGRAMS NEGATIVE ROLE MODELS “UNCONTROLLABLE LIFESTYLES” SCHOOL EXPERIENCES DECREASE STUDENT INTEREST

MACY REPORT RECOMMENDATIONS INCREASE FUNDING INCREASE EXPOSURE TO COMMUNITY HEALTH SETTINGS EXPANSION OF PRIMARY CARE RESIDENCY PROGRAMS ESTABLISH DEPARTMENTS IN ALL UNIVERSITIES MEDICAL EDUCATION THAT FOCUSES IN “REAL WORLD” COMPETENCIES IMPROVE THE PRACTICE ENVIRONMENT FOR PRIMARY CARE PHYSICIANS.

TO INCREASE STUDENT INTEREST PROVIDE EXCELLENT ROLE MODELS ALL 4 YEARS OF TRAINING SHOW STUDENTS HOW TO BE A TEAM LEADER LESS “HASSLE” IN COORDINATING CARE OF PATIENTS FAMILY MEDICINE TRACK BETTER LIFESTYLE INNOVATIVE HEALTH CARE DELIVERY SYSTEMS WITH STATE OF ART TECHNOLOGY

PATIENT CENTERED MEDICAL HOME TWO BASIC PARTS: THE HOME AND ACUTE CARE COVERAGE. THE HOME: EASY ACCESS, HEALTH CARE COORDINATOR, CHRONIC DISEASE MANAGEMENT, AUTHORIZATION, TEAM CARE, TECHNOLOGY (E-VISITS, QUALITY IMPROVEMENT, PATIENT PORTALS, E- PRESCRIBING, E-REFERRALS) ACUTE CARE VISITS

USUAL PAYMENT: HISTORY USUAL HISTORY IS THAT INSURANCE COMPANIES EXPECT MORE AND PAY LESS THE THINGS LISTED IN THE MEDICAL HOME ARE NOT COVERED COSTS BY INSURANCE, IT IS EXPECTED 50% OR GREATER OF THE COSTS OF PRIMARY CARE ARE THE ITEMS EXPECTED AS A MEDICAL HOME EVEN THOUGH THE EXPECTATION IS TO OFFER THESE SERVICES, THERE IS NO PAYMENT TO DO SO

IN ADDITION: IF NOW YOU ARE TO ADD STATE OF ART TECHNOLOGY FOR HEALTH CARE DELIVERY IF YOU ADD MORE SUPPORT FOR TEAM CARE APPROACH IF YOU ADD TIME TO IMPLEMENT THESE CHANGES IF YOU ADD TIME TO TRAIN HEALTH CARE COORDINATORS AND GETTING YOUR MA’s TO WORK AT THE “TOP OF THEIR LICENSE” YOU NEED “UP FRONT” FUNDING

EXPECTATION IS TO MAKE THE CHANGE WITH NO UP FRONT FUNDING OR TIME TO IMPLEMENT THEREFORE, IT IS SAFER FOR PHYSICIANS TO CONTINUE TO OFFER CARE IN THE USUAL WAY HISTORY HAS SHOWN US THAT PHYSICIANS WON’T CHANGE WITHOUT FUNDING AND TIME

MONEY IS NEEDED: TO INCREASE NUMBER OF MA’s TO PROPERLY TRAIN HEALTH CARE COORDINATORS AND MA’s THAT CAN FUNCTION AS PART OF THE TEAM TO PURCHASE EHR TO GIVE TIME TO IMPLEMENT EHR TO PROPERLY TEACH RESIDENT PHYSICIANS AND STUDENTS IN THIS METHOD OF HEALTH CARE DELIVERY

CHALLENGES FOR TRAINING THE ACADEMIC HEALTH CENTERS HAVE TO BE THE LEADERS IN MAKING THIS CHANGE THE FACULTY NEED TO BE WELL VERSED ON THIS KIND OF HEALTH CARE DELIVERY IN ORDER TO TEACH THE FACULTY NEED TO BE THE POSITIVE ROLE MODELS TO ENCOURAGE STUDENT INTEREST IN PRIMARY CARE

SPECIFIC TEACHING GOALS IMPROVE AMBULATORY TRAINING TEAM BASED CARE IN PATIENT MANAGEMENT PATIENT EDUCATION TO ENCOURAGE SELF- MANAGEMENT INCLUDE HEALTH DISPARITIES: CULTURAL, DISADVANTAGED AND RURAL SHOW BEST PRACTICES IN PATIENT CARE SHOW INNOVATIVE AND TRULY BRILLIANT CARE POSITIVE ROLE MODELS

COMPETENCIES TO BE TAUGHT (JOINT PRINCIPALS) PERSONAL PHYSICIAN DOCTOR DIRECTED CARE WHOLE PERSON ORIENTATION COORDINATED/INTEGRATED CARE THAT INVOLVES INFORMATION TECHNOLOGY, CHRONIC DISEASE REGISTRIES, INFORMATION EXCHANGE

NECESSARY ATTRIBUTES LEADERSHIP OF PATIENT CARE TEAM WORK CULTURAL COMPETENCY DISEASE PREVENTION HEALTH PROMOTION SHARED DECISION MAKING IMPROVED OFFICE ENVIRONMENT IMPROVED HEALTH OF THE COMMUNITY

CONCLUSIONS STUDENT INTEREST IN PRIMARY CARE NEEDS TO BE INCREASED BY PROVIDING TRAINING IN IMPROVED OFFICE ENVIRONMENTS BY POSITIVE ROLE MODELS UTILIZING STATE-OF-THE-ART TECHNOLOGY FOR THAT TO OCCUR OUR ACADEMIC HEALTH CENTERS NEED TO PROVIDE CARE IN THAT SETTING FUNDING NEEDS TO OCCUR UP FRONT TO DEVELOP THE MEDICAL HOME AND ONGOING TO CONTINUE OFFERING MEDICAL HOME ATTRIBUTES THIS WILL ENCOURAGE BETTER HEALTH CARE DELIVERY SYSTEM WITH MORE AND BETTER PROVIDERS TO SERVICE THE HEALTH CARE NEEDS OF OUR STATE