building tomorrow’s doctors….. today in tulsa
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Building Tomorrow’s Doctors….. Today in Tulsa. Gerard P. Clancy, M.D. Professor, OU School of Community Medicine President, University of Oklahoma, Tulsa. The Problem List . US health care costs too much and delivers too little compared to other developed countries. - PowerPoint PPT PresentationTRANSCRIPT
Building Tomorrow’s Doctors….. Today in Tulsa
Gerard P. Clancy, M.D.Professor, OU School of Community MedicinePresident, University of Oklahoma, Tulsa
The Problem List 1. US health care costs too much and delivers too little compared to other developed countries.
2. Although doctors themselves are 20% of US health care costs, their decisions determine 80% of health care costs.
3. Not enough doctors. 4. Mal-distribution of
doctors– By specialty – By geography
When you move your company here, be sure to pack your hiking boots.• The region’s outstanding quality of life translates into a productive
workforce that experiences less absenteeism and places fewer demands on the healthcare system. Colorado has the nation’s lowest rate of obesity and is among the four lowest states for deaths caused by heart disease, diabetes, and cancer.
• While no state is immune to rising obesity rates, we’re curbing the gradual expansion of our waistlines by re-adjusting our culture. Metro Denver is aiming to become "America’s Healthiest Community" by instituting strategies that support worksite wellness, school policy, and the creation of interlinked, walkable communities.
5. The Problem List…
Health Ranking by Region: Commonwealth Fund 2012
6. The Problem List……Of 306 regions across the US,:- Tulsa ranks #281- Lawton ranks # 286- OKC ranks # 298
The Problem List 7. Health Disparities:• 14 years in Tulsa• 20 year in Baltimore
(Johns Hopkins led improvement initiative)
8. Poor are getting poorer, increasing diversity health literacy….illiteracy. 9. Medical Student Debt10. Understanding how to care for the poor.
A New Version of a US Medical Student• New Medical College Admissions Test:
– Testing Sections: chemistry, organic chemistry, biology, physics, reading comprehension, charts and graphs.
– Adding Sections - culture, social, behavioral, reasoning skills.
• New Medical School Admission Interview:– Adding Multiple Mini-Interview – applicants interview
patients during med school admissions interview. • New United States Medical Licensing Exam:
– Adding engineering skills to testing.
Your next doctor:1. More Primary Care skills, Geriatrics
skills, Psychiatry skills. 2. Team Skills, Team Leader Skills3. Advanced Informatics Skills4. Pragmatic Care of the Poor5. Multi-lingual, Cultural Competent6. Attention to Cost of Care7. Low Loan Debt through Service
Payback Scholarships8. Helping Build our Next Health Care
System9. Might not be a doctor….
Healthy Community
of Individuals & Families
PCMHPCMH
PCHM
PCMH
PCMH
PCMH
PCMH
Adapted from Premier Healthcare Alliance PCPCC 3/11
PCMH
PCMH
1. Stronger Primary Care Through Patient Centered Medical Home Interdisciplinary Teams (PCMH)
Primary Care
PCMH Certifications- Morton – JCAHO- OU Physicians – NCQA
PCMH Teaching Programs- Morton PAL Clinics- OU Bedlam Clinics
EveningSchool-basedLongitudinal
2. Stronger Primary Care Through Enhanced Payment: National Comprehensive Primary Care Initiative “Fixing US health care is easy…pay more for primary care”
Greater Tulsa is 1 of 7 across the US:Comprehensive Primary Care Initiative
• Multi-payer public-private collaboration
• Strengthen primary care.
• Start-up payment to coordinate care
• Shared Savings
68 Practices280 Providers
43,740 Medicare
Comprehensive Primary Care
Initiative PCMHPCMH
PCMH
PCMH
PCMH
PCMH
Care Coordination
PCMH
3. Add Care Coordination and Health Information Exchange to the PCMH Network
Health Information Exchange
PCMHPrimary Care
The greatest variable in regional health care costs is post hospital acute care. New England Journal of Medicine 4/ 2013
Healthy Community
of Individuals & Families PCMHPCMH
PCHM
PCMH
PCMH
PCMH
PCMH
PCMH PCMHPrimary Care Community
Collaborative Link EMRs Central database Clinical summary Services “due” lists Decision support Quality analytics
Service to PCMHs Enhance PCMH Coordinate care Access specialists Improve quality Train workforce
Care Coordination
Health Information Exchange
Healthy Community
of Individuals & Families PCMHPCMH
PCHM
PCMH
PCMH
PCMH
PCMH
Adapted from Premier Healthcare Alliance PCPCC 3/11
PCMH
PACE
High Risk Heart Disease
High Risk Stroke
High Risk Emphysema
High Risk Asthma
Pre-natal Care for Poor
4. Add Focused Teams for the Highest Cost Patients
High Risk Care Teams
Cancer Screening Outreach
PCMHPrimary Care
Care Coordination
Health Information Exchange
Palliative Care
Addiction Medicine
Severe Mental Illness
Fragile Diabetes
Sickle Cell
Hemophilia
Foster Care Kids
Child Abuse
5. Add School Culture, Health Literacy and Pragmatic Care of the Poor Initiatives
• Morningcrest Health Literacy Center at OU-Tulsa– Health library in our main clinic staffed with librarian – assists
staff, students and patients. – Health literacy electronic prescription sent from clinicians to
librarian. • OU Summer Institute – First week of medical school
– Students learn the anatomy of the community before they learn the anatomy of the human body.
• OU Bedlam, Morton, Community Outreach are Teaching Clinics– Cost effective care for patients that can’t afford care.
• Scholarships for Service – Warren Foundation, Saint Francis, George Kaiser Family Foundation
• Altruism Study – Our teaching environment maintains altruism
6. Now that we have created a modern clinical environment, time to expand training programs….• New OU – TU Physician’s Assistant Program – 81 students• OU – TU School of Community Medicine – medical student class
size expanded - 280 students.– $164,000,000 in local private support to do so.
• Morton Teaching Health Center – New OU family medicine residents at Morton – 18 family medicine positions.
• Tulsa Medical Education Foundation – from 180 to 222 OU residents and fellows – added emergency medicine residency, new fellowships in nephrology, sports medicine, trauma, addictions.
• Expand OU Nurse Practitioner program – 90 students.• Full partner – OU College of Public Health, Tulsa Health Dept.