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.