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41st Annual Spring Conference
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Thursday, May 1
8:15-10 am
“Improving Access to High Quality, Affordable Care—How to Eliminate Medical Homelessness”
Richard Wender, MD, Thomas Jefferson University
The evidence supporting the value of the primary care medical home is clear and uncontested. Providing that home improves health and is more affordable than the medical homelessness that so many people experience. However, the reality is that some of the standard features in a high-end medical home make it harder to pay the mortgage—the return on investment in our current payment system just isn’t there. Moreover, although we would like to create easy access to our medical homes, many people are getting lost along the way. The mounting dissatisfaction with American health care is providing impetus for change, but we must realize that our uniquely American health care crisis demands a uniquely American solution. At the end of the day, the homes we offer must be comfortable and welcoming, but also efficient and affordable. Our family of patients will be assigned their own set of chores and responsibilities, but we will need to provide the right set of tools to help get the jobs done. The primary care medical home offers a unique opportunity to prevent and manage chronic illness. Together, as educators, we need to keep figuring out how to make it happen.
Richard Wender, MD, is alumni professor and chair of the Department of Family and Community Medicine at Thomas Jefferson University. A graduate of Princeton University and the University of Pennsylvania, Dr Wender directed the family practice residency program at Thomas Jefferson for 10 years, became vice chair of the department in 1995, and chair in 2002. In addition to being a practicing family doctor, Dr Wender’s major area of academic focus has been cancer prevention and screening. He was the editor of the American Cancer Society Primary Care Physicians Newsletter for 10 years and is now on the editorial advisory board of CA: a Cancer Journal for Clinicians. He served as president of the Philadelphia Division of the American Cancer Society (ACS) and first president of the newly formed Commonwealth Division, now. He was elected ACS president in November 2006, becoming the first primary care clinician to serve as national president in the 93-year history of ACS; he is currently the American Cancer Society’s immediate past president. Understanding and overcoming barriers to primary care based preventive health services delivery and chronic disease management is his principle focus of teaching and investigation while improving access to high quality care remains his principle passion.
Friday, May 2
8:15 - 10 am
2007 Blanchard Memorial Lecture:
“The Challenge of Practice Variations and the Future of Primary Care”
John Wennberg, MD, MPH, The Dartmouth Institute for Health Policy and Clinical Practice
Today, the future of primary care and the role its practitioners will play in health care reform is under active debate. An understanding of unwarranted variation in health care delivery provides the basis for defining new roles and responsibilities for health care professionals. The critical issues facing the nation are: (1) poor care coordination and overuse of acute care hospitals in managing chronic illness (in light of evidence that greater care intensity doesn’t produce better outcomes), and (2) misuse of discretionary procedures and screening exams that do not reflect the wants and needs of the individual patient. The remedy for unwarranted variation in the management of chronic illness includes care coordination among providers and across sectors of care—ambulatory care, home health care, and institutionalized care, including acute care hospitals. Remedies for unwarranted variation in preference-sensitive treatments require that informed patient choice become the standard for defining medical necessity.
My thesis is that primary care physicians are the best situated among health care professionals to take responsibility for coordinating the care of the chronically ill and for ensuring that patients are fully informed about treatment options and helped to make decisions that correspond to their needs and value tradeoffs. In this role, the primary care physician becomes essential to any national effort to reduce unwarranted practice variation and improve the quality of care. But to undertake this new responsibility and achieve these goals, the leadership of primary care must link this vision of the future of primary care to the emerging concept of the Patient-Centered Medical Home and work to ensure that changes in reimbursement systems make it possible.
John Wennberg, MD, MPH, is the Peggy Y. Thomson Chair in the Evaluative Clinical Sciences and founder and director emeritus of The Dartmouth Institute for Health Policy and Clinical Practice. He has been a professor in the Department of Community and Family Medicine since 1980 and in the Department of Medicine since 1989. He is a graduate of Stanford University and the McGill Medical School. Dr Wennberg and colleague Al Mulley are cofounders of the Foundation for Informed Medical Decision Making, a non-profit corporation providing objective scientific information to patients about their treatment choices using interactive media. Dr Wennberg is the founding editor of The Dartmouth Atlas of Health Care, which examines the patterns of medical resource intensity and utilization in the United States. The Atlas project has also reported on patterns of end of life care, inequities in the Medicare reimbursement system, and the under use of preventive care
Saturday, May 3
8:15-10 am
“Something You Somehow Haven’t to Deserve: A Medical Home for Every American”
John Saultz, MD, Oregon Health and Science University
As the debate about health reform in America intensifies, what was once a political issue is becoming a policy challenge. Central to most reform plans are the concepts of universal access and delivery system restructuring and the most respected sources of information about delivery system redesign are talking and writing about the concept of a medical home for every American. But the medical home thus far has been poorly defined and the lack of a clearer definition could become a significant barrier to the reform process. Is the medical home concept a marketing gimmick, or is it actually a new way of caring for patients? The answer seems to depend somewhat on both the author and the audience being addressed. This presentation will review what is known about the medical home concept and will suggest directions for research and education in family medicine that can bring clarity to the delivery system redesign process. In fact, creating a science around the ideal design of a medical home can become the organizing theoretical framework for the future of our discipline.
Professor and chair of the Department of Family Medicine at Oregon Health & Science University, John Saultz, MD, completed his residency in family medicine at Dwight David Eisenhower Army Medical Center, and a faculty development fellowship at the University of North Carolina at Chapel Hill. From 1986 to 1994, he was the family medicine residency director at Oregon Health & Science University. He also has served as director of Oregon’s statewide Area Health Education Centers Program and was founding medical director of Careoregon, a Medicaid HMO designed to implement the Oregon Health Plan. In 2003-2004, Dr Saultz was named a Bishop fellow. Dr Saultz is a diplomate of the American Board of Family Medicine, a fellow of the American Academy of Family Physicians, and a member of the Society of Teachers of Family Medicine. He has served as president of the Association of Family Medicine Residency Directors and the Oregon Academy of Family Physicians. He has served on the Residency Review Committee for Family Practice and on the Accreditation Council for Graduate Medical Education. He is the author of three books and more than 100 journal articles and book chapters. His current research interests include continuity of care in the doctor-patient relationship, medical decision-making, and the future of family medicine.
Sunday, May 4
10-11:30 am
“Managing Change to Foster Creative Innovation”
Barbara Johnson, PhD, TransforMED, Leawood, KS
Family medicine has so much hope to offer our broken health care system with its emphasis on keeping the whole person at the forefront of care. To realize this hope in the 21st century, family medicine is undergoing transformational change on both the practice and residency training fronts. Each of these sectors of family medicine have embarked on a path to bring new and creative innovations to this specialty by bringing the patient centered medical home center stage. Will this endeavor succeed? Much depends on how change is managed. Too many beautifully crafted plans end up in the trash heap, not as a result of poor planning but of poor execution. Managing change well is the engine of any creative innovation project. This is no less true in family medicine than anywhere else. What makes change successful? This talk will discuss the core elements of change excellence as they apply to redesigning family medicine for the 21st century.
Barbara Johnson, PhD, is practice enhancement facilitator for TransforMED, assisting family practices with implementing the TransforMED Model of Care. TransforMED’s facilitators are completing this project to create specific changes in family practices and to assess the effectiveness of the methods used for doing so.
She has more than 15 years experience implementing social change in both non-profit and for-profit organizations. This experience includes designing and implementing strategic plans, developing change management programs, and leading mission critical projects. She has built and led strong teams, and revitalized organizations to create greater workplace satisfaction, efficiency, accuracy and cost effectiveness. Dr Johnson directed one module of the National Institute of Health Infrastructure project to determine how the Internet could be used to increase the effectiveness and efficiency of medical practices. Conflict resolution and negotiation have been integral aspects of all her endeavors.
She has a PhD in sociology with specialization in medical sociology, organizational behavior, and social psychology. Her certifications include facilitator (Development Dimensions International), Myers-Briggs (Lee Hecht Harrison), and PMP (Project Management Professional). She is in the Who’s Who Registry of Executives. Her memberships include: Organizational Development Network, International Society for Performance Improvement, Kansas City Project Management Institute, and the American Society for Training and Development.