During the Patient-Centered Primary Care Collaborative Fall Conference, Iora Health CEO Rushika Fernandopulle, M.D., M.P.P., discusses how changes in primary care are crucial to health reform efforts.
Before she found her way to good primary care, a 60-year-old Massachusetts woman named Sharon spent years cycling through the health care system. Although her chronic illnesses remained about the same all during that time, her frustration grew.
Iora Health CEO Rushika Fernandopulle, M.D., M.P.P., described the comfort Sharon finally found in a primary care setting. He shared the story in the closing keynote address at the Patient-Centered Primary Care Collaborative Fall Conference, held here Nov. 11-13.
Because of multiple chronic conditions -- diabetes, chronic obstructive pulmonary disease, hypertension, lung cancer and osteoporosis -- Sharon spent about nine months a year in a hospital or skilled nursing facility toward the end of her life. She lacked even the care coordination of being treated at a single hospital or by a single pulmonologist.
"No one had any sense of a plan, and it was affecting her family," said Fernandopulle. "What Sharon needed and what the U.S. health care system needs is some good old-fashioned primary care."
- Iora Health CEO Rushika Fernandopulle, M.D., M.P.P., made a passionate case for accelerating changes in primary care during the Patient-Centered Primary Care Collaborative Fall Conference.
- It should be easier for physicians to care for patients without always requiring an office visit, he said.
- He rallied physicians to demand systems that realize the potential to improve patient care and engagement, not simply facilitate billing.
Sharon eventually found what she needed after a health coach met with her one day for three hours and reviewed her medical history. The medical team was stunned to learn about the array of subspecialists she was seeing and the list of 27 medications she was taking.
"She was on every inhaler I ever heard of," Fernandopulle said.
A team at Iora created a plan that kept only a few of those subspecialists, or "particularists," as Fernandopulle called them. Although the medical team could not roll back time and reverse all the causes of her poor health, they were able to make her final days more comfortable. Sharon died at home surrounded by family, having spent only one month of her final year in medical institutions.
This type of care can come only from a disciplined, coordinated approach, said Fernandopulle, and he made a passionate case for accelerating changes in primary care that make such an approach possible.
At Iora, for instance, Fernandopulle said one-third of staff time is devoted to connecting with patients considered to be at high risk for hospital admission, rather than focusing only on fee-for-service office visits.
Acknowledging strict reimbursement policies of insurers, he said it is "ridiculous" in 2015 to require patients to visit the physician's office for care that can be handled through other means. Most patient consults at Iora, he said, are conducted by email, text or video.
Fernandopulle is encouraged by the renewed emphasis on primary care he sees indicated by increased payments, payment reform and innovative approaches. Insurers are paying more for primary care, he said. Some employers are contracting with direct primary care practices. New medical schools are opening with an emphasis on primary care.
Those who value such changes must seize the moment, he said.
"Every 17 years, we get the courage to remake our health care system, and we're in the middle of that period now," said Fernandopulle. "If we don't do it now, we'll have to wait until 2030."
Fernandopulle is a strong advocate of payment reform and changing the fee-for-service practice model, yet he is critical about initiatives that undervalue primary care. Some, he said, offer per-member, per-month payments that are too low to encourage permanent practice changes.
Alluding to customer service complaints from patients, he said practices need to do more to make their working environment more comfortable for staff, which, in turn, could improve the patient experience.
"We should create a practice where people want to work," he said. "Sometimes, we think the way to fix health care is to make our staff work harder."
On the technology front, Fernandopulle said physicians should press for systems that realize the potential to improve patient care and engagement, not simply facilitate billing and transactions.
"We in primary care need to hold ourselves to a higher standard when it comes to making changes," he said. "We should decide how we want to practice and make the system work for us."