AAFP President Robert Wergin, M.D., of Milford, Neb., opened the 2015 AAFP National Conference of Family Medicine Residents and Medical Students held here July 30-Aug. 1 by declaring that the answer to the problems with health care delivery in the United States today was "right here in this room."
During a July 30 panel discussion at the 2015 AAFP National Conference of Family Medicine Residents and Medical Students, moderator Lauren Hughes, M.D., M.P.H., M.Sc., (far left) helps explain the Health is Primary campaign to attendees. Panel speakers were (from left) solo practitioner Karen Smith, M.D., of Raeford, N.C.; Manisha Sharma, M.D., a clinical innovator for Iora Health in Cambridge, Mass.; and Thomas Cornwell, M.D., of Wheaton, Ill., chair and chief medical officer of the Home-Centered Care Institute.
"It's family medicine," he said. "It's a no-brainer."
In a panel presentation that focused on the Health is Primary(www.healthisprimary.org) campaign, moderator Lauren Hughes, M.D., M.P.H., M.Sc., deputy secretary of health innovation for the Pennsylvania Department of Health, spotlighted three innovative family physicians who are transforming primary care delivery.
"You will see from our panelists that there is no single path forward," Hughes told students and residents who attended the session. "Family medicine offers so many options in how to live and how to practice. There has never been a better time to be a family doctor."
Hughes explained that the Health is Primary campaign aims to make the case to payers, policymakers and the public that true primary care can solve many of the country's health care problems. The campaign is a product of Family Medicine for America's Health, which is a partnership of the AAFP and seven other family medicine organizations.
Panel Inspires With Tales of Innovation
Panelist Karen Smith, M.D., who runs a solo practice in rural Raeford, N.C., discussed the importance of networking through the AAFP, just as she did 24 years ago when she first attended National Conference and formed friendships she still has.
- The 2015 AAFP National Conference of Family Medicine Residents and Medical Students opened with a presentation on the Health is Primary campaign that spotlighted three innovative family physicians.
- Panelists were solo practitioner Karen Smith, M.D., of Raeford, N.C.; Manisha Sharma, M.D., clinical innovator for Iora Health in Cambridge, Mass.; and Thomas Cornwell, M.D., of Wheaton, Ill., chair and chief medical officer of the Home-Centered Care Institute.
- Attendees had plenty of questions about practice models for the panelists after the presentation concluded.
Smith said she used Academy resources to build her practice into a patient-centered medical home (PCMH). She also added fiber-optic lines to boost the speed of the electronic health record system she installed, and the practice is now certified as a Level 3 PCMH by Blue Cross Blue Shield.
"But that is not enough," Smith said. "We go to Raleigh, N.C., to advocate for our patients. And when that is not enough, we go to Washington to speak with our senators."
And things keep evolving, she said. For example, she recently attended the sold-out Direct Primary Care Summit in Kansas City, Mo., that the AAFP co-organized.
Smith said the questions she wanted to answer were, "What is this new payment model? How can this work for us and how can it work for our colleagues?
"We network and share what we learn."
Smith's latest accomplishment: Last week, she signed an agreement for her practice to join one of the first regional rural accountable care organizations in North Carolina.
Panelist Manisha Sharma, M.D., of Baltimore, is a clinical innovator for Iora Health who introduced herself by saying she never wanted to be a doctor -- she wanted to be a dancer. But in her early 20s, that dream came to an abrupt halt when she was hit by a car and subsequently underwent seven hip surgeries and extensive physical therapy to repair the damage. During this process, she got an extended view of the American medical system that she didn't like, so she decided to become a patients' rights advocate.
"I saw scores of other patients who endured the same struggles that I did (with insurance and treatment issues), and I realized that this was a bigger problem than just me," Sharma said.
After the session, panelist Manisha Sharma, M.D., (center, in black sweater) explains how her interest in social justice drives her approach to family medicine to a group of residents and students.
Once she realized that a patient's biggest advocate is his or her physician, Sharma decided she wanted to become a "family medicine social justice doctor."
"I wanted to be part of the system that incorporated social justice into the art of medicine," she said.
Sharma said Iora Health was a perfect fit for her because the organization's vision is "to 'blow up' primary care." The group created a three-pronged approach to innovating payment, technology and care.
"We focus on what matters to our patients, not what's the matter with them," she said. The ultimate goal is "cultivating true, collaborative team-based care -- where everyone who has touched a patient is just as important, if not more important, than (the physician)."
Iora Health, Sharma said, offers a path to the quadruple aim of "health care access, quality of care, cost control and, most importantly, waking up every day feeling joy and love for the work we do as a united team."
Panelist Thomas Cornwell, M.D., of Wheaton, Ill., is chairman and chief medical officer of the Home-Centered Care Institute. During his more than 20 years in practice, Cornwell has made more than 31,000 house calls to more than 4,000 home-limited patients.
Cornwell said he is very grateful he didn't let his medical school dissuade him from his dream to be a family physician. "To the medical students in here, do not let them change your mind," he said to enthusiastic applause.
Panelist Thomas Cornwell, M.D., says he has always been drawn to disenfranchised patients, including his current passion for treating home-bound patients.
Cornwell said he has always been drawn to disenfranchised patients, including his current passion for treating home-bound patients. "Their only access to health care is an expensive ambulance trip to an expensive emergency department that usually leads to an expensive hospitalization, which is dangerous to the frail and elderly," he said.
His average patient's age is 80, with one-third older than 85, and virtually all of them have six or more chronic diseases. All of Cornwell's younger patients have mobility issues due to muscular skeletal conditions.
Cornwell explained that in June, CMS announced that after the first year of its three-year Independence at Home Demonstration,(innovation.cms.gov) participating practices saved more than $25 million -- an average of $3,070 per participating beneficiary -- while delivering high-quality patient care in the home.
"So you are going to be hearing a lot about house calls," Cornwell said, "not only because it is such wonderful care, but because of these wonderful cost savings."
Panel Answers Questions, Concerns
After their presentations, panelists answered questions from an eager audience of residents and students.
Amanda Patterson, of the University of Illinois-Rockford, asked panelists how they recommended addressing a lack of resources, such as food deserts, that patients in underserved minority communities sometimes experience.
Sharma explained that she worked in the Bronx, N.Y., where food deserts are common. "We had to get creative," she said. "How are we supposed to tell people to eat right and exercise if they don't have a safe place to walk or a place to buy groceries that they can afford?"
The solution? Her medical practice partnered with the corner bodegas in the area to offer affordable and healthy food to patients.
This example piqued the interest of Sarah Waterman, of the Creighton University School of Medicine in Omaha, Neb., who told AAFP News Sharma's comments offered "food for thought for medical students to think about these types of things before we start practicing."
Tiffany Chang, of the University of Illinois-Rockford, agreed, saying she was inspired by how much the panelists incorporated creativity into their family medicine practices.
"I've always considered myself a creative person outside of medicine," she said. "But I haven't thought about how I could use that in a practice and impact patient care. I think in the next year, I am going to think about this and how I can help solve social problems, as well."
When Alex Mroszczyk-McDonald, M.D., of Kaiser Permanente in Fontana, Calif., asked Cornwell how he suggested removing the perception that home visits are made in a less-than-clean environment that offers physicians fewer tools, Cornwell had his iPhone screen projected to the large on-stage screen so audience members could see him monitoring his vital signs in real time using a smartphone.
"Technology allows us to do great primary care in the home," Cornwell said. "Using data for advocacy to senators and congressmen, it becomes so apparent where the cost savings (of home care) are."
Cornwell described a patient who had venous stasis ulcers because she could not lie down. "It wasn't because of heart failure or back arthritis; it was because of the two to four feet of garbage everywhere in her Wrigleyville apartment in Chicago. That was the diagnosis -- that we needed to clean up her apartment."
Ricardo Uriostegui, M.D., of Chicago's Provident Hospital of Cook County, told AAFP News after the session that home visits are required for his program and he understands their value.
"I see the importance of caring for the patient in their home, seeing what kind of conditions they are living in and seeing how we can be more aware of their health care needs," he said.
Sharma concluded her comments by saying that the audience of residents and students represented a mouthpiece for family medicine.
"We bleed what we do," she said. "If we aren't talking about what we do, then it's our fault. It starts in your exam room; it starts in your program."
Becky Davies, of Creighton University School of Medicine, heard this message loud and clear.
"I'm realizing family med is at the front line of the health care our country needs right now," she told AAFP News. "And it's cool to think I will be a part of this."
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