During the Denver stop on the Health is Primary City Tour, panelist Luke Casias, M.D., describes the successes of the Fit Family Challenge, a program designed to fight childhood obesity, including a significant decrease in participants' body mass index.
The national Health is Primary(www.healthisprimary.org) campaign, sponsored by Family Medicine for America's Health, hosted a panel here Oct. 2 highlighting primary care delivery innovations happening across Colorado. The Denver event was the fourth stop on this year's national tour showcasing the value of primary care through the groundbreaking work family physicians are doing across the country.
"Colorado has long been recognized as a leader in health care, and their communities continue to innovate and improve on their already strong system," said Glen Stream, M.D., M.B.I., president and board chair for Family Medicine for America's Health, in a news release(www.healthisprimary.org) about the panel discussion. "If all Americans had access to the coordinated, patient-centered, prevention-based care Colorado's health care leaders have shown is achievable, we would be a healthier society with a more efficient, cost-effective health care system."
The event was moderated by author, documentary filmmaker and reporter T.R. Reid, who asked panel members to discuss their successes in areas that included fighting the obesity epidemic, integrating primary care and expanding the family medicine pipeline.
- To combat the childhood obesity epidemic, family physicians across Colorado developed the Fit Family Challenge to integrate childhood obesity guidelines and implement primary care office-based intervention in the clinical setting.
- The Colorado State Innovation Model was established in February with a key goal of integrating behavioral health into primary care.
- Rocky Vista University College of Osteopathic Medicine was established in 2006 to help Colorado and other Mountain West states reduce the region's shortage of well-trained rural physicians.
Reducing Childhood Obesity
Although Colorado perennially is one of the healthiest states, it has seen the same startling rise in childhood obesity that the rest of the country has experienced, especially in its rural and underserved populations. To combat the issue, family physicians across the state developed the Fit Family Challenge (FFC)(www.coloradoafp.org) to integrate childhood obesity guidelines and implement primary care office-based intervention in the clinical setting.
The FFC program encourages children ages 6-12 whose body mass index (BMI) is in the 85th percentile or higher to participate, and it helps with goal-setting through each child's primary care physician. Monthly meetings with parents and family members allow discussion of goals and the data that have been collected. The FFC also provides training and support for physicians on screening for childhood obesity and patient-centered counseling.
"We've had remarkable impacts," said panelist Luke Casias, M.D., co-founder and medical director of FFC. "Probably the most incredible is we are showing behavioral modification with a decrease in sweetened beverage use, increased physical activity, and an increase in fruit and vegetable consumption. Over three years, we were able to track and show statistically significant changes in all three of those markers."
Casias said the hardest thing family physicians do is to change patients' health-related behavior. "But after nine to 15 months (in the program), we were able to show that statistically, we actually decreased BMI on these children in this short timeframe."
Since the program's launch, family physician leaders have developed a clinical guide and group visit guides for facilitators and families. And across Colorado, 29 primary care clinics have enrolled in the program, and 290 children have joined the challenge. In light of this growing interest, FFC has submitted a grant request to further expand the initiative.
Panelist Nicole King, M.A., program manager for the Colorado State Innovation Model, explains the group is starting with payment reform, working with Medicaid and six private payer groups that have committed to pilot an alternative value-based payment model.
Increasing Access to Integrated Primary Care
Despite the strong efforts of the Colorado Department of Health Care Policy and Financing, health care costs in the state have continued to rise and patients are still receiving fragmented care. So state officials applied for and received a $65 million grant from the CMS Innovation Center to implement and test its State Health Care Innovation Plan.
The Colorado State Innovation Model(www.colorado.gov) (SIM) was established in February with a key goal of integrating behavioral health into primary care. The SIM also looks to address value-based payment structures, expand health IT efforts and finalize a state plan to improve population health.
Panelist Nicole King, M.A., program manager for population health and consumer engagement at the Colorado Department of Health Care Policy and Financing, State Innovation Model, said the group is starting with payment reform by working with Medicaid and six private payer groups that have committed to pilot an alternative value-based payment model.
Rounding Out the Denver City Tour Panelists
Other panelists who participated in the Denver stop on the Health is Primary City Tour were
- Elizabeth Cookson, M.D., director of psychiatry for the Colorado Coalition for the Homeless, Stout Street Clinic;
- Clint Flanagan, M.D., co-founder and owner of Nextera Healthcare and North Vista Medical Centers;
- Bonnie Jortberg, Ph.D., M.S., R.D., C.D.E., assistant professor in the family medicine department of the University of Colorado School of Medicine;
- Elizabeth "Cissy" Kraft, M.D., chief medical officer for Anthem Blue Cross and Blue Shield in Colorado;
- Kim Marvel, Ph.D., executive director of the Colorado Commission on Family Medicine and the Colorado Association of Family Medicine Residencies; and
• Donna Marshall, M.B.A., executive director and founder of the Colorado Business Group on Health.
A collection of additional stories(healthisprimary.org) from the Health is Primary City Tour offers a glimpse of other successes primary care has seen across the country this year.
"We realize this is going to be crucial to the success of integrated care throughout Colorado," she said. "We need to make this sustainable, and we need to incentivize people to participate."
The SIM also is partnering with local universities to providing practice transformation support. "So we understand that as primary care physicians, you are already doing a lot of behavioral health care," King said. "But we've also heard from a lot of physicians throughout the state that in order to do this well, they need support."
For example, she said, for practices struggling to integrate behavioral health into their electronic health record (EHR) system, clinical health IT advisers will be available to assist in the process. The same goes for business consulting on integrating behavioral health into a practice. CME credit will be offered for this training through the SIM.
"We also realize there is a cost to this, so we will be providing some small grants to help cover costs of building out exam rooms or integrating aspects of (electronic health records) into these efforts," King said.
In addition, the SIM is working with a group of stakeholders to better integrate telemedicine to increase access to care for rural communities and also to work on systems for data aggregation and warehousing to allow physicians access to patients' records across different platforms.
Eleven other states have received SIM funding from CMS during this round of grants but Colorado was the only one focusing its efforts on integrating behavioral health care.
The SIM has begun to integrate behavioral health in 100 of its goal 400 primary care practices during its four-year grant period and is looking to improve the health of 80 percent of Coloradans by 2019.
Easing Shortage of Rural Physicians
Further supporting rural communities, Rocky Vista University (RVU) College of Osteopathic Medicine(www.rvu.edu) in Parker was established in 2006 to help Colorado and other Mountain West states reduce the region's shortage of well-trained rural physicians. RVU established specialized educational tracks -- a rural and wilderness medicine honors track, a global medicine honors track, and a military medicine elective enrichment track -- for the top 25 percent of each class to learn the extra skills needed to deliver quality care with limited resources in a rural setting.
Panelist Thomas Told, D.O., dean and chief academic officer for Rocky Vista University College of Osteopathic Medicine, tells attendees about the school that was established in 2006 to help Colorado and other Mountain West states reduce the shortage of well-trained rural physicians.
Panelist Thomas Told, D.O., dean and chief academic officer for RVU, said the school matriculated its first class in 2008.
"As we evolve, we continue to have that mantra to identify people, particularly from rural and underserved areas, and will hold about 13 seats open for those people who want to do family medicine," he said.
According to Told, the original dean of the school said if a faculty member told a student that he or she was "too smart for family medicine and should instead try another specialty," that was grounds for termination. Instead, RVU teaches students the value of family medicine and their role in providing care to patients.
"Right off the ground, we try to impart the fact (to our students) that it's a special talent that you have to enter into family medicine and it's going to take a little bit of extra time and effort to do that," he said. "So we'll offer them extra courses in procedures, for example, that will help them stand out when they get into a residency program."
RVU has graduated four classes of 150 to date, and of these 600 students, half have chosen primary care. About 200 of those matched into family medicine residency programs.
"This has to be a cultural shift," Told said. "You have to put your best faculty mentors into the department of primary care, and you have to emphasize programs that not only highlight family medicine but also full-scope family medicine."
As to being trained to be a rural physician, he said, "In my own experience, you get better pay to do more in a rural area and actually have a better quality of life.
"Now, being an urban patient, I still go back to the country to get my care."
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