DANIEL SPOGEN, MDCHAIRMAN, DEPARTMENT OF FAMILY AND

COMMUNITY MEDICINEUNIVERSITY OF NEVADA, SCHOOL OF

MEDICINE, RENO

TO IMPROVE HEALTH CARENEED TO INCREASE THE NUMBER OF

PRIMARY CARE PROVIDERSNEED TO INCREASE THE MEDICAL

STUDENT INTEREST IN FAMILY MEDICINEIMPROVE THE FAMILY PHYSICIAN “ROLE

MODEL”INCREASE THE TRAINING OF PHYSICIANS

IN PRIMARY CARE

DECREASE IN STUDENT INTERESTDECREASED (COMPARED TO SPECIALISTS)

COMPENSATIONPOORLY FUNDED PROGRAMSNEGATIVE ROLE MODELS“UNCONTROLLABLE LIFESTYLES”SCHOOL EXPERIENCES DECREASE

STUDENT INTEREST

MACY REPORT RECOMMENDATIONSINCREASE FUNDINGINCREASE EXPOSURE TO COMMUNITY

HEALTH SETTINGSEXPANSION OF PRIMARY CARE

RESIDENCY PROGRAMSESTABLISH DEPARTMENTS IN ALL

UNIVERSITIESMEDICAL EDUCATION THAT FOCUSES IN

“REAL WORLD” COMPETENCIESIMPROVE THE PRACTICE ENVIRONMENT

FOR PRIMARY CARE PHYSICIANS.

TO INCREASE STUDENT INTERESTPROVIDE EXCELLENT ROLE MODELS ALL 4

YEARS OF TRAININGSHOW STUDENTS HOW TO BE A TEAM

LEADERLESS “HASSLE” IN COORDINATING CARE OF

PATIENTSFAMILY MEDICINE TRACKBETTER LIFESTYLEINNOVATIVE HEALTH CARE DELIVERY

SYSTEMS WITH STATE OF ART TECHNOLOGY

PATIENT CENTERED MEDICAL HOMETWO BASIC PARTS: THE HOME AND

ACUTE CARE COVERAGE.THE HOME: EASY ACCESS, HEALTH CARE

COORDINATOR, CHRONIC DISEASE MANAGEMENT, AUTHORIZATION, TEAM CARE, TECHNOLOGY (E-VISITS, QUALITY IMPROVEMENT, PATIENT PORTALS, E-PRESCRIBING, E-REFERRALS)

ACUTE CARE VISITS

USUAL PAYMENT: HISTORYUSUAL HISTORY IS THAT INSURANCE

COMPANIES EXPECT MORE AND PAY LESSTHE THINGS LISTED IN THE MEDICAL

HOME ARE NOT COVERED COSTS BY INSURANCE, IT IS EXPECTED

50% OR GREATER OF THE COSTS OF PRIMARY CARE ARE THE ITEMS EXPECTED AS A MEDICAL HOME

EVEN THOUGH THE EXPECTATION IS TO OFFER THESE SERVICES, THERE IS NO PAYMENT TO DO SO

IN ADDITION:IF NOW YOU ARE TO ADD STATE OF ART

TECHNOLOGY FOR HEALTH CARE DELIVERYIF YOU ADD MORE SUPPORT FOR TEAM

CARE APPROACHIF YOU ADD TIME TO IMPLEMENT THESE

CHANGESIF YOU ADD TIME TO TRAIN HEALTH CARE

COORDINATORS AND GETTING YOUR MA’s TO WORK AT THE “TOP OF THEIR LICENSE”

YOU NEED “UP FRONT” FUNDING

EXPECTATIONIS TO MAKE THE CHANGE WITH NO UP

FRONT FUNDING OR TIME TO IMPLEMENTTHEREFORE, IT IS SAFER FOR PHYSICIANS

TO CONTINUE TO OFFER CARE IN THE USUAL WAY

HISTORY HAS SHOWN US THAT PHYSICIANS WON’T CHANGE WITHOUT FUNDING AND TIME

MONEY IS NEEDED:TO INCREASE NUMBER OF MA’sTO PROPERLY TRAIN HEALTH CARE

COORDINATORS AND MA’s THAT CAN FUNCTION AS PART OF THE TEAM

TO PURCHASE EHRTO GIVE TIME TO IMPLEMENT EHRTO PROPERLY TEACH RESIDENT

PHYSICIANS AND STUDENTS IN THIS METHOD OF HEALTH CARE DELIVERY

CHALLENGES FOR TRAININGTHE ACADEMIC HEALTH CENTERS HAVE

TO BE THE LEADERS IN MAKING THIS CHANGE

THE FACULTY NEED TO BE WELL VERSED ON THIS KIND OF HEALTH CARE DELIVERY IN ORDER TO TEACH

THE FACULTY NEED TO BE THE POSITIVE ROLE MODELS TO ENCOURAGE STUDENT INTEREST IN PRIMARY CARE

SPECIFIC TEACHING GOALSIMPROVE AMBULATORY TRAININGTEAM BASED CARE IN PATIENT MANAGEMENTPATIENT EDUCATION TO ENCOURAGE SELF-

MANAGEMENTINCLUDE HEALTH DISPARITIES: CULTURAL,

DISADVANTAGED AND RURALSHOW BEST PRACTICES IN PATIENT CARESHOW INNOVATIVE AND TRULY BRILLIANT

CAREPOSITIVE ROLE MODELS

COMPETENCIES TO BE TAUGHT(JOINT PRINCIPALS)PERSONAL PHYSICIANDOCTOR DIRECTED CAREWHOLE PERSON ORIENTATIONCOORDINATED/INTEGRATED CARE THAT

INVOLVES INFORMATION TECHNOLOGY, CHRONIC DISEASE REGISTRIES, INFORMATION EXCHANGE

NECESSARY ATTRIBUTESLEADERSHIP OF PATIENT CARETEAM WORKCULTURAL COMPETENCYDISEASE PREVENTIONHEALTH PROMOTIONSHARED DECISION MAKINGIMPROVED OFFICE ENVIRONMENTIMPROVED HEALTH OF THE COMMUNITY

CONCLUSIONSSTUDENT INTEREST IN PRIMARY CARE NEEDS TO

BE INCREASED BY PROVIDING TRAINING IN IMPROVED OFFICE ENVIRONMENTS BY POSITIVE ROLE MODELS UTILIZING STATE-OF-THE-ART TECHNOLOGY

FOR THAT TO OCCUR OUR ACADEMIC HEALTH CENTERS NEED TO PROVIDE CARE IN THAT SETTING

FUNDING NEEDS TO OCCUR UP FRONT TO DEVELOP THE MEDICAL HOME AND ONGOING TO CONTINUE OFFERING MEDICAL HOME ATTRIBUTES

THIS WILL ENCOURAGE BETTER HEALTH CARE DELIVERY SYSTEM WITH MORE AND BETTER PROVIDERS TO SERVICE THE HEALTH CARE NEEDS OF OUR STATE