Building Tomorrow’s Doctors….. Today in Tulsa

1. Building Tomorrow’s Doctors….. Today in Tulsa Gerard P. Clancy, M.D. Professor, OU School of Community Medicine President, University of Oklahoma, Tulsa

2. The Problem List • US health care costs too much and delivers too little compared to other developed countries. • Although doctors themselves are 20% of US health care costs, their decisions determine 80% of health care costs. • Not enough doctors. • Mal-distribution of doctors • By specialty • By geography

3. 5. The Problem List… When you move your company here, be sure to pack your hiking boots. • The region’s outstanding quality of life translates into a productive workforce that experiences less absenteeism and places fewer demands on the healthcare system. Colorado has the nation’s lowest rate of obesity and is among the four lowest states for deaths caused by heart disease, diabetes, and cancer. • While no state is immune to rising obesity rates, we’re curbing the gradual expansion of our waistlines by re-adjusting our culture. Metro Denver is aiming to become "America’s Healthiest Community" by instituting strategies that support worksite wellness, school policy, and the creation of interlinked, walkable communities.

4. 6. The Problem List…… • Of 306 regions across the US,: • Tulsa ranks #281 • Lawton ranks # 286 • OKC ranks # 298 Health Ranking by Region: Commonwealth Fund 2012

5. The Problem List 7. Health Disparities: • 14 years in Tulsa • 20 year in Baltimore (Johns Hopkins led improvement initiative) 8. Poor are getting poorer, increasing diversity  health literacy….illiteracy. 9. Medical Student Debt 10. Understanding how to care for the poor.

6. A New Version of a US Medical Student • New Medical College Admissions Test: • Testing Sections: chemistry, organic chemistry, biology, physics, reading comprehension, charts and graphs. • Adding Sections - culture, social, behavioral, reasoning skills. • New Medical School Admission Interview: • Adding Multiple Mini-Interview – applicants interview patients during med school admissions interview. • New United States Medical Licensing Exam: • Adding engineering skills to testing.

7. Your next doctor: • More Primary Care skills, Geriatrics skills, Psychiatry skills. • Team Skills, Team Leader Skills • Advanced Informatics Skills • Pragmatic Care of the Poor • Multi-lingual, Cultural Competent • Attention to Cost of Care • Low Loan Debt through Service Payback Scholarships • Helping Build our Next Health Care System • Might not be a doctor….

8. 1. Stronger Primary Care Through Patient Centered Medical Home Interdisciplinary Teams (PCMH) • PCMH Certifications • Morton – JCAHO • OU Physicians – NCQA • PCMH Teaching Programs • - Morton PAL Clinics • - OU Bedlam Clinics • Evening • School-based • Longitudinal PCMH PCMH Primary Care PCMH Healthy Community of Individuals & Families PCMH PCMH PCMH PCMH PCMH PCHM Adapted from Premier Healthcare Alliance PCPCC 3/11

9. 2. Stronger Primary Care Through Enhanced Payment: National Comprehensive Primary Care Initiative “Fixing US health care is easy…pay more for primary care”

10. Greater Tulsa is 1 of 7 across the US:Comprehensive Primary Care Initiative 68 Practices 280 Providers 43,740 Medicare • Multi-payer public-private collaboration • Strengthen primary care. • Start-up payment to coordinate care • Shared Savings

11. 3. Add Care Coordination and Health Information Exchange to the PCMH Network Care Coordination Primary Care PCMH PCMH Comprehensive Primary Care Initiative PCMH PCMH PCMH PCMH PCMH PCMH Health Information Exchange The greatest variable in regional health care costs is post hospital acute care. New England Journal of Medicine 4/ 2013

12. Care Coordination • Community Collaborative • Link EMRs • Central database • Clinical summary • Services “due” lists • Decision support • Quality analytics • Service to PCMHs • Enhance PCMH • Coordinate care • Access specialists • Improve quality • Train workforce Primary Care PCMH PCMH Healthy Community of Individuals & Families PCMH PCMH PCMH PCMH PCMH PCMH PCHM Health Information Exchange

13. 4. Add Focused Teams for the Highest Cost Patients High Risk Care Teams Care Coordination Cancer Screening Outreach Child Abuse Primary Care Pre-natal Care for Poor Foster Care Kids PCMH PCMH Healthy Community of Individuals & Families PCMH PCMH High Risk Asthma Hemophilia PCMH Sickle Cell PCMH High Risk Emphysema PCMH PCMH High Risk Stroke Fragile Diabetes PCHM High Risk Heart Disease Health Information Exchange Severe Mental Illness Palliative Care Addiction Medicine PACE Adapted from Premier Healthcare Alliance PCPCC 3/11

14. 5. Add School Culture, Health Literacy and Pragmatic Care of the Poor Initiatives • Morningcrest Health Literacy Center at OU-Tulsa • Health library in our main clinic staffed with librarian – assists staff, students and patients. • Health literacy electronic prescription sent from clinicians to librarian. • OU Summer Institute – First week of medical school • Students learn the anatomy of the community before they learn the anatomy of the human body. • OU Bedlam, Morton, Community Outreach are Teaching Clinics • Cost effective care for patients that can’t afford care. • Scholarships for Service • Warren Foundation, Saint Francis, George Kaiser Family Foundation • Altruism Study – Our teaching environment maintains altruism

15. 6. Now that we have created a modern clinical environment, time to expand training programs…. • New OU – TU Physician’s Assistant Program – 81 students • OU – TU School of Community Medicine – medical student class size expanded - 280 students. • $164,000,000 in local private support to do so. • Morton Teaching Health Center – New OU family medicine residents at Morton – 18 family medicine positions. • Tulsa Medical Education Foundation – from 180 to 222 OU residents and fellows – added emergency medicine residency, new fellowships in nephrology, sports medicine, trauma, addictions. • Expand OU Nurse Practitioner program – 90 students. • Full partner – OU College of Public Health, Tulsa Health Dept.