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National Academy of Medicine Summit Focuses on Value-Based Care
By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President
National Academy of Medicine Summit in RTP Focuses on Value-Based Healthcare
The National Academy of Medicine (NAM), under the direction of Dr. Victor Dzau, the former Chancellor of Health Affairs at Duke University, brought their Vital Directions for Health and Health Care Symposium to North Carolina last November, highlighting the innovative work going on in our state.
The NAM, formerly the Institute of Medicine, is Congressionally-chartered to serve as the advisor to the nation on health and healthcare. The Academy launched the Vital Directions Initiative in 2016 to create “a comprehensive assessment of the issues that matter most to improving health” and present a framework for achieving better health and well-being, high-value healthcare and strong science and technology for the nation. The symposium served as the first in a series of state-based extensions of the national initiative to bring stakeholders together to better understand actions that are being taken at the state-level to improve health.
Family Medicine played a central role in the two-day summit at the NC Biotechnology Center on November 21-22, 2019.
One of the keynote speakers, Karen DeSalvo, MD, MPH, MSc, called out the importance of Family Medicine and general Internal Medicine, noting that they are two of the most underpaid and underappreciated specialties. DeSalvo was a Professor in the Department of Medicine and Population Health at the University of Texas at Austin Dell Medical School and previously served in the Obama Administration as Assistant Secretary for Health and National Coordinator for Health Information Technology. Last December, she joined Google as their Chief Health Officer.
“Technology and data analytics are tools that should give us more time and space and emotional energy to think and treat people as human beings,” DeSalvo said during her comments, emphasizing the personal touch of primary care. “Technology should help us understand context and trajectory to meet people where they are, but today we are too busy dealing with the cognitive burden. We need to get back to what is fundamental to all of this.”
DeSalvo called on a national dashboard for health, saying the United States is constantly looking in the rearview mirror. “We can’t forecast or even now-cast,” she said. In comparison, DeSalvo noted that the minister of health in Cuba finds out every morning what happened the day before and looks to see how to address key health issues daily.
In addition to keynote addresses by DeSalvo, North Carolina Governor Roy Cooper and NC Department of Health and Human Services Secretary Dr. Mandy Cohen, the event included a series of panels, including a perspective from Family Medicine in almost every panel.
Past NCAFP President Dr. Karen L. Smith (2005), served on the first panel charged with outlining health care priorities and challenges in North Carolina, along with Steve Neorr, Senior Vice President of Population Health for Cone Health, and Dr. John Lumpkin, President of the BlueCross BlueShield of North Carolina Foundation. Smith called on healthcare providers to be miracle makers for North Carolina healthcare transformation and make the ordinary, extraordinary.
Neorr noted that being responsible for an ACO makes him have a different reaction to a high census at the
hospital than most hospital presidents have. And Lumpkin noted that Wake County is the healthiest county in the nation, but a distance of five miles still reflects an 11-year difference in life expectancy.
Family Physician Alisahah Cole, MD, Chief Community Impact Officer for Atrium Health, served on a panel discussing investments being made into whole person health by integrating physical, behavioral and social health. Two family physicians also served on an additional panel discussing moving toward seamless information flow and data sharing, including Annette DuBard, MD, MPH, VP of Clinical Strategy for Aledade, and Eugenie Komives, MD, Chief Medical Officer for WellCare of North Carolina and Secretary-Treasurer of the NCAFP Foundation.
DuBard noted that primary care practices are ready to be valued differently and provide care the way it is meant to be provided. However, many primary care practices are just trying to keep their business alive and practice in an information vacuum. But there is hope. Komives stated that primary care practices are pure and can make changes quicker than large systems. The key is managing limited resources. Komives said that care management is a limited resource, but data can help determine how to manage this scarce resource.
The discussion then moved to a 21st Century Health Workforce, with Erin Fraher, PhD, MPP, an Associate Professor in the Department of Family Medicine at UNC and Director of the Carolina Health Workforce Research Center, participating in the panel. Some of Fraher’s comments focused on the need to decentralize training away from tertiary care centers.
In another panel on paying for value, Rahul Rajkumar, MD, JD, FACP, Senior Vice President and Chief Medical Officer for BlueCross & BlueShield of North Carolina, highlighted the three ways his company is attacking rising healthcare costs: asking the largest healthcare systems in the state to share risk; ensuring there is a lane for independent primary care by providing right-sided risk powered with an arsenal of tools; and working with Advanced Primary Care practices such as Iora Health, CareMore and CityBlock. Those practices have reduced panel sizes but are also responsible for “incredible amounts of risk.”
Rajkumar noted that BlueCross NC wants to be in deep partnership with providers. “Being a good partner means being in a long-term contract, committing to sharing data, and developing rational and simple approaches to quality measurement,” Rajukumar said. As part of his company’s commitment, they plan on investing at least 10% of every premium dollar into primary care. “Our risk model treats the primary care physicians as the quarterback, and you’ve’ got to provide resources to that quarterback.”
Finally, family physician Don Bradley, MD, MHSCL, a consulting professor in the Department of Community and Family Medicine at Duke, moderated a wrap-up panel on Vital Directions for health and health care.
To begin the conference, Governor Cooper called healthcare a moral imperative, noting that someone should not have to file bankruptcy because of an unexpected medical bill. Cooper called on a system-based on value, but value in a way that healthcare provides care for all North Carolinians, including the lowest wealth individual. Secretary Cohen echoed the Governor’s comments, noting that we need a commitment to a clear vision of health, alignment of incentives and initiatives that lead to action and alignment of cross-sector infrastructure investments.
