Importance of IPE/ICP for Addressing the Health Care

Needs of Populations

David Garr, MDExecutive Director

South Carolina Area Health Education ConsortiumAssociate Dean for Community Medicine

Medical University of South Carolina

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Patient-Centered Medical Homes Use of Electronic Health Records Accountable Care Organizations Increasing emphasis on population health-

shifting from numerator to denominator health care

The Landscape of Health Care Delivery is Changing

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• Engaged leadership• A quality improvement strategy• Emphasis on continuity of care• Patients’ involvement in decision-making about

their own care• Enhanced access by patients to health care and to

their clinical information after hours• Care coordination to reduce duplication of services

Patient-Centered Medical Home

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• Certified EHR systems capable of interoperability

• Ability to e-prescribe• Ability to monitor the health of the

population• Higher reimbursement for meaningful use of

the EHR

Use of Electronic Health Records

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Workforce changes with an integral role for primary care and IP teams

Focus on quality of care and the provision of preventive services for populations

Reimbursement changes from volume-based to value-based care, i.e. pay-for-performance

Accountable Care Organizations

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Incentives for collaboration between hospitals, ambulatory care facilities/PCMHs, long term care facilities, home health agencies, pharmacies, and others

Incentives for avoidance of readmissions, preventable complications and duplicative services

Accountable Care Organizations (cont.)

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• Expectation to focus on the health of all patients registered in practices, not just on those who come for appointments

• No longer acceptable to label some people as “bad patients”

• Attention to the social determinants of health

Emphasis on Population Health

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Provision of evidence-based care Use of templates to guide clinical decision-

making Reimbursement tied to providing evidence

of quality care

Emphasis on Population Health (cont.)

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• The clinician can’t do it all

• Re-engineer the system of care in the

practice

• Use the EHR to share responsibility for care

among the members of the team

The Interprofessional Team

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• Continuing education for the entire healthcare team, not just for individuals on the team based on their professional disciplines

• Outreach by the practice to their patients-patient reminders, role for community health workers

• Increased job satisfaction of the members of the team

The Interprofessional Team (cont.)

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Providing excellent clinical experiences for students in sites that are practicing the health care of the future

Building and sustaining relationships with clinical practices that will serve as premier learning laboratories for students

Challenges for Health Professions Educators

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Maintain an ongoing relationship with IP teams in precepting practices so they remain aware of the critical role they play in educating students about ICP

Provide incentives and rewards for clinical practices that will encourage their participation as model teaching sites

Challenges for Health Professions Educators

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Conducted an assessment of the readiness of clinical practices to serve as models for health care delivery (EHR use, PCMH status, ICP) – a survey followed by on-site interviews

done by AHEC Health Professions Coordinators Established the Institute for Primary Care

Education and Practice for students, faculty and community-based preceptors

Funding from The Duke Endowment with matching funds from the five participating colleges

Some Initiatives Underway in South Carolina

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47 first year MUSC and USC advanced practice nursing, medical, and physician assistant students have joined the Institute along with 22 preceptors

Monthly seminar series and mentoring opportunities for students

Creating an outreach program for practices interested in examining the effectiveness of their IP care and ways to improve the quality of care for the populations they serve

Value of using a self-assessment instrument for IP practice

Primary Care Institute

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Health care is changing in significant ways The next generation of clinicians need to be

prepared for these changes ICP, quality improvement and population

health are becoming increasingly important Students need to have the opportunity to

work in settings where the health care of the future is being delivered

Academic faculty and AHEC programs can work together to identify and support these clinical practices

Conclusion