Getting patients in to see primary care practitioners is key to the Affordable Care Act. Image courtesy DIBP Images, flickr creative commons.
Getting patients in to see primary care practitioners is key to the Affordable Care Act. Image courtesy DIBP Images, flickr creative commons.

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National speakers come to Raleigh to laud the state’s primary care landscape.

By Jen Ferris

As a solo family practitioner in a rural area, Karen Smith relies on innovation to keep her Raeford office humming. For Smith, whose office is home to the town’s only fiber optic internet connection, technology is a vital lifeline that keeps her practice afloat.

“Technology was introduced into our practice as a matter of need,” Smith said, speaking at a panel sponsored by a new collaboration of physicians calling itself Family Medicine for America’s Health. By using a robust electronic health record system, Smith says she has been able to improve patient outcomes, decrease hospitalizations for her patients and reduce overhead costs.

Smith was one of eight North Carolina experts in family medicine who spoke at the Raleigh stop of the Health is Primary tour, a national five-city series of conversations about leveraging family practice innovation to meet the triple aim of better population health, lower health care costs and an improved patient experience.

Health reporter and documentarian T.R. Reid (far right) led a panel of North Carolina primary care doctors in talking about state-based innovations in Raleigh last week. Photo credit: Jen Ferris

“Your state is really considered a major innovator in health policy innovation,” moderator T.R. Reid told the 100-plus primary care doctors who gathered for the event. Reid is a documentary filmmaker and health care reporter who has written nine books about global health care.

Success stories

Reid lauded the work of Edward Bujold, a Granite Falls physician who decreased hospital admissions for his patients by 80 percent in five years by switching to a patient-centered medical home model.

In order to better meet patient needs, Bujold added a team of specialists to his practice. Physical therapists, clinical pharmacists, dieticians and psychologists work together to manage patients’ needs holistically.

“As a result of everyone on the team contributing,” Bujold said, speaking on the panel, “there is a smile on everyone’s face and patients are healthier. It was well worth the pain of the transition.”

“There is a smile on everyone’s face and patients are healthier. It was well worth the pain of the transition.”

Another panelist, Mary Hall, is working to improve family medicine by establishing a stronger foundation for new doctors. In her role as the chief academic officer for Carolinas HealthCare System, Hall oversees more than 31 residency programs. As they begin to learn, Hall said, medical students and residents need to learn the value of team-based medicine.

One of the programs she helps run, the I3 collaborative, is a three-state consortium that improves community health through placing medical residents in places of need in South Carolina, North Carolina and Virginia.

“It’s about expanding the right kind of experience for our students,” Hall said.

Fewer than 17 percent of medical students go into family practice annually, despite the fact it is North Carolina’s largest single medical specialty. Improving the residency experience, Hall said, will drive more graduates to fill the need.

The Health is Primary campaign has created a public relations campaign to encourage young doctors to choose primary care and get the message to patients about the importance of having a primary care physician. Photo credit: Jen Ferris

According to numbers released by Family Medicine for America’s Health, an increase of one family physician per 10,000 people served has measurable improved outcomes for patients.

Factory builds better outcomes

In Hickory, Cathie Petitt’s clients – a group of furniture builders – noticed employees were taking excessive sick days. They initially solved this with an onsite nurse practitioner who could bandage small wounds or write prescriptions and send workers back to the factory. In 2009, Petitt founded DirectNet, a patient-centered medical home group that fosters long-term employee wellness by moving beyond acute care.

“Less than 20 percent of our population were seeing a primary care physician,” Petitt said, explaining why the onsite nurse turned out to be a poor medical decision. After researching advances in medical philosophies, Petitt and the companies she worked with decided to be more proactive.

It took $2 million to bring 12,000 members’ wellness up to date, Petitt said. Medical groups contracted by DirectNet screened the employees for diabetes, heart disease and other complicated medical factors, and gave them long-term support and services accordingly. The patient-centered medical home plan is voluntary – employees are also offered a more expensive PPO – but 99 percent of employees enroll.

“North Carolina has some of the best health outcomes for Medicaid patients.”

Moderator Reid said North Carolina is filled with stories like those of the panelists, of physicians and companies finding creative ways to help patients achieve lifelong health.

That is why the group had originally chosen to kick off its Health is Primary Tour in Raleigh. The schedule was changed due to the late-winter snowstorms this year, but the sentiment remained.

“North Carolina has some of the best health outcomes for Medicaid patients,” Reid said. “And the striking thing is, almost all these innovations come from family docs, primary care doctors.

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