As PCMS Executive Director Bruce Ehrle continues to report back to his contacts in the nation’s capital in Congress, at HHS, and at CMS about one of the most important practice success and community engagement activities for the Society—improving population health in Pierce County that will lead to provider success in meeting new quality and payment metrics tied to overall patient outcomes—he has received favorable feedback from government leaders about the efforts that the Pierce County Medical Society is making in these areas. Here is a 2017 mid-year report:
Social Determinants of Health
With the release last year of PCMS tools to screen patients for shortcomings in the social determinants of health (quality housing, access to nutritious food, economic opportunities, transportation, education, etc.) that impact over half of overall health outcomes and to refer them for help, this year the PCMS Social Determinants of Health Workgroup convened to review activities already underway by providers in the county. Participants in the workgroup include senior representatives of CHI Franciscan, MultiCare, Northwest Physicians Network, Community Health Care, and the Tacoma-Pierce County Health Department. The next meeting of the Workgroup will take place immediately after the summer to review best practices in use nationally and internationally to help patients relating to social determinants. Steps ahead for the Workgroup and PCMS on this topic include development of a menu of options for physicians to utilize to screen and refer patients who demonstrate a need for help in these areas that will offer the least disruption to already overburdened practitioners, conducting outreach to organizations working in these areas at the local level such as food banks, and advocating massive strengthening of resources in the community for appropriate care follow-up, referral monitoring, and coaching with patients. By improving population health through addressing social determinants and by decreasing health inequities, as much as a decade may be added to the lives of the citizens of Pierce County. Providers will also be lined up to achieve success in meeting new payment and quality metrics with as much as ten percent bonuses and ten percent penalties at stake for some providers.
Pierce County Medical Society and Pierce County Project Access recently launched a long term joint initiative to improve health literacy among all demographics in the county with the goals of increasing the use of primary care, having patients know what to expect from interaction with primary care providers in 21st Century medicine, avoidance of the use of Emergency Departments for either non-emergency routine care or for acute situations that might not have progressed had they been addressed earlier in a preventive care setting, better health outcomes resulting in success for providers in meeting the new quality and payment metrics, and lower costs. Initial steps in this endeavor will be to gather best practices in use by health systems and insurers in order to broaden them by next year in to a proactive, aggressive, direct outreach program to patients through housing agencies, food banks, churches, employers, and many other organizations including with verbal presentations and distribution of multi-lingual written materials keyed to get eye popping attention by patients.
Public Health Coordination
Pierce County Medical Society performs an ongoing role to coordinate public health issues with physicians, PAs, and school nurses through regular meetings of its PCMS Public Health School Health Committee that includes school nurses from all over Pierce County, practicing pediatricians, PCMS, and the Tacoma-Pierce County Health Department as well as through the participation of a leading PCMS member physician on the Tacoma-Pierce County Board of Health and membership on the PCMS Board of Trustees by the Tacoma-Pierce County Director of Health. As public health and population health efforts increasingly merge in some topic areas, PCMS keeps all lines of communication open in order to foster a collaborative partnership to those efforts.
The Society advocates with federal and state officials to focus on social determinants of health in order to support physicians/providers who are increasingly being paid less in fees for service and more based on overall patient outcomes, quality, and value. PCMS has been consulting with elected leaders about how new budgeting techniques might be in order where planned long-term health expenditures are spent now on things like food, housing, transportation, education, and economic opportunity with likely savings on health care applied in those later years through overcoming health disparities and inequities leading to a healthier population and reduced costs.
PCMS also advocates with federal leaders for a national effort to improve health literacy of the population to move patient care in to preventive settings such as primary care to improve population health and reduce costs.
Another component of PCMS advocacy to improve population health is an ongoing call for more resources for behavioral health (facilities, methods of referral, integrated care and unified medical records) as well as an increase in residency slots to adequately intake the record number of students coming out of medical school. Additionally, PCMS has been pressing for early career physicians to receive assistance with their massive debt loads especially if the new doctors go in to primary care or behavioral health through loan repayment programs based on income or through direct federal incentive grants to help alleviate the shortages in these areas of care delivery so that patients have an easier time of establishing and maintaining appropriate preventive care.
Improvement of reimbursement rates in Medicaid is also advocated for by the Society to increase patient access to preventive and primary care.
Finally, PCMS pushes elected leaders for potential mandates by the federal government that insurance companies permit patients to have unlimited visits to their primary care physician for preventive care beyond the usually allowed annual “wellness visit” without a co-pay or deductible with the insurance company covering 100 percent of that cost.
As warranted, PCMS will schedule educational opportunities such as webinars with guest speakers to provide ongoing education about best practices and trends in population health improvement.
Improving population health, meeting new payment and quality metrics, reducing health disparities and inequities, overcoming shortcomings for patients in social determinants of health, improving health literacy, and achieving advocacy goals related to these endeavors is not easy and not accomplished overnight. However, failing to be engaged strongly in these areas could likely lead to failure by physicians and other providers to be successful in the new paradigm of care delivery and payment that is underway--and failing to be engaged won’t help patients either. The promise of success in these areas for physicians, other providers, and patients is exciting and worthwhile. Therefore, your medical society will keep working hard on all these topics with an ultimate goal of a healthier population in Pierce County and a physician community that shares in that success as a valued partner in the evolution of health care.