Transforming Health CareMay 20, 2014
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Interviewer: Transforming healthcare. How difficult could that be really? Pretty difficult. It's the institute for healthcare transformation and we are talking with Linda French, professor and chairman of the Department of Family Medicine at the University of Toledo.
How excited are you to be a part of this prospect? I mean, we're at a great time in our society where we are thinking about this topic.
Dr. Linda French: Yeah, this topic is really exactly what we have to be thinking about right now in healthcare. We know that our traditional fee for service system is so fragmented and doesn't work together that we have to find systems that do work.
Interviewer: Now, what does it mean to you when somebody says transforming health care? What does that mean?
Dr. Linda French: To me, transforming health care means that we have something that really works like a system and not just random pieces that don't communicate with each other.
Interviewer: And do you think that will solve a lot of the problems that's facing health care right now? The increase in cost versus wages and that sort of thing?
Dr. Linda French: I do think that it's necessary but not sufficient. It's going to reveal to us where our areas are that we need to work on. Right now, with everything so fragmented, we have a hard time even knowing where our excess costs are, for example.
Interviewer: Throughout this [inaudible 00:01:23], they speak of using scientific principles to tackle this problem, academic principles, I should say. To you, does that mean getting the good data to be able to see where the problems are as opposed to speculating and guessing and thinking? Has that been a problem in the past?
Dr. Linda French: Yes, that has been a problem in the past and this effort is founded and really based on that idea. We have to have the appropriate data and then, on top of it, know how to analyze it, know how to test things that change it and understand the results that we are getting.
Interviewer: There is a lot of talk here about the notion of population health and I have a feeling that that's going to be a word that all of us are going to have to become familiar with. Can you explain what population health is?
Dr. Linda French: What we are talking about when we talk about population health is the idea that we are considering the health of our entire society and that has just so many ramifications. It really transcends health care delivery a lot and really gets into the makeup of society as a whole, including things like education and the kind of work that we do and how we spend our free time and all of the things that our society does that provides factors that determine health, outside of our interactions with health care system or health care providers.
Interviewer: How does the notion of population health compare to the way that we are used to receiving health care or health care in general in United States?
Dr. Linda French: Our idea about health care in United States is very much based on individual relationships within individual providers. Although we do have pretty good models in this country that we can refer to for population health from the public health side. For one example, what happened with smoking in our country. The main key to the decrease in smoking rates and decrease in smoking related illness in our country is not what happened in between individuals and their physicians in office settings. Although, that's a little bit of it. It was much more things like laws that prevented smoking in public places and taxes on cigarettes and a much more comprehensive view that discourages smoking as well as the idea took hold that smoking is bad for your health. So that's a specific example about population health.
Interviewer: Is it fair to say that the notion of population health goes beyond the current model which is, I get sick, I go to my doctor?
Dr. Linda French: Absolutely.
Interviewer: It's more of everybody taking ownership of their own health in a way that culturally we just really haven't before. Are you seeing a change that we are more so or?
Dr. Linda French: I think the health care providers need to change our mindset more towards the idea that the individuals are responsible for their own health and we are there to provide support for that.
Interviewer: So, the notion of population health, this really isn't a new concept in some areas of the world?
Dr. Linda French: Correct.
Interviewer: Tell me about your experience in Chile.
Dr. Linda French: Well, I lived for a number of years in Chile and actually went to medical school there and worked in their health care system for two years, and it was actually a really valuable experience and made me decide that I wanted to go into primary care when I returned to the United states because I saw the value of what was happening in primary care, they are for the population. It wasn't particularly great for doctor pocket books but as for health of the population, it was great and I worked in a specific clinic that provided the primary care services for a sector of a city and we had a high integration of public health services and individual personal health services. We did planning and went out into the schools and were considered by the surrounding areas of the city as their source of health care.
Interviewer: What could the United States learn from that experience or what from that experience would you bring you to health care to help solve this problem?
Dr. Linda French: It was the value of the system that we didn't have fragmented care and we had actually smooth working relationships. If we had to send patients to the hospital for specialty care, ambulatory specialty care, or for hospitalization, we had a smooth link with that too. We often had specialists from the hospital who tended to be few in numbers and rather overwhelmed with their work, come out to our individual clinics to teach us to better manage chronic diseases so that we would only send them the cases that they felt were the sickest of the sick, that they needed to care for.
Interviewer: You mentioned in one of the sessions, something that really intrigued me, that the general population does not want a relationship with health care. Explain that thought a little bit, I find that interesting and it resonated me.
Dr. Linda French: It actually resonates with me. I think that most healthy people don't want to feel that they need an ongoing, very personalized relationship with an individual provider or maybe even a specific health care team. On the other hand, if you start feeling bad, you want to have some place for turn. For example, if you come down with an acute appendicitis or if you get pregnant, you want to have a health care system there that's available to you, but the idea that even routine health checkups are needed is something that I actually rather question.
Interviewer: I use somewhat considered non-traditional muscle massage therapy. The deep tissue massage therapy, chiropractic care, which, I feel, give me great benefit above and beyond what I can get from a doctor. What are your feelings on involving some of those other expertise's in the health care system? Did you feel that they are missing from the health care system right now?
Dr. Linda French: Actually, I think those resources are present in the health care system but not well integrated and sometimes, the benefits that those kind of providers offer are not offered by peoples health insurance, like massage therapy, often times nutrition counseling services which can be a key thing for a person who is trying to take steps to improve their own health, are not a covered benefit. Physical therapy is one that is often covered and probably a lot of the benefits that you got from, perhaps, your chiropractor and your massage therapist could have been provided by a physical therapist but it maybe wasn't really known and particularly accessible.
You can't go directly, usually, to a physical therapist. You have to go to a doctor or a nurse practitioner, at least a physician assistant and get an order for that kind of service and perhaps, that's not the right model.
Interviewer: Do you have a couple of ideas so far that have risen on the top during this conversation and resonating in your head?
Dr. Linda French: The cost of that IT infrastructure has been rising so fast and every piece that you add has such a big price tag that it also becomes unaffordable. The cost of the IT infrastructure to support health care is going to need to start decreasing like has happened with other kinds of information technologies. It's got to start dropping.
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