Jul 25, 2014


Dr. Kyle Bradford Jones: Family medicine is your doctor. The physician who understands you, knows your context, knows your family, knows what's going on in your life and therefore, can better deal with issues that you face.

Recording: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Interviewer: We are with Dr. Kyle Bradford Jones, family medicine doctor.

Dr. Kyle Bradford Jones: The nice thing about family medicine, we're trained in all ages, we're trained in muscular skeletal muscles, obstetrics. We learn a lot of procedures and we are trained to look at the patient as a whole. And so, if you are having trouble sleeping, it may not be a sleep problem. It maybe something that's contributing to this. And so, we are able to take the broader view and say, "Okay. Let's figure out what the underlying issue is."

Interviewer: So the real advantage there is, I go to you, you can...if I go to a sleep specialist, they're just going to try to solve this symptom. If I go to you, you're going to say, "Well, it could be your diet, it could be your environment, you might be stressed out, it could be a physical thing, it could be an illness."

Dr. Kyle Bradford Jones: Exactly.

Interviewer: And family medicines, family medical doctors are trained to see that big picture and then direct. Is that what they do?

Dr. Kyle Bradford Jones: Exactly. A lot of times, we can treat the issues ourselves but if we can't, then we involve specialists. But the nice thing about it is that, once the specialist sees you and takes care of the problem then you are left on your own. We're, the family physician, is always there for you. We help coordinate all the different care you receive from different specialists and what not. So that you can come back and we can say, "Okay. You've had this problem before. Now we know how to deal with it, we know what to keep an eye on and we can better deal with it in the future."

Interviewer: And you call that the medical home. Is that what you refer to it as?

Dr. Kyle Bradford Jones: Yes. So the medical home is a newer concept that has been taking shape a lot throughout the country but not so much in Utah. So the medical home is a place where your doctor is, where your medical information is. It's kind of a central place where there is a team caring for all of your needs. And so, you have a problem, you go to your medical home, then we sort it out from there. We figure out if you need a specialist, if we can start treatment here and it's a central place for you to go for your care.

Interviewer: Is this concept of team based care, is it something new?

Dr. Kyle Bradford Jones: Yes and no. It's been around for a while however, it hasn't been used much. So in that sense, it's very new. If you think about some of the work that's been done in the community clinics with the university health care. They are bringing in pharmacists, they're bring in therapists, they're bringing in care managers, and bringing in these all together as a team to care for all the needs that you may have.

Interviewer: So help me out understand this. I've a doctor I go to every year to get my physical. We check in with each other. He's not family medicine per se. Is he my medical home then? Or would I want to switch to more family medicine and use him differently?

Dr. Kyle Bradford Jones: You know, it kind of depends. A lot of people who have an internist or kids who have a pediatrician who provides their primary care, which is excellent. The difference with family medicine is, we provide that but we can take care of the whole family. And so, we provide a little bit more of a context for the issues that you are dealing with. We do those things that you mention such as getting your physical, but then we can help further.
Now, with the medical home, as I mentioned, this is kind of a new concept that hasn't really caught on yet in Utah. You have your doctor that you go to for a physical every year. That does not necessarily make it a medical home. However, adding some of these other components where there is more of a team, where there is more of this central location, that's a little bit more what the medical home is.

Interviewer: Why hasn't it caught on in Utah? What's the barrier here?

Dr. Kyle Bradford Jones: One of the biggest issues throughout the country, with this catching on, has been payment because medicine isn't a fee for service world. So we only get paid if we do something. So, if we have something like a care manager or a pharmacist who helps us take better quality care of you, we don't necessarily get paid for that.
And so, there are insurance companies around that country that have said, "Hey. If you can be recognized by meeting these criteria as a medical home, we'll give you a monthly payment for each patient in addition to the fee for service payments that you receive so you can pay for it."

Interviewer: And that monthly payment is the concept, "Here is X amount of dollars, take care of this family. Keep them healthy."

Dr. Kyle Bradford Jones: Exactly. But it's not a pure, what's called, capitated system that we've had in the past where it's strictly, "This is the amount of money that you have and that's all you are going to get." It's a little bit of a monthly payment to help care for the patient and the family as well as the payments for the treatments and the various other things that we do.
So in Utah, one of the biggest issues has been insurance companies will say, "Okay. Well, you change your practice to medical home and then we'll provide these payments." Whereas medical providers say, "Well, you provide the payments and then we'll change our practice to bring this here." And so, it's a bit of this disconnect that . . .

Interviewer: It's face-off.

Dr. Kyle Bradford Jones: Exactly.

Interviewer: Who's going to change first?

Dr. Kyle Bradford Jones: Exactly. And we haven't quite been able to get past that stalemate yet in Utah.

Interviewer: So, you are in family medicine so your opinion might be a bit biased, but how is this system better than the way things have been? Going towards a family medicine system, how does that give a patient better care?

Dr. Kyle Bradford Jones: Lots of studies have been done with family medicine about, that we provide better quality care for a lower cost. So it improves the value of the healthcare experience that a patient has.

Interviewer: And how is that? How can you do it for a lower cost?

Dr. Kyle Bradford Jones: Because of the way we are trained and the way we look at the whole person and in the context of the community and the environment. So looking at that, helps us be able to get to the root problem with little better and better deal with issues that people face.

Interviewer: So, better care, lower cost. Is that fair to say? You provide more quality care because you have that behind you?

Dr. Kyle Bradford Jones: Yes, exactly.

Interviewer: Any final thoughts?

Dr. Kyle Bradford Jones: Just that, if you are interested in finding a family physician or learning more, you are welcome to contact the University of Utah, the community clinics. We do have a department of family medicine that can answer questions and provide any guidance if you're interested.

Recording: We are your daily dose of science, conversation and medicines. This is The Scope, University of Utah Health Sciences Radio.

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