Laurel Case Lecture January 2014
Phillips provides road map for department, OHSU future
Robert "Bob" Phillips, MD, visiting professor for the Third Annual Laurel Case Lecture, offered OHSU and the Department of Family Medicine a road map for the future which included financial reform, accountability and focus on community health. View recording.
A national expert on health policy and health services research, Phillips has done extensive research using Geographic Information Systems to study patterns of care. Phillips presented his lecture, "As the Community Goes, We Go: Aligning Health Professions Education with Mission and Being Accountable" on Jan. 8, 2014 in the OHSU Old Library Auditorium.
In his introduction of Phillips, John Saultz, MD, described Phillips as being "at the forefront of looking at how maintenance of certification and career-long tracking of physician performance can be used in evaluating educational outcomes for medical schools and residency programs."
Phillips began by highlighting the strengths and success of OHSU and Family Medicine.Historically, 18 percent of OHSU's graduates go into family medicine and half of them stay in Oregon.
"From 2000 to 2006 … primary care production and family medicine production was actually higher than it has been in your whole history," Phillips said. "That's almost unheard of. Over the last 10 years, primary care production has dropped about 20-25%."
Maintaining a strong leadership role in health care and health care education will be challenging, in light of health-care reform. How will OHSU respond, for example, if accountability is built into Medicare and Medicaid payment systems? How will the organization transition to population health care and financing, after operating on a fee-for-service basis?
Based on studies of other health care leaders, Phillips offered the following suggestions:
- Develop a network of community health workers. The University of New Mexico saw a 62% reduction in cost to Medicaid Managed Care Organization with this model.
- Train all medical students and residents in public health to improve overall community health.
- Establish health extension rural offices, staffed with community resources that are "extensions" of the university to support transformation of health and health care.
- Develop a School of Community Medicine track that teaches medical students community-oriented primary care, offering scholarships and subsidies for those who subsequently pursue residency in a community setting.
- Negotiate a Medicaid waiver that includes medical education. Texas, Maine and Arkansas, for example, have waivers that include training for health care professionals. Oregon does not.
- Convince your payers (and yourselves) to double spending in primary care to 10-12% of the total, and negotiate to keep at least half of the savings from the inpatient side. "This would involve making primary care more robust, more comprehensive, more integrated, more team based, more IT enhanced and preserving, in all of that, the relationships," Phillips said.
- Persuade philanthropists to fund comprehensive health care. Phillips said, "I wonder if it's time to go back to your philanthropies and say, "Thank you. And, we have this mission to serve all Oregonians, not just those with cancer and heart disease. Can you partner with us to make the model health care, health professions, outreach the meeting the needs of the state?"
Phillips is the vice president for Research and Policy at the American Board of Family Medicine and a professor at Georgetown University and Virginia Commonwealth University. He was selected by the Secretary of Health and Human Services to serve on a Federal Negotiated Rule Making Committee for the redesignation of shortage and underserved areas. Phillips also served as vice-chair of the US Council on Graduate Medical Education and continues to advise federal and state government on health education policy.