Here we probe deeper into the critical issues in primary care.  Sonya Collins, Progress Notes Editor, seeks out the key thought leaders in the field and interviews them via phone or Skype.  These are videos and transcripts of those interviews. If there's a conversation you'd like to hear, email Sonya.

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The future of nursing in primary care
An interview with Virginia P. Tilden, Ph.D., R.N., F.A.A.N.
By Sonya Collins

Thank you for giving us an interview for National Nurses Week.
 
I’m very pleased to know that PCP is honoring National Nurses Week.  And I hope in the future that it’s joined by a Team-Based Care Week that is all about doing the right thing for patients.
 
 
I love that idea.  And how do you see the role of nurses in primary care evolving in the coming years? How do you see this role in ten years?
 
I see nurses in both staff and provider positions having a vital and expanding role and a responsibility for reinventing primary care now and in the years ahead.
 
In the staff role in traditional primary care practices, the RN typically does patient triage, telephone advice, and prescription management, sometimes including case management and chronic care management. Overall job satisfaction in this role typically is low, and burnout and turnover are high, such that medical assistants have tended to step into this staff role.
 
However, important reinvention of the RN staff role is happening now with exciting results. A recent ABIM Foundation study of innovative primary care practices found many RNs playing a different role. Care in these practices is typically team-based with RNs working at the top of their licenses as care coordinators, case managers, and systems specialists, resulting in much better patient care and higher morale for everyone, including physicians. Read more...

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Beyond the clinic: Taking prevention online
An interview with Sean Duffy, Co-Founder & CEO, Omada Health
By Sonya Collins

“Peggy” is an overweight, 54-year old woman with prediabetes. One day, as she was walking through the mall as part of a new exercise and weight loss regimen meant to turn her health situation around, a couple of teenage boys snickered and joked about her size.  It ruined Peggy’s day.  So she went home and posted a comment on the discussion board of her online weight loss and exercise group.
 
“I was at the mall and these two kids were making fun of my weight, and it’s put me in a horrible mood. Am I being a big baby? I feel terrible.”
 
Peggy has never met the people in her group. They are all participants in Prevent, an interactive online program for prediabetics who want to prevent onset of the disease.  Even though she’s never met them, Peggy’s group members all showed their support.
 
“That’s happened to me, too. You’ve got to ignore it. That’s why we’re in this program. Hang in there. Forget about them,” one wrote. Several more responded within the hour, and later that afternoon, their health coach posted an encouraging message as well. 
 
Prevent, created by Omada Health, Inc., is an online diet and exercise program based entirely on The Diabetes Prevention Program (DPP). In a 2002 randomized controlled trial, DPP, which aims to help participants reduce their weight by 7%, proved to reduce diabetes risk in prediabetics by 58% -- better than the drug metformin. 
 
Yesterday, Prevent was launched for the general public.  Besides keeping participants on a diet and exercise program geared towards meeting their goals, “It creates a safe, anonymous, online space to allow participants like Peggy to be vulnerable and seek the support they need,” said Sean Duffy, Founder and CEO of Omada Health, Inc. 
 
We recently interviewed Duffy about Prevent. Here’s what he had to say.

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Choosing care wisely
An interview with Daniel Wolfson, Executive VP and COO, ABIM Foundation

Choosing Wisely^® is a campaign of the ABIM Foundation to help physicians be better stewards of health care resources and help patients choose care that is truly necessary. Here Daniel Wolfson, who spearheaded the campaign, tells Primary Care Progress about the campaign and what he feels is primary care’s role in lowering health care costs.
 
Tell me why you started the Choosing Wisely Campaign.
 
Part of the mission of the ABIM Foundation, which is focused on advancing medical professionalism as articulated in Medical Professionalism in the New Millennium: A Physician Charter, is the stewardship of finite medical resources as part of physicians’ social contract with society. When the Charter first came out, a lot of people criticized the notion of physicians’ having a responsibility for both stewardship and, as it says in the charter, “the primacy of the patient,” putting the interests of the patient above all else. Read More.

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Adding value to decision-making
An interview with Neel Shah, M.D.

Neel Shah, M.D., is an ob/gyn and the founder and executive director of Costs of Care, a nonprofit whose mission is to empower caregivers to integrate information about cost and value into clinical decision-making. Dr. Shah talked to us about why Costs of Care’s mission is so important.
 
Why is it important to integrate cost and value into clinical decision-making?
 
Seven hundred billion dollars a year is spent on tests and treatments that don’t measurably improve outcomes. It’s a big number that suggests there’s room for improvement. Not all of it is necessarily immediately addressable. About 80 percent of it is tied up in fixed costs, like turning on the lights in the emergency room, and out of what is left, there might be another 30 percent that’s outside the immediate control of the physician. But we think there’s about 100 billion dollars that’s just low-hanging fruit, that’s not adding any value to health outcomes at all. Read more.

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Bringing care to Marylanders who need it most
An interview with Maryland’s Lt. Gov. Anthony Brown
 
In April, Maryland’s Gov. Martin O’Malley signed the Health Improvement and Disparities Reduction Act into law. The Act, spearheaded by Lt. Gov. Brown, will designate zones where the greatest health disparities exist.  Primary care practitioners, community organizations and health departments in these areas will be offered incentives to expand access to care, improve health, and reduce disparities.
 
Here Lt. Gov. Brown tells Primary Care Progress about the bill and why primary care is so important to Maryland’s administration. See the video and read more.

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Teaching the future of primary care
An interview with Rick Snow, D.O.

Besides transforming 50 sites around the state into patient-centered medical homes, The Ohio Patient-Centered Medical Home Education Pilot Project will implement a medical school curriculum that will help prepare future physicians to practice in this new setting.  
 
Here we spoke to Dr. Rick Snow, who is leading this curricular reform.

You’re creating curriculum that incorporates the competencies needed to coordinate the patient-centered medical home. Why is that important?

When I worked with the American Osteopathic Association, we developed the Clinical Assessment Program, a registry for measuring outcomes of newly implemented clinical action plans. We started out measuring outcomes of a new diabetes action plan, and they were only a little bit better than before.  So that got me thinking, “What’s missing here? Why hasn’t it gotten better?” Read more...

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How an (unfunded) bill becomes a law
An interview with Ted Wymyslo, M.D.

Ted Wymyslo, M.D., now director of Ohio Department of Health, helped lead the movement to write and pass Ohio state legislation to establish 50 patient-centered medical homes (PCMH) in four critical quadrants of the state. These transformed practices are not only expected to improve patient care, but they will also serve as training sites for health professionals students to learn this new model of integrated, collaborative care.  
 
We are thrilled the Ohio Department of Health has invited Primary Care Progress to collaborate with them as they roll out this new model of care and training.  
 
In his interview with Progress Notes, Dr. Wymyslo explains the initiative and how he got it moving without a dime.  See the interview here.

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Zumba as a cost-lowering tool
An interview with Bob Phillips, M.D., M.S.P.H.

Dr. Phillips is a family physician and director of the American Academy of Family Physicians’ Robert Graham Center: Policy Studies in Family Medicine and Primary Care. Here he shares his predictions for the future of primary care and what it will take to get us there.

Watch the video and read the full interview.

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iPod more effective than Xanax and no side effects
An interview with Rushika Fernandopulle, M.D.

Iora Health is building a new model of primary care from the ground up that changes how patients receive and pay for care.  Dr. Rushika Fernandopulle is the founding director of Iora Health, and he told Progress Notes about this new model.

Tell me how this practice model works.
 
Employers pay us a flat amount per patient per month to deliver primary care services for the patient, actually roughly double that of typical primary care. That lets us, not the payer, decide how to meet the patients’ needs, and allows us to completely redesign how we run the practice. The proposition is that we will save them money by keeping people out of the hospital and out of specialists’ offices. Read more...

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Telling stories for social change
An interview with Marshall Ganz, Ph.D.

If you want to be a part of PCP’s movement to transform primary care, here’s one thing you can do: Share your story.
 
Here Marshall Ganz tells us why story telling is such a powerful tool to incite change.  Leaving Harvard in 1964, a year before graduating, Ganz volunteered as an organizer in the Civil Rights Movement in Mississippi. A year later, he had joined Cesar Chavez and his United Farm Workers movement, and went on to become the union’s Director of Organizing. An expert in leadership and organizing, Dr. Ganz now teaches these skills at Harvard’s Kennedy School of Government, and he tells us that story telling is a crucial part of the skill set.  See the full interview here.

The Comprehensive Primary Care Initiative
An interview with Richard Baron, M.D. 

In 2012, Medicare will pilot its Comprehensive Primary Care Initiative. Through this program, Medicare will pay selected private practices an average additional $20 per month per Medicare patient for non-visit-based services – such as emails and phone calls to patients – and care coordination across the allied health professions. The program will also solicit health insurance plans to make a greater investment in non-visit-based services and team-based care for its members with the hope that these combined public and private investments will improve primary care quality and access for all.  
 
In November, 2011, we spoke to Richard Baron, M.D., the director of the Seamless Care Models group at the Center for Medicare and Medicaid Innovation – the department that spearheaded the initiative. Before Dr. Baron moved into this government position, he was in private practice at a patient centered medical home in Philadelphia. He serves on Primary Care Progress’s National Advisory Board. See the full interview here.

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Project ECHO: Telemedicine for Rural New Mexico and Beyond
An interview with Sanjeev Arora, M.D.

In rural New Mexico where hepatitis C is widespread, rural primary care doctors lacked the expertise to treat it while specialists were only found hundreds of miles away at the university. So Dr. Sanjeev Arora, gastroenterologist and hepatologist at the University of New Mexico, founded Project ECHO. 
 
Through Project ECHO, rural doctors present their patients’ cases to university specialists via video conferencing in order to learn best practices for the treatment of hepatitis C. The project’s great success with the disease has led Arora to expand the program to other conditions that challenge rural doctors.

Watch a clip of our January, 2012, video conference with Dr. Arora in which we interacted with him in the same way that rural primary care doctors do. Then read the full interview.

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Collaboration in the face of a workforce shortage
An interview with Christine Sinsky, M.D.

Here Christine Sinsky, MD, talks to Progress Notes about an innovative solution to a common problem doctors face.  As one of the principle investigators for an American Board of Internal Medicine Foundation primary care initiative, also sponsored by the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, Sinsky travels around the country observing new models of primary care practice. 

When you're out on the road visiting practices, what have you seen that's made you the most excited?  Read More