The future of American health care will rely on coordinated programs that bring a range of health sciences to bear for each patient and that focus more on the quality and humanity of care delivered than on its volume.
That was the message delivered Thursday, November 3, 2011, at Western University of Health Sciences by Robert Margolis, MD, Managing Partner and CEO of HealthCare Partners, who was the featured speaker for the 3rd annual Dr. Philip Pumerantz Distinguished Lectureship.
Margolis, whose topic was “The Future of Health Care Delivery: A Physician’s Perspective,” founded HealthCare Partners in 1992 after working for several years as a practicing physician, notably affiliated with California Hospital Medical Center in downtown Los Angeles. His efforts to provide follow-up care for emergency room patients at that hospital who had no specific physicians of their own eventually led to the establishment of California Primary Physicians Medical Group, a practice dedicated to such care, and eventually to the formation of HealthCare Partners. HealthCare Partners now serves more than one million patients, with more than 8,000 doctors in three states and more than 100 clinical sites.
At the Pumerantz Lecture, Margolis set the stage for his vision of where health care should go by first noting what he believes is wrong with the American medical system. “First and foremost, the incentives are wrong – paying for volume, not for quality or performance, has got to go,” he said. “The insatiable appetite of consumers – our patients – for tests and treatments, mixed with the clinician’s financial incentive to do all these tests, is clearly leading to a cost conundrum while not demonstrably improving quality or outcomes.”
Margolis also noted studies have shown no correlation between usage of the health-care system and satisfaction, but that strong correlations were made with empathy, listening skills, and the trusting relationship between doctors and patients. These qualities – which he described as “the softer side of medicine” – must play a key role in the team approach to care, which he said was the only way the system could become treatment- and cost-effective.
“We should be compensated not on what we do, but on whether we improve the health of our population,” he said. “So the future of medicine … is understanding the health needs of your patient population – your panel of patients.”
Margolis said patient care ideally will be provided in teams following a care plan based on an evaluation of a patient’s burden of illness and on the data available about them. Who’s on the team depends on the patients; prevention, diet, exercise and health diet strategies require educators and dietitians, will disease-specific teams might require nurse practitioners, nurse educators and nutritionists. Collaborative mental health teams of psychologists and/or psychiatrists would work with physician assistants or nurse practitioners in diagnosing depression and other disorders, while teams of social/home health workers and rehab specialists would deal with home-based patients, rather than having them in long-term care facilities or bouncing in and out of emergency rooms.
“Hopefully, you now the get the picture of a much more idealized and patient-centric delivery model – one that’s specifically designed to improve outcomes, is customized to patient needs, increases quality of outcomes and compliance with best-evidence guidelines, avoids unnecessary or duplicate tests, and reduces errors through technology … All this collaborative teamwork also leads to significant improvement in avoidable admissions, readmissions and overall use of institutionalization,” Margolis said.
“If we as doctors and caregivers want a challenging and flourishing, highly satisfying profession, and we all work to improve the health, well-being, and sustainable finances for a healthy, sustainable American health care system, we can and will make quality, affordable care for all Americans our priority,” he concluded.
Margolis then answered several questions from the audience of more than 300 students, faculty, staff and community members, including questions from WesternU’s COMP-Northwest campus in Lebanon, Oregon, which participated via the Pumerantz Lecture webcast. Responding to one question about the “team” health-care approach, he said, “The collaborative care teamwork being taught at WesternU is the future of better-quality, affordable care,” a reference to the university’s innovative interprofessional education program.
WesternU President Philip Pumerantz, PhD, then joined Thomas G. Fox, PhD, WesternU’s senior vice president, and Clinton Adams, DO, dean of the College of Osteopathic Medicine of the Pacific (COMP) on stage to present Margolis with a certificate of appreciation and to unveil the lectureship plaque, which each year has the name of the latest speaker added to it. Margolis’ name follows Dr. John Kitzhaber, governor of Oregon, who spoke at the inaugural Pumerantz Lecture in 2009, and Kimberly Belshe, former secretary of health and human services for the state of California, who was the 2010 speaker.
Earlier in the evening, Margolis met with a small group of COMP students and student government leaders for a private discussion about the future of health care. “Any of you going into primary care?” he asked the group of about 30 students. “Let’s see some more hands, guys. It’s not going to be a great world for specialists.”
Margolis told the students that the future of health-care will lie in a focus on wellness and preventive care, as well as better management of end-of-life issues, and that under that scenario, specialists will play a smaller role and will be needed less often.
The lectureship, in honor of Dr. Pumerantz, who is WesternU’s founder and president, was established in 2009 as part of a $5.1 million pledge to WesternU by Drs. Daljit and Elaine Sarkaria of Orange.
The Sarkarias dedicated $100,000 of their pledge to create the lectureship to encourage and foster exemplary medical research, education and quality patient care.