ceo-rounds-oct-25-2024-changing-the-system-begins-by-building-relationships | CEO Rounds: Oct. 25, 2024 - Changing the System Begins by Building Relationships | Latest_News | Shared_Content/News/ceo-rounds/2024/ceo-rounds-oct-25-2024-changing-the-system-begins-by-building-relationships | <div class="col-md-12">
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<h5>October 25, 2024</h5>
<h2>Changing the System Begins by Building Relationships</h2>
<p>Jennifer Hanscom, CEO</p>
<p>
How many articles have you read lately that start with the line "The health care system is changing..."? Yes, I admit at the WSMA we overuse that phrase. In fact, hasn't health care already changed? When I look at what is happening in the larger environment, what I see is policymakers who are trying to control the cost of health care by setting their sights on physicians, clinics, and hospitals, when, in reality, money is leaving the system.
</p>
<p>
As you'll soon read in the November/December issue of WSMA Reports, health care organizations increasingly rely on for-profit companies, including pharmaceuticals, EHR vendors, medical device manufacturers, technology consultants, and more, and these third-party vendors are rapidly driving up the cost of care while reimbursement for those who provide the care is rapidly declining.
</p>
<p>
How do we-in fact, can we-change this dynamic? I believe we can, but it won't be overnight, and it will take all of us in medicine working together to force change.
</p>
<p>
I'm so excited for this upcoming issue of WSMA Reports to hit your mailboxes so you can read more about what physician leaders believe needs to occur to evolve our current health care system for the benefit of patient care and the profession.
</p>
<p>
What's the WSMA's role in all of this? As I see it: Prepare the profession with the skills they need to be advocates within their clinics, systems, and organizations; and, secondly, fix the environment that is causing the system to be dysfunctional in the first place.
</p>
<p>
On the latter, as we have shared throughout this past year, policymakers and legislators are seeking ways to control cost in health care. We must show them the correct path and we need them to listen to and trust us-and that starts with building relationships.
</p>
<p>
Our political action committee, WAMPAC, headed by Alex Wehinger, has spent the last several months connecting our members with candidates seeking legislative or statewide office. Below Alex shares an update on what lies ahead.
</p>
<h3>Elections Are Less Than Two Weeks Away! Here's What You Need to Know</h3>
<p>
Alex Wehinger, WAMPAC Director
</p>
<p>
Ballots for the 2024 general election have been mailed to voters, featuring several initiatives and numerous candidates for office. Regardless of the outcome of the elections, Washington state will have a new governor, attorney general, and insurance commissioner for the first time in over a decade. There are also more than 100 seats in the Legislature up for election and a new House Health Care Committee chair yet to be determined.
</p>
<p>
WAMPAC, WSMA's nonpartisan campaign arm, works year-round to build connections with elected officials and ensure our state is the best place to practice medicine and receive care. Our work on campaigns helps promote WSMA's legislative agenda, which includes increasing Medicaid rates, defending against inappropriate scope of practice proposals, and supporting the health care workforce. The outcome of these elections impacts health care policy decisions and, ultimately, how care is delivered.
</p>
<p>
In addition to our standard campaign work, the WSMA is also engaging on two of this year's ballot initiatives pursuant to policy adopted by the House of Delegates. A resolution was approved by the 2024 House of Delegates directing the WSMA to oppose Initiative 2109, which would repeal the state's capital gains tax. During House debate, it was noted that passage of the initiative would significantly impact the state's budget, as the capital gains tax generates annual revenue of around $900 million. The WSMA also opposes Initiative 2117, which would repeal the state's Climate Commitment Act, pursuant to <a href="[@]wsma/about/policies/whats_our_policy/environmental-health/clean-air.aspx">policy adopted at the 2018 House of Delegates</a>.
</p>
<h4>Election resources</h4>
<p>
We know you care about electing candidates friendly to the physician community. Want to know how your state legislators supported the house of medicine during the 2023-24 legislative biennium? WAMPAC can help. As you fill out your ballot, be sure to check out the <a href="[@]wsma/advocacy/wampac/wampac_legislator_report_card.aspx?_zs=B3aFd1&amp;_zl=x8ir9">WAMPAC Legislator Report Card</a>, which details your legislators' track record on issues important to you and your patients.
</p>
<p>
As a reminder, the general election is on Tuesday, Nov. 5. If you need to register to vote, there's information about how to do so on the <a href="https://www.sos.wa.gov/elections/voters/voter-registration/register-vote-washington-state">secretary of state's website</a>. Voting in Washington state occurs by mail, so the outcomes of some elections may not be determined on election night as ballots continue to be counted over several days.
</p>
<p>
If you are interested in becoming more involved in campaigns, you can <a href="[@]wsma/advocacy/wampac/give_to_wampac/wsma/advocacy/wampac/give_to_wampac.aspx?hkey=665ce949-b574-4ec7-8e5a-7a796233e5d7&amp;_zs=lfaFd1&amp;_zl=Q35o9">join the Diamond Club</a> at the bronze level for a discounted rate of $100 for a limited time. Diamond Club members receive special election updates, opportunities to connect with elected officials, recognition at WSMA events, and more.
</p>
<h4>Join the WAMPAC board of directors</h4>
<p>
WAMPAC is governed by a board of physicians representing each of the state's 10 congressional districts and whose responsibilities are to direct campaign activities, such as candidate interviews and contributions. The board has several open positions and is seeking applicants to represent the 3rd Congressional District, which encompasses Lewis, Pacific, Wahkiakum, Cowlitz, Clark, and Skamania counties, and the 5th Congressional District, which comprises all or part of 12 counties in Eastern Washington. You can <a href="https://app.leg.wa.gov/DistrictFinder/">locate your congressional district here</a> by entering your home address.
</p>
<p>
For those who are interested in politics, board membership provides an excellent opportunity to gain a better understanding of campaigns and connect with elected officials and candidates for office. The WAMPAC board holds two in-person meetings per year and Zoom meetings as needed.
</p>
<p>
If you are interested in seeking a position on the WAMPAC board of directors or have any questions about our campaign work, please <a href="mailto:alex@wsma.org">reach out to me</a>.
</p>
</div> | 10/25/2024 12:00:00 AM | 1/1/0001 12:00:00 AM |
how-do-we-fix-primary-care | How do we fix primary care? | Latest_News | Shared_Content/News/Latest_News/2024/how-do-we-fix-primary-care | <div class="col-md-12">
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<h5>October 25, 2024</h5>
<h2>How Do We Fix Primary Care?</h2>
<p>
By Jake Berman, MD, MPH</p>
<p>
Consider the plight of today's primary care physicians and practitioners.
</p>
<p>
First, clinical guidelines for screening, preventive health, and chronic disease management continue to grow in number and nuance, yet the time and resources needed to address them remain stubbornly fixed and insufficient. By some estimates, PCPs would need 26.7 hours per day to render guideline-concordant care for a typical panel of 2,500 adult patients <sup>1</sup>. It has been observed (with biting wit) that progress could be made if "<a href="https://www.bmj.com/content/363/bmj.k4983">general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don't like them much anyway</a>." For PCPs, the supply-demand mismatch is real, painful, and unsustainable, a common source of stress, burnout, and moral injury.
</p>
<p>
Second, in the face of these impossible demands, the PCP often remains a lone warrior, expected to address an enormous range and volume of tasks, many of which do not require the PCP's clinical expertise and many of which would be better addressed by the expertise of other health care professionals or community partners. Team-based care to support primary care patients is far from a novel concept, yet its implementation has often come in fits and starts, and many practices struggle to achieve sustainable, integrated team-based care models.
</p>
<p>
Third, such challenges in establishing and scaling effective team-based care arise in no small part because spending on primary care remains woefully inadequate. According to current estimates, in Washington state, only 4.4-5.6% of health care dollars are spent on primary care, far short of the state's goal of 12%. This yawning gap is acutely and chronically palpable for the PCP.
</p>
<p>
Finally, the pain points of primary care practice are driven not only by investing too little in primary care but also by the way in which we generally pay for primary care. Despite some forays into and some successes with value-based models, billable encounters with PCPs, which do not incentive quality and constrain the variety of ways in which primary might be rendered, largely remain the coin of the realm for many primary care practices. As the National Academies of Science, Engineering, and Medicine recommended in its landmark 2021 report Implementing High-Quality Primary Care, "<a href="https://nap.nationalacademies.org/read/25983/chapter/2">Pay for primary care teams to care for people, not doctors to deliver services</a>." Paying for teams to take care of people not only better aligns the incentives for high-value, patient-centered care but also opens the way for innovative, multimodal primary care models that can more flexibly meet diverse patient needs. The tension between primary care's business model and its clinical paradigm creates dissonance for PCPs, care teams, and patients alike. The Work Relative Value Unit simply does not describe primary care's value or lend itself to meaningfully assessing PCP performance.
</p>
<p>
Fortunately, there is hope, not only on the horizon but in the waters in which we currently swim.
</p>
<p>
In June 2023, the Centers for Medicare and Medicaid Innovation announced a new primary care model called Making Care Primary. MCP seeks to support primary care through a combination of upfront capacity-building payments and a gradual transition from fee-for-service to prospective population-based payments for primary care services, with a host of resources and incentives to advance quality, equity, efficiency, and patient experience. Washington state was selected as one of eight states to participate in MCP, in no small part because the Washington State Health Care Authority was looking to integrate the program with its Primary Care Transformation Initiative, which includes an ongoing effort to advance a multi-payer primary care model increasingly built on value-based payments. In Washington, 21 clinical practices have enrolled and 11 payers have signed a letter of intent to align with the model.
</p>
<p>
MCP is not a panacea. Nor is it the only way forward. Yet, the model is engineered to foster—and invest in—team-based care, care integration, and, ultimately, an approach that pays for the value of primary care relationships rather than billable encounters. For PCPs, this could mean a reimagined clinical workday, with investments and a payment model that enable more time and flexibility for patient care through whichever channel works best—a brick and mortar visit, a digital visit, the electronic inbox, remote patient monitoring, the community—and support for a care team that is better-suited to addressing the scale and variety of patient needs. With an effective care team, the estimate of PCP time needed to provide guideline-concordant care dropped from 26.7 hours per day to 9.3 hours per day-still too much, but a marked improvement <sup>2</sup>.
</p>
<p>
How else could a program like MCP truly impact the everyday life and work of PCPs? Among other things, the model seeks to support better integration of care between PCPs and specialists, including through a new e-consult code that pays specifically for the work the PCP does to place and follow up on a virtual consult. MCP also supports investment in building desperately needed behavioral health capacity, such that PCPs could have better access for their patients to counselors, social workers, and psychiatrists. Significantly, MCP also seeks to better integrate medical services with community resources by incentivizing the collection of data on health-related social needs and providing resources that can be invested in roles like community health workers, who may be best positioned to support and engage patients in their everyday lives. Have a patient whose diabetes is nearly impossible to manage given food insecurity? The MCP care team could include a community health worker able to assist the patient in troubleshooting root causes and pursuing nutritional resources. At its core, the model looks to enhance the primary care medical home while situating this medical home in a more cohesive medical neighborhood, empowering PCPs with more and better-integrated resources to support their patients.
</p>
<p>
MCP will be what we make of it, and the types of organizational, cultural, and practice change required for success can be complex. But with the resources provided by the program and with thoughtful execution, PCPs could chart their way out of the current predicament to a future where they are set up successfully to do what so many of us originally signed up for: make care primary.
</p>
<p>
<em>Jacob Berman, MD, MPH, is the medical director for population health integration at UW Medicine and a clinical associate professor in the department of medicine at the University of Washington. This essay reflects Dr. Berman's own views and not those of UW Medicine.</em>
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
<p><span style="font-size: 10px;">
1. J GenIntern Med 38(1):147–55 DOI: 10.1007/s11606-022-07707
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<p><span style="font-size: 10px;">
2. J GenIntern Med 38(1):147–55 DOI: 10.1007/s11606-022-07707
</span></p>
</div> | 10/25/2024 12:00:00 AM | 1/1/0001 12:00:00 AM |
member-spotlight-sheree-sharpe-md | Member Spotlight: Sheree Sharpe, MD | Latest_News | Shared_Content/News/Latest_News/2024/member-spotlight-sheree-sharpe-md | <div class="col-md-12">
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<h5>October 25, 2024</h5>
<h2>Member Spotlight: Sheree Sharpe, MD</h2>
<p>
<strong>About you:</strong> Sheree Sharpe, MD</p>
<p>
<strong>Works at:</strong> Community Health Care, Tacoma.
</p>
<p>
<strong>How long in practice:</strong> 17 years.
</p>
<p>
<strong>Specialty:</strong> Family medicine.
</p>
<p>
<strong>Why WSMA: </strong>The WSMA represents and advocates for the physician community in Washington state. For me, this means I have a powerful voice through the WSMA that supports and defends the interests and well-being of physicians, ensuring we have the resources and support to deliver high-quality care to our patients. Through the WSMA, I have shared values in advocacy, representation, and leadership, aligning with my own passion for advancing health care and advocating for others.
</p>
<p>
<strong>Proud moment in medicine:</strong> I will never forget the opportunity I had to assist my patient navigate a challenging diagnosis. After weeks of uncertainty, I worked closely with her to ensure she understood her options and felt supported throughout the process. Witnessing her relief and gratitude after we developed a clear path forward was incredibly rewarding. It reinforced my belief in the importance of compassionate care and effective communication, reminding me of the profound impact we can have on our patients' lives during their most vulnerable times.
</p>
<p>
<strong>Top concerns in medicine:</strong> My concerns revolve around three critical areas. First, ensuring equitable access to high-quality health care for all, regardless of socioeconomic status, is paramount. Disparities in health care access create barriers that prevent many from receiving the care they need, which can have long-term impacts on community health and well-being.
</p>
<p>
Second, the issue of burnout among physicians and health care professionals is increasingly alarming. Burnout not only affects the mental and emotional health of clinicians but also directly impacts patient care. Addressing this challenge is crucial to maintaining a healthy and effective health care workforce.
</p>
<p>
Lastly, I am deeply concerned about the current focus on reactive treatment over preventive medicine. By emphasizing prevention, we can improve long-term health outcomes and significantly reduce health care costs. This shift is necessary to build a more sustainable and patient-centered health care system.
</p>
<p>
<strong>Inspired by:</strong> I am inspired daily by the opportunity to make a meaningful difference in people's lives through individual patient interactions—promoting health, preventing illness, and offering compassionate care during their most vulnerable moments.
</p>
<p>
<strong>Challenges to our profession: </strong>The health care profession is facing several significant changes that are reshaping the way care is delivered. One of the most impactful is workforce shortages. Many organizations are grappling with a lack of health care professionals, which leads to heavier workloads and increases the risk of burnout among existing staff. This issue not only affects the well-being of health care workers but can result in compromised quality patient care and the overall efficiency of health care systems.
</p>
<p>
Another major challenge is the rapid adoption of telemedicine. As telehealth becomes more widespread, it has transformed patient interactions, offering greater accessibility but requiring health care organizations to adjust to new technology and adapt traditional care models to fit virtual platforms. This shift demands a reevaluation of how we maintain quality, continuity, and personal connection in patient care. Technological advancements also pose both opportunities and challenges. The rapid development of innovations such as electronic health records and artificial intelligence has the potential to enhance patient care and streamline operations. However, keeping up with these advancements requires ongoing education, training, and careful integration to ensure they support, rather than hinder, the clinical process.
</p>
<p>
<strong>When I knew I wanted to be a physician:</strong> From an early age, I was captivated by the intricacies of the human body and driven by a deep curiosity to understand how it works. As a 6-year-old, when asked why I wanted to become a doctor, my simple answer was, "to help people." That childhood desire, combined with my passion for science and medicine, inspired me to pursue the path of becoming a physician. It's a calling that allows me to merge my fascination with the human body with my genuine commitment to improving the lives of others.
</p>
<p>
<strong>Why my specialty: </strong>I am drawn to family medicine because it aligns with one of my core beliefs that "prevention is better than cure." As a family medicine physician, I have the privilege of focusing on preventive care, guiding patients toward healthier choices that promote long-term well-being. Family medicine allows me to build long-term relationships with my patients and empower them to take control of their health and well-being, which is both fulfilling and deeply meaningful to me.
</p>
<p>
<strong>If I weren't a doctor:</strong> l'd be a lawyer, because I believe in strong advocacy for oneself and others.
</p>
<p>
<strong>Leadership lessons:</strong> Throughout my journey in leadership, I have learned three crucial lessons that have significantly shaped my approach.
</p>
<p>
First, <strong>be kind to yourself</strong>. Leadership can be incredibly demanding, and I have found that self-compassion is essential for long-term success. By practicing kindness toward myself, I have discovered that resilience stems from maintaining balance, taking time to rest, and prioritizing my well-being. When I take care of myself, I am better equipped to lead and support others effectively.
</p>
<p>
Second, <strong>be your authentic self</strong>. Authenticity is vital for building trust and credibility. By staying true to myself in my leadership role, I have realized that genuine connections form the foundation of effective teams. It becomes much easier to inspire and lead others when they know I am honest and consistent in my actions and words.
</p>
<p>
Lastly, <strong>be vulnerable</strong>. Embracing vulnerability fosters deeper relationships and trust within a team. I have learned that being open about challenges, uncertainties, and mistakes not only humanizes leadership but also encourages a collaborative and solution-oriented environment. When I model vulnerability, it inspires others to share their own struggles, creating a culture of support and teamwork.
</p>
<p>
Together, these lessons have profoundly influenced my leadership style, allowing me to cultivate a more compassionate, authentic, and collaborative environment.
</p>
<p>
<strong>Best advice:</strong> The best advice I ever received came from my dad, who encouraged me to stay focused and dedicated to my goal of becoming a physician. When I was contemplating psychology as an alternative career path, his unwavering support and guidance helped me reaffirm my commitment to medicine. His belief in my potential motivated me to pursue my true calling, ultimately shaping the course of my professional journey in medicine.
</p>
<p>
<strong>Spare time: </strong>I love to travel and explore new places. I enjoy immersing myself in different cultures and learning new languages, as it enriches my understanding of the world and connects me with diverse communities. Each adventure offers a unique opportunity for growth and discovery, fueling my passion for exploration.
</p>
<p>
<strong>Hobbies: </strong>I love swimming and cooking gourmet meals. Swimming allows me to relax and stay active, while cooking gourmet meals lets me express my creativity and passion for food. Both activities bring me joy and balance in my life.
</p>
<p>
<strong>Goals for the year ahead:</strong> One of my key goals this year is successfully launch a new medical clinic. This endeavor represents a significant opportunity to positively impact my community by providing high-quality health care services.
</p>
<p>
In addition to my professional aspirations, I am committed to personal growth through language acquisition. Learning conversational Spanish is another important goal of mine. I believe that this skill will enhance my ability to communicate with a broader range of patients, fostering better connections and understanding.
</p>
<p>
Finally, I am eager to experience a new culture in a different country. Traveling to a new destination will allow me to immerse myself in diverse traditions and perspectives, enriching my worldview and inspiring my work.
</p>
<p>
<strong>What people might not know about me: </strong>Something that most people might not know about me is that I am a descendant of Samuel Sharpe, a Jamaican national hero and a prominent slave abolitionist. His legacy of courage and advocacy for freedom is a source of inspiration for me, and it deepens my commitment to justice and equality in my own work and life.
</p>
<p>
<strong>Pet peeves:</strong> One of my biggest pet peeves is cell phone use during conversations. I find it extremely frustrating when people are distracted by their devices instead of engaging fully in the moment. It undermines the connection and communication that is so important in our interactions.
</p>
<p>
<strong>Favorite books:</strong> My favorite book is the Bible because it offers inspiration and timeless relevance across the ages. Its teachings and stories resonate deeply with me, providing guidance, wisdom, and a sense of connection to something greater than myself. The lessons found within its pages continue to influence my perspective and actions in everyday life.
</p>
<p>
<em>This article was featured in the November/December 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 10/25/2024 12:00:00 AM | 1/1/0001 12:00:00 AM |