Jan 072013

Dr. Paul Cunningham, dean of the Brody School of Medicine at East Carolina University
B. Lamont Lowery

Dr. Paul Cunningham, dean of the Brody School of Medicine at East Carolina University

By Michael Abramowitz

Sunday, January 6, 2013

The opportunities and challenges of health care reform began to make their presence known to eastern North Carolina health care professionals even before the Affordable Care Act became law.

Delivering higher-quality health outcomes in a more efficient and cost-effective way will require nearly a complete transformation from a conveyor belt of services to an integrated system of stakeholder responsibilities, measured outcomes and shared accountability, the experts said.

Those who deliver health care must be trained for the new models being invented along the way, and those who train them also must invent new models for doing that, according to local leaders in medical and health education.

Dr. Paul Cunningham, dean of the Brody School of Medicine at East Carolina University, said his institution is ready — more than any other in the country.

“The challenge of providing access to patients will require that teaching institutions do what we know best, in terms of educating the next group of providers,” Cunningham said. “But we have to do more than that. It involves embracing our… capabilities in a way that we haven’t been able to do to this point. There is pent up demand from people who haven’t been privileged enough before to have medical insurance and now seek appropriate health care services.”

Fortunately, Cunningham said, the Brody school has set the benchmark, producing more primary care doctors than any other school in the nation.

“Beyond that, we have the most prolific producer of nurses in the state on our campus, the most respected school of allied health and a dental school that has been patterned after our medical school in providing services to rural environments,” he said. “We need to be aware of our advantages because, from Greenville, we will be modeling for the entire nation.”

The uncharted frontier of health care into which doctors and health professionals are entering extends beyond numbers, Cunningham said, to a new way of approaching the concept of delivering health care to the population. Staying ahead of the curve and making the transition from fee-for-services medical practices to more efficient and cost-effective outcomes-based care requires a sea change in culture, he said.

“It doesn’t mean just a few things here and there. It requires new processes with new leadership that does not just bend the cost curve, but transforms the way we provide care to our patients, both within and outside the hospital, on a continuum that goes from the hospital back into the community around us,” Cunningham said.

The Brody leadership team presented some of the concepts it has thus far formed to the people of New Bern last fall through a “creating conversations, creating the future” program that created ground-breaking opportunities for the future. From that encounter alone came 49 initiatives, many now running on their own, beyond the supervision of one person or entity, but involving the entire community, Cunningham said.

“We learned that each of us has a shared responsibility to work together, not just the physicians, hospitals and the medical community, but all of us (patients and healthy citizens, too) working together in a synergistic format,” Cunningham said.

The Brody school dean said now is an excellent time to be a student there.

“I have said for a while that being the most efficient medical school in the nation, based on our tuition, fees and productivity, the return on an investment in the Brody School of Medicine could not be better,” he said.

That optimism is shared by Stephen Thomas, dean of the college of allied health sciences at East Carolina University. Allied health providers, including physician assistants, occupational and physical therapists, laboratory scientists and rehabilitation specialists will be mostly concerned with specialized care in the new health care model.

“Hospitals and medical centers know they need more physicians, but they’re just not there, so they’re going to rely on nurses and allied health professionals in other disciplines to help pick up the slack in a timely and cost-effective way that results in better outcomes for patients. We’re talking about maximizing the scope of health care providers, not replacing doctors,” Thomas said.

Another important aspect of allied health’s role in the new model will be seen in the field of health informatics, the collection and distribution of medical records and information.

“That was the first initiative from President Obama that I thought was really smart. Pitt Community College has a large regional grant to do training in that area,” Thomas said.

The challenge, he said, will be to get rural physicians with small practices to invest in electronic systems that can cost up to $100,000. If met, the result will be all health care professionals working to their fullest capacities in a connected way that prevents inefficient or unnecessary duplication of services, Thomas said.

Thomas tempers his evaluation of his school’s opportunities with realistic talk about the depth of the challenges that his graduates will have to face, including convincing legislators to support the reform movement. Thomas served with Cunningham on the health care reform task force of the N.C. Institute of Medicine, looking at the state’s response to the challenge of implementing the mandates of Affordable Care Act.

“There’s politics going on all around this issue, but government, federal and state, needs to understand that in this process, we must have a full range of coverage for all people, or our system isn’t going to work. It’s simple as that,” Thomas said. “Politicians seem to react at the last minute. They’re thinking that it’s too expensive, and they need to think about making it work.”

Contact Michael Abramowitz at mabramowitz@reflector.com or 252-329-9571.

via The Daily Reflector.


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