Walt Mills, a family practice physician in Sonoma County for nearly three decades, was recently named the incoming president of the Sonoma County Medical Association.
Currently with Kaiser Permanente, Dr. Mills has been involved with some of the most significant developments in the regional health care landscape. Among such developments are helping to start Primary Care Associates of the Redwood Empire back in 1986, which later merged with St. Joseph Medical Foundation, and also being a co-founder of the Northern California Center for Well Being in 1996.
Additionally, he has serves as a board member for the Santa Rosa Community Health Centers, and he has been actively involved with the Santa Rosa Family Medicine Residency Program, which is run by Sutter Health. He will be program director of Kaiser Permanente’s recently announced Family Medicine Residency Program which will collaborate with the existing Sutter residency .
Dr. Mills recently shared his thoughts on a number of topics with the Business Journal, from health care reform to the primary care physician shortage to the evolving local health care scene.
Q: As incoming president of the Sonoma County Medical Association, what are your priorities, and what would you say are the most pressing issues affecting the local health care landscape?
Dr. Mills: My year’s goals for the medical association are to focus on the fourth dimension of what some are calling the “quadruple aim.” This expands on Medicare’s triple aim of improving quality, cost, and patient experience to include improving the physician (staff) experience. I believe the SCMA can influence this foundational piece to authentic “health reform” and should. Physicians are going to be adapting to the health reform and will need support to do so successfully.
I think the Medicare concept of the triple aim articulates a means to meet the challenges of the future — it talks about cost, it talks about quality and it talks about access to care. The “fourth aim” must address the health and sustainability of those who provide the care. My own priority is to understand ways we can support our physicians’ vitality.
Change is hard even if it’s good change. You always have to let go of some things go in order to change. And health reform may not be “good” change for some people or some groups, as the paradigm shifts. Yes, change can be hard and we’re in for probably the biggest changes in health care that we’ve ever seen in our country. So, the most pressing issue I see for our local healthcare landscape is how we successfully lead and sustain positive changes amidst our complex adaptive system. How do we ensure that those leading change are supported and effective—that will make the difference in how we fare during this time of the massive transformation embodied in health reform. To that end the SCMA is formally instituting a leadership development program for our board and officers, which we intend to use to enhance the SCMA’s ability to support solid support for our physicians who will be at the forefront on leading the changes needed for our community’s health.
You’ve been involved with the Sutter Family Residency Program, and you are going to be the program director for the newly announced Kaiser residency program. As a physician, how important, in your mind, are these programs?
Dr. Mills: Family Medicine training is important in that the specialty is foundational for any health care delivery system to perform well. For Kaiser, it’s important that it’s the first family medicine program — there’s pediatric and internal medicine residency programs that teach primary care in Kaiser Northern California — but there’s no other family medicine program. But given the forecast in primary care physicians, we’re headed for a crisis in terms of adequate family physicians in the very near future. So these programs are a very important part of meeting that challenge by increasing the number of graduates into our community.
The SCMA and the Sonoma County Department of Public Health issued a primary care workforce analysis back in December, 2010. The forecast was we were going to be short100 or maybe 200 primary care physicians in the next decade given retirement, given that people were relocating
Why do you think Sonoma County was chosen over other areas, say the East Bay or the Central Valley, for this family medicine residency?
Dr. Mills: Partly in response to that, we’ve had a strategic plan for increasing the number of primary care physicians being trained, attracted and retained in our community. And we’re fortunate that Kaiser has a commitment to education and recognizes a need to foster primary care physicians. And given our relationship with the current Sutter residency program, and success of it, it was natural for Kaiser to invest further in supporting our local programs.
Though Kaiser has 21 other facilities in Northern California, we’re the best place to start because we’ve already demonstrated commitment and a capacity to partner with our community to train physicians. We’re one of the most prepared Kaiser sites, but won’t be doing this alone, as Kaiser Vallejo (Napa-Solano) is going live with a new Family Medicine Residency in 2014 simultaneously. A part of good quality health care has to be investing in the future via graduate medical education, and Sutter is doing that and has not backed away — it’s just so fun to see folks who are usually competitors collaborating on this.
In your words, how is health care reform playing out on the local level and what are some other significant developments?
Dr. Mills: It was good the Supreme Court did not road block the unfolding of the planned ACA/Health Reform. However, the upcoming election may affect how parts of it are implemented, but I think it’s clear that there will be accountable care organizations, an increase focus on primary care, prevention, chronic care, changes in payment incentives, and other important improvements in our delivery models. We will go forward with some form of exchanges, and it looks like we’re going to continue with access, innovation and improvement related to how we deliver care—how that really looks is not quite clear. One of the more interesting parts of the future will be what the local alliances will be as ACOs are formed.
What are your thoughts on the Affordable Care Act overall — does it go far enough? Too far?
Dr. Mills: I think the ACA is a good start. It is just that — it’s a beginning. The way I always frame it is that we are the most expense health system by nearly a factor of two compared to other industrial countries, but we rank in the middle for quality. So I know we can do better in quality. I think aligning payment with desired improvements for our patients and communities is probably going to be the most beneficial. For example, realigning payment to encourage primary care be given in offices, rather than relying on emergency rooms to provide care, and by incenting hospitals and groups to avoid unnecessary hospitalizations.
So that’s the most hopeful — that we have a system that is truly aligned with caring for people in a proactive, preventive way, rather than only when they’re sick — moving from a sick care system to a health care system — from a fragmented sick care system to a integrated health care system.
Do you sense that more training physicians will go into primary care now that incentives are being established, both federally and locally, or will the shortage of family care physicians persist, with more going to the lucrative specialties?
Dr. Mills: I’m hopeful that we’ll be seeing more people go into primary care. One bright spot I just heard was that this year there will be 10 Stanford graduates going into family medicine. Typically it’s been zero or one, and never more than two. I believe there’s going to be a trend for more primary care physicians being trained but we have a very long way to go to reach the 50-50 ratio that most experts recommend for a balance between primary care and specialty. We’re about 30-70 and some places are 10-90. That gives you an idea. It’s going to take a long time.
The other part is that people often point towards nurse practitioners and physicians assistances helping solve the primary care crisis, but the reality is most of them do the same thing — eventually going into specialty care. But primary care has become ever more complicated so it needs to be done well.
How would you say the health care landscape in Sonoma County and the region has changed over the years? Where have improvements come from and what still needs improving?
Dr. Mills: The general thing, as in most other industries, is that we’ve seen increases in consolidation, increases in the usefulness of advanced technology, and enhanced appreciation of the importance of relationship-centered care, ie service. The improvements have come from increased use and appreciation for system-based care, again technology, and knowledge management to do population based care and disease management. What still needs improving? We need to move to the new paradigm of integrated delivery systems founded upon robust primary care. There’s some of that happening, but we’re a long way from the ideal and what we’re capable of. That said, I’m optimistic.
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