Lisa Amador is Sutter Health's strategy and business development executive for Sutter Medical Center of Santa Rosa and Sutter Pacific Medical Foundation. The North Bay Business Journal's Health Care Conference will feature a panel of health care providers that will include Mike Purvis, chief administration officer of Sutter in Santa Rosa. Ms. Amador answered the following questions on his behalf.
Q: The North Bay now has two accountable care organizations -- Meritage Medical Network and Redwood Community Care Organization. How does this impact the delivery of care and can we expect more movement in this direction as providers plot health care reform strategies?
Ms. Amador: Sutter Health is talking to all health plans about ACO-inspired arrangements of various kinds. Each health plan has its own preferred area(s) to target savings. When the health plans and the provider organizations can work together and share information we can expect the total cost of care to go down and everyone to benefit. This model will not be exclusive to Medicare, we can expect to see more of this model in commercial contracts as well.
Q: What can the North Bay and the health care sector in general expect in terms of increased consolidation? And how might this affect the physician landscape in the future, as health systems and hospitals seek to add providers to their networks?
Ms. Amador: It has becoming increasing difficult for solo practices and small group practice to survive in today’s health care market place. Consolidation into multi-specialty medical groups, particularly in the medical foundation model, will continue. Foundation supported medical groups and preferred hospitals are generally aligned within the same systems integrating health care resources and information in ways that will improve care to patients in our community. We can expect that this kind of consolidation to continue.
Q: In order to provide more coordinated care across the North Bay landscape, every provider has mentioned the importance of patient data, whether a health plan, hospital or health center. What are the challenges behind this, and how will this transform care? What efforts are you undertaking to address this?
Ms. Amador: Up-to-date actionable information shared at all points of care holds great promise for improved patient care and reduced cost. In 2008 all of Sutter’s care centers moved to an electronic health record to coordinate, improve care and provide convenience for patients. Today Sutter patients are able to directly schedule appointments online, e-mail health questions to their doctor, view test results, order prescriptions etc… The new Sutter Hospital will also activate the same electronic health record providing a full spectrum of the record of care and baseline information for each patient.
Q: With thousands of new, previously uninsured residents coming into the health care system, health experts and systems have touched on the importance of behavioral health, particularly as it relates managing population health. How is that component of care going to be delivered in the North Bay and what is your organization doing to address this potential need in the North Bay?
Ms. Amador: The need has not changed simply because now more uninsured will have insurance. Every health plan has its own internal structure for providing behavior health services. We expect providers in Sonoma County already involved in providing mental health services will be included in these services. This component of care in the North Bay will be handled as it is today with more of the community insured.
Q: Every major health system seems to be expanding into the outpatient realm, either through medical office buildings or through various partnerships. How is the Affordable Care Act driving this and what does it mean for the hospital setting?
Ms. Amador: Care in the outpatient setting is less expensive than in the hospital. If we are to be successful in driving down the total cost of care for patients it will be because we are providing better outpatient and preventative care. Today there are many emergency room visits that could be avoided with a stronger culture of preventative care and better office and home-based chronic care management. Reducing the need for hospital visits and reserving hospital capacity for those with higher acuity and need for hospital services will help to improve access and the cost of care.
Q: There is a well-documented physician shortage across the health care landscape. What do you make of some efforts to expand the responsibilities of other providers, such as nurse practitioners, physician assistants, etc.?
Ms. Amador: There is a nationwide shortage of primary care physicians, especially internal medicine, pediatrics and family medicine. For example, the most recent data indicate that only 4 percent of internal medicine graduates are going into traditional office based primary care practices. The remainder go into sub-specialties or hospitalist medicine. Because the need for primary care physicians is increasing at exactly the time when their availability is declining, other licensed clinicians such as nurse practitioners and physician assistants offer the best opportunity to expand primary care to meet the demand. Under the guidance of a physician, physician assistants and nurse practitioners can perform many of the functions a primary care physician currently provides, enabling the primary care physician to focus on the more complex patients.
