ADVERTISEMENT

By Scott Scanlon

Refresh Editor

The mechanics of the U.S. health care system – and how it can best work to help patients – has intrigued Dr. Thomas J. Foels since he became a pediatrician in the mid-1980s.

Foels, 57, a North Tonawanda native, has a master’s degree in medical management from Tulane University as well as his medical degree from the University of Rochester. He started working part time at Independent Health in 1994 and has worked full time for the insurer since 1997, the last four as chief medical officer. In that role, he has helped Independent Health continue to improve a team-oriented approach to regional health care.

He has been among the key players in an Independent Health initiative launched last summer called the Primary Connection, which combines computer data, greater medical collaboration and a willingness to share best practices among more than 20 doctor groups, including internal medicine, family practice and pediatric physicians.

Q. What do you feel is the condition of the U.S. health care system now?

We have to think about a different path, and that’s where I think communities are going to come into play, because I really don’t think there’s going to be some grand edict out of Washington that’s going to solve all of these issues.

Q. Can you describe the Primary Connection in terms of what it does for the system and how it’s going to help patients?

A. What it represents is 200 primary care physicians and their staffs that have built off the trust and relationship they’ve had with the health plan for many decades to really assume a role as lead architect for a new system of care. We call the ultimate goal the triple aim. Three things. You’ve gotta hit ’em all:

• Improved affordability. Lower the cost. We understand there’s a lot of waste and redundancy and non-value-added investment.

• Improved quality. We’re good, but we’re not as good as we could be, we should be.

• Service excellence or service attributes: Access, communication, empathy. Those are measurable, too.

Affordability is certainly measurable. Quality is now measurable.

We call that the triple aim because three out of three, you score. Two out of three? Try again.

Q. How does the effort work?

A. Primary care physicians often do their work kind of siloed. The average Medicare patient has seven doctors. They usually have five specialists and two primaries in the same group. My dad has five doctors … but the five never talk to one another. They don’t communicate well, and they’re not incentivized in any way to work together. They’re all busy, and the patient doesn’t have anyone to help navigate them. And the primary care physicians generally make referrals based on who they know, who they trained with, who they’ve used in the past. Now, since this collaborative formed, they say, ‘You know, we can probably start making decisions on who we refer to based on whether they’re aligned with the same principles were trying to follow. Who’s got the better quality outcomes? Who’s got the better service attributes? Who’s going to work and collaborate with us, so when you have a diabetic patient seen by a cardiologist, where diabetes is a big contributor to their cardiac disease, are we both looking out for the diabetes of the patient or is the cardiologist turning a blind eye to that?’

So the primary care doctor can say when it comes to choosing specialists, ‘I’m going to make very informed decisions. It’s going to be data driven, I’m going to hold the specialist to new expectations for service and communication, and I’m going to start referring my patients to those people who are going to collaborate with me.’ To the credit of the speciality community, they are also very interested in saying, ‘Got it.’

Q. Are insurers in the region collaborating a little bit more? Are you competing?

A. Probably neither. The health plans have taken various runs at this. … We at Independent Health have been working in this space for a very long time and have an evolving vision on where the community could be taken. We’re all in on this. Now, when an office begins to transform how it practices, it doesn’t do it just for its Independent Health patients. It does it across everybody – it’s Health Now (BlueCross BlueShield of WNY), it’s Univera, it’s Medicare, it’s Medicaid – which is absolutely fine with us. Do unique benefits come to Independent Health patients? Absolutely. We have unique data on those patients … (but) we’re trying to raise the bar in the community.

Read more from Dr. Thomas J. Foels on the Affordable Care Act and more specific examples about how the Primary Care Connection is working in the region in the Refresh Buffalo Blog at www.BuffaloNews.com

email: refresh@buffnews.com