Category Archives: UNC Health Care

Two passionate surgeons

Today the UNC medical family is learning about and dealing with the loss of two of our most committed colleagues.

Dr. Keith Amos, assistant professor of surgery, and outstanding surgical oncologist, died very unexpectedly while in Edinburgh, Scotland, as a visiting scholar. He was one of our best and brightest young physician leaders, with a special passion for treating breast diseases and for eliminating health disparities.

Dr. George Sheldon, who chaired the UNC Department of Surgery from 1984 to 2001, died after an illness at UNC Hospitals. He was an internationally renowned leader in medicine and surgery, having served as president or chair of practically every surgical society in the country, and as chair of the Association of American Medical Colleges.

In the days and weeks ahead, we will each look for ways to remember and celebrate the work of Keith Amos and George Sheldon.

But today as I remember them both – I am struck by the remarkable gift we have in medicine – to make a difference in the lives of others – and in each of their cases, in the lives of many others.

George and Keith were very different people in many ways, and they were at very different places in their careers – one near the end his, the other in the most productive period of his.

But they both were passionate surgeons, dedicated to serving others.

We will miss them very, very much.

UNC Health Care partners with High Point Regional

I am pleased to announce that UNC Health Care recently entered into a strategic partnership with High Point Regional Health System. Once our contract is finalized, High Point Regional will be fully integrated into the UNC Health Care System.

I believe that patients in Guilford County and surrounding areas will greatly benefit from this partnership. Our institutions will collaborate to provide patients with the health care resources they need, delivered by the local hospitals and doctors they trust.

Employees of High Point Regional Health System will remain in their current positions, but will now have access to UNC’s managerial expertise and services and engage in a collaborative relationship on complicated cases, when necessary. Our arrangement will not result in any layoffs or changes in pay rates or benefits of current employees.

This new relationship with High Point Regional will resemble UNC’s successful 12-year partnership with Rex Healthcare in Raleigh. UNC provides Rex with operational guidance and access to UNC physicians, research, technology and facilities – all while Rex maintains strong local governance and community involvement.

The partnership between UNC and Rex has strengthened both institutions over the years, and I anticipate this will be the same with High Point Regional. I look forward to working closely with all at High Point Regional and to adding our expertise and experience to their strong line of services.

SAS blog about Carolina Advanced Health

Jason Burke, managing director & chief strategist for the SAS Center for Health Analytics & Insights, recently toured Carolina Advanced Health (CAH), a collaborative venture between UNC Health Care and Blue Cross and Blue Shield of North Carolina. The practice brings together a comprehensive and coordinated team of primary care physicians and other health care providers, including professionals trained in internal medicine, family medicine, behavioral health, nutrition, medication management, laboratory services and care management. Burke’s blog post focuses on how the combination of the team and technology at CAH make it an innovative model for care. You can read his post here.

State Snapshots from the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) recently released its 2011 State Snapshots, which provide state-level performance overviews on treating cancer, diabetes, maternal and child disorders, heart disease and other diagnoses. According to the data, North Carolina performs well in areas like preventative care and acute care. Quality of hospital care also remains on track with national averages. In clinical areas, our state has improved respiratory disease and cancer care since baseline year data was collected. You can view North Carolina’s full state snapshot here.

I am proud of North Carolina’s performance in these categories and I commend the work of our state’s providers. However, there is still much to be done to improve the quality of and access to care across our state. For instance, we lag behind other states in diabetes and heart disease measures. According to the Centers for Disease Control, nearly 30 percent of North Carolinians were considered obese in 2010 – making them more susceptible to diabetes and heart disease. As the needs of our state increase, the care we provide must change to meet the growing demand for services.

At UNC Health Care, we are working with other organizations and providers across the state to meet the growing demand for services and care. By improving access to quality public health services, training the next generation of physicians and conducting research, we hope to mitigate the challenges our state continues to face. The AHRQ snapshots provide a helpful benchmark for improvement as we move forward.

Patient Experience at UNC Health Care

UNC Health Care recently received its Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS) scores for June 2009-June 2010. HCAHPS measure patients’ ratings of their hospital experience and the results are compiled into 10 core measures as outlined by the department of Health and Human Services.

We ranked highest in the Triangle area in all core measures, which include things like overall hospital experience, bedside manner, communication, cleanliness and guidance through treatment options, among others.

We also were given a high overall ranking by 81 percent of surveyed patients, exceeding the state and national averages of 69 and 67 percent, respectively. The full list of our rankings can be found here.

We strive to provide our patients with the best care we can deliver. Through coordination of care and collaboration with other health systems, we are able to offer better measurement of outcomes, ultimately improving care. This will become increasingly important as we continue to grow.

Our HCAHPS scores help us identify our strengths and weaknesses as a System through the lens of our most valued graders: our patients. And these measurements will help us drive improvements in care quality as we move forward.

Expanding Care in our Area

Last week, UNC Health Care broke ground on its new Hillsborough campus, set to open for patient care in 2013. This expansion is part of our mission at UNC Health Care to provide access to high-quality care across our state. Once complete, the Hillsborough campus will ensure better access for patients who require care outside of the Chapel Hill community and help to alleviate some of the capacity issues at our main campus.

This expansion would not be possible without the dedication and hard work of our physicians. Their role is the focus of phase one of the project, a three-story physician office building, which will be completed in 2013. This facility will include an urgent care and outpatient clinic, imaging and oncology services. UNC Health Care Physicians are central to our ability to provide these services to the surrounding community.

The urgent care unit, in particular, will allow people with non-emergency issues to receive treatment, rather than traveling to our main campus’ emergency room. This will ease our emergency room crowding issues and help us keep medical costs low.

The second phase of the project is the UNC Hospitals – Hillsborough Campus, which will be home to 68 beds. Fifty of those will be used for acute care and 18 for intensive care units. We plan to be fully operational by 2015.

UNC Hospitals has 803 licensed beds in Chapel Hill currently, and those beds are typically at 90 percent. However, in the past few months, we have operated at nearly 100 percent capacity. The Hillsborough campus will allow us to move patients with non-emergency issues off our main campus to receive the care they need. This also will give us an opportunity to turn some of our semi-private patient rooms into private rooms – providing a better patient experience.

Our new Hillsborough campus will translate into jobs and overall growth for our area. This project is the result of decades of hard work and we are pleased to meet the growing health needs of our surrounding community.

Health care services: growing demand, diminishing resources

There is no shortage of troubling trends in health care: increasingly high rates of obesity and chronic disease, rising costs – all amid a backdrop of falling resources in both the public and private sectors.

But before you succumb to pessimism, take note of some real progress being made to design a health care system that can do more with less.

UNC Health Care is making a sustained effort to improve communication between doctors and patients. As I discussed briefly in a prior post, doctors and patients can be on different pages, leading to inefficient, fragmented care.

For example, a patient heavily influenced by direct-to-consumer advertising may demand drugs that are not appropriate for his situation. And busy work and family schedules can cause patients to delay seeking care, all too often moving treatment from primary care physicians to crowded (and expensive) emergency departments.

A recent Health Affairs report found that acute care – newly arising health problems that are not typically life-threatening – is treated by a primary physicians only 42 percent of the time. Nearly a third of acute care visits – 28 percent – are emergency room visits. The other 30 percent of acute care visits are made to specialists and outpatient departments.

At UNC Health Care, we are working to build team models that coordinate the actions of multiple physicians and help patients become more informed advocates for their own care. This will help close the information gap between health care professionals making treatment decisions and patients receiving care.

One promising concept is the “patient-centered medical home.” This approach teams primary care doctors with specialists, gives patients better cost and quality information and leverages health information technology to avoid duplication and medical errors. It gives patients a convenient and trusted place to go for care, encouraging earlier and less-costly treatment options.

We are piloting the medical home concept with Blue Cross and Blue Shield of North Carolina, our first such partnership with a third-party-payer. Working together to drive quality up and prices down makes sense to both parties and we have high expectations for the project.

We also are working to provide patients with greater access to coordinated care facilities through the establishment of the Triangle Physician Network. Physicians in our network share a collaborative spirit and have access to robust electronic patient records that facilitate coordination of treatment.

These initiatives are early but important steps toward a new era of collaboration between providers and their patients. We believe these efforts will yield more fruitful doctor-patient communications, better coordination among health care professionals and greater consumer understanding of how the delivery system works. None of these improvements will happen overnight, but there are promising signs that we are moving in the right direction.

Annual North Carolina Leadership Dinner

Raleigh, NC

Yesterday evening, I spoke at the North Carolina Leadership Dinner as part of the 2011 Emerging Issues Forum, presented by the Institute for Emerging Issues at North Carolina State University. Each year, the Forum brings together leading thinkers and decision makers to foster bigger and better ideas for innovation and improvement of our state and nation. I have included my remarks below.

I have been working on improving the public’s health for almost 35 years. And as I look out in the audience, I know that many of you have been in the trenches for as long, or longer than I have.

We are fortunate in this state – and especially fortunate in this region – to have access to some of the best medical care this country has to offer. I arrived in this state a little over a decade ago. The decisions that our state’s leaders made long before I arrived, and the teamwork with which they approached the challenge of building modern health care in North Carolina paved the way for all that we enjoy today.

But through the years, there have been several activities that I am especially proud of:

From fluoridating the public water supply in my home town, Birmingham, Alabama, to starting Medicare’s efforts to publish information allowing quality comparisons across the Nation’s hospitals.

From adding “Prevention” to the name of the CDC, and making prevention a practical reality in the Nation’s health system, to creating the NC Institute for Public Health, the outreach and service arm of UNC’s school of public health.

And from building the NC Cancer Hospital to implementing the new University Cancer Research Fund, I am deeply proud to have been involved in each of these efforts – but I am by no means claiming exclusive credit for any of them – they were very much team efforts. These achievements required lots of people, many organizations and institutions, working together to do challenging and important things to improve the public’s health.

For most of these years, I also have been working on reforming the American health care financing and delivery system – beginning with my work as a lower-level White House staffer for President Reagan.

I did the staff work for his health reform package from his State of the Union speech 28 years ago. I am sure you all remember it, right?

No, you don’t, because it did not get enacted.

Many health reform efforts – by many administrations – over many decades – went nowhere.

Of course, last year President Obama and the Democrats in Congress passed the Accountable Care Act. And promptly, the Republicans began the repeal effort.

It is too early to say how all this will turn out – and it is not my purpose this evening to speak in favor of or against the ACA.

Many of you know this, but let me be plainspoken. I have been appointed to political positions by three Republican presidents – Reagan, Bush 41 and Bush 43. At the same time, Nancy-Ann Deparle and Don Berwick – the key people on health reform for President Obama – are close friends of mine.

So I believe I have a reasonably balanced perspective on health reform.

You do not need me to handicap what’s going on in Washington – there are plenty of others who are doing that – take your pick.

But I will make one point – the various activities I mentioned at the beginning of my talk this evening – things I’m proud of being a part of over the years – they were team efforts – made possible by broad-based, bipartisan collaborative work.

We very much need a team effort to fix health care in America – and here in North Carolina.

Of course, there are limitations to what a single state can do, acting alone. But that should not be an excuse for total inaction.

That’s my message this evening – to all of us here convened by Governor Hunt and the Emerging Issues Forum – all of us, consumers and providers, business leaders and elected officials, rural and urban, Republicans and Democrats.

I believe the single biggest thing holding us back from thoroughgoing reform of our health care system is that we each believe that somebody else needs to change, needs to reform. If only they would do it, then all would be well.

I think we are the collective victims of our concerted efforts to blame someone else. Or to believe some things that just aren’t true.

What I am going to do with the remainder of my time this evening is empower us to rethink our long-held assumptions, and to move us from our comfortable, but mistaken, positions. This will guide us toward a team effort to build a much better American health care system, starting here in North Carolina.

So, here is my list of the top things we know for sure about health care – things that are not true.

1. The American health care system is the best in the world.

For all the good it does, it really needs a major overhaul. I believe the oft-reiterated slogan that our country’s system is the “best in the world” is evidence of a desire to keep everything as is. I am an “American exceptionalist” too, and I know that some of you hate international comparisons – but it is simply undeniable that on average, outcomes of care in the US are not as good as average outcomes in many other industrialized countries. This is mostly because of our inability to close the disparity in the health outcomes for certain ethnic or racial minorities.

The international comparisons are not looking at the best each country has. They are comparisons of where things are on average – from top to bottom. And our bottom is what pulls us down. These people spend large parts of their lives outside the health care system. They haven’t seen the inside of a doctor’s office for years. They know only the ER at a hospital as their usual source of care. When it comes to a national average, they get equal billing with those who take advantage of the best we can offer.

2. Everybody eventually gets the care they need.

Repeated studies have shown conclusively that there is a huge cost to American society of “uninsurance” – people seek care later, have worse illnesses and worse outcomes. And we have the crazy quilt of cross subsidies – paying customers pay much more to cover the cost of uncompensated care – for UNC Health Care, which includes Rex Healthcare here in Wake County, that’s $300 million this year.

3. Almost always, the quality of care people get is very good.

Many researchers, especially Dr. Beth McGlynn at RAND, have shown that far too commonly, people do not get the care they need – and others like the Institute of Medicine have shown the harm done in the processes of care because of the lack of attention to patient safety. I chair the board of the National Quality Forum, and we are working with all parties at interest to measure and report results and then to drive vast improvements in care quality.

4. The cost of care in America is not really a problem. It is a clean, non-polluting industry that employs millions of people. And at a time when the economic problem is “jobs, jobs, jobs,” health care is one sector where employment continues to grow.

Health care now represents 17 percent of our economy, which is far more than any other country. At a time when we are worried about our competitive position in the world economy, this has to be a concern. And the Medicare actuary has just said that health reform is going to add to aggregate health spending.

Let me be even more emphatic – proposals for health care reform that do not take cost control seriously should not themselves be taken seriously. Indeed, that is a major shortcoming in last year’s legislation.

5. If you like your care, nothing about it will change

This is a line often used by President Obama. Unfortunately it is one of the most hurtful of these mistaken ideas. Because almost everything about American health care must change if we are to be successful in overhauling it as I am suggesting.

We need to redesign care in fundamental ways, to create coordinated care across primary and specialty doctors and others, so that each of us has a “patient-centered medical home.” As I hope you have heard, that is what we are doing in a very innovative pilot medical office with Blue Cross Blue Shield of North Carolina.

This initiative, if successful, could help avoid putting consumers in the middle of health insurance conflicts.

Let me say a bit more about health reform. The news media focuses on conflict in the health care debate. That focus keeps attention from an emerging Washington consensus on health care. In watching the back and forth between Republicans and Democrats, we pay no attention to what they agree on.

They agree that on the fact that future government will take less of the financial risk attributed to growing health care costs. Yes, they disagree about who should bear the risk instead, and how that risk should be borne. Democrats in Washington prefer solutions that put more risk in the hands of health care providers, and Republicans want individuals to deal with more of the risk themselves. But we should not let this back and forth cloud the reality that both parties are telling us that the government will take less of the risk. Both parties are saying that some parts of the health care system will have to change in the future.

Let me say again – we very much need a team effort to fix health care in America – and we need to do that right here in North Carolina.

I have tried to tell you the truth, about a series of long-held and unfortunately mistaken ideas about health care. You might be sitting there frustrated, and even disappointed with what I have told you.

I am hoping that as I went through some of the myths about our health care system, many of you thought, “Well, Bill, you’re right.”

The problem is that the myths don’t go away. Ours is a free country, and everyone is entitled to believe what he wants. And unfortunately, I think the average North Carolinian is not yet on board to face the challenges ahead.

There is a vast gap between the experts and the public on health care. For example, there is a consensus among those who do research on our health care system that much care that is delivered is unnecessary. But that is not the view of the average American. When surveyed, 67 percent said they do not get the tests and treatment they need. Only 16 percent said they received care that was unnecessary.

This divergence of views has had a powerful impact on what happens when health care experts suggest ideas to politicians about how best to go about dealing with lowering costs. By going along with the experts’ assumption that we have unnecessary care, those politicians created an opportunity for their opponents to reach the 67 percent who think they do not get the tests and treatments they need. And that, I would suggest, is how the term “death panel” gained such potency.

The reason we continue to over-treat is three-fold:

  • Patients demand more
  • Most health care is paid for on a fee-for-service basis, so the more you do the more you make
  • Our medical liability system makes providers reluctant to say no to patients.

Those who expect individual consumers to make more cost aware choices also have reason to be disappointed. Only 22 percent of Americans say they have ever asked about cost when making health care choices.

As someone who has worked very hard to create information that would allow comparisons of health care providers, I find it disheartening to learn that 70 percent of Americans believe there are no big differences across health care providers. If you don’t believe there is a difference, you will never want to look for anything better.

In a free market, the consumer rules. At this point, the consumer is not open to much of what the experts recommend.

As we try to rally the citizens of North Carolina and the nation to take on the challenge of health care overhaul – a major problem is this disconnect between the “experts” and the “average person.” I confess to being a health policy wonk – and we “experts” have long been concerned with the issues on my list above.

But the typical hard working North Carolinian – who today may hold down two jobs and surely wants to be responsible – all too often cannot afford the co-pays and deductibles if he has a sick child, especially one with a chronic illnesses.

That is what real people are worried about. And we owe it to them to come together to work on these real issues with vigor and determination, not just hunkering down with our long-held positions and slogans.

Our state has long had a proud record of innovation and leadership in health and health care. With the ideas and energy that you and the Emerging Issues Forum speakers have brought to this conference, I am very hopeful.

Yes, I mean those words. I am hopeful, but they can surely sound like high-minded platitudes. It is not enough for us simply to say “let’s work together.” We actually have to do it.

There is an old Greek proverb: “A society grows great when old men plant trees whose shade they know they shall never sit in.”

Friends, young or old, let’s go out – together – and plant some trees. With teamwork, we can do great things for North Carolina.

Pre-State of the Union Reflections

President Obama’s upcoming State of the Union speech will be met with high expectations. Not only is this his first chance to address Congress since the November election, but it comes on the heels of eloquent remarks about the importance of civil public discourse following the Arizona shootings that drew praise from both sides of the aisle.

The President’s speech will give us some clues about how the rest of his term could go, particularly as it relates to Congressional relations. This is most important in the arena of health care reform. The House just this week passed a bill repealing the Affordable Care Act, but this measure will likely fail in the Senate. There is no doubt that the public is divided about whether the new health care reform law is the right approach for improving care, increasing coverage and reducing costs.

The next few months are expected to usher in a period of continued debate about changing federal health reform legislation. The State of the Union speech should tell us what President Obama hopes to achieve.

I hope the President will mention progress on the much-anticipated rules for accountable care organizations (ACOs) being written by the Centers for Medicare and Medicaid Services. The broad outlines for how ACOs will operate are becoming clearer, but many of the details are yet to be ironed out. ACOs could have a profound impact on how Americans access quality care in the future: This system would provide a financial incentive for reliable performance measurement and improved outcomes.

I hope the President also will recognize that profound change is sweeping through health care independent of the ongoing Washington debate: industry consolidation, greater partnerships between hospitals, physicians and other health professionals, and an increased emphasis on shared responsibility for improving health outcomes and reducing costs. I recently spoke with UNC-TV’s NC Now about these changes.

Regardless of what happens at the federal level, it seems clear that health care delivery models based on patient volume alone is not sustainable. UNC Health Care is moving swiftly to put in place new arrangements that make possible more cooperation and between primary care, in-patient care and specialty providers.

One way UNC Health Care is working to keep pace with these changes is our innovative, first-of-its-kind partnership with Blue Cross and Blue Shield of North Carolina to form a new medical practice based on the medical home approach. We also are partnering more closely with physician groups, bringing them greater IT resources for decision making and integrating their expertise into our hospital system.

The oft-stated goals of health care reform promoted by the president and the opponents of his approach to reform are similar to the mission of UNC Health Care – improving quality and efficiency so that we can ensure patients have access to excellent and affordable care. I look forward to hearing what President Obama sees as the next steps to reaching this goal.