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Sarah Woolsey, MD, is board-certified in Family Medicine and a current Medical Director with HealthInsight. She is the clinical lead with the Utah Beacon Communities Project and has a passion for empowering care providers around Diabetes quality care. She has worked in quality improvement in outpatient settings for over 10 years with primary care and has 13 years of experience with underserved populations in Salt Lake City as a full-spectrum family doctor. Dr. Woolsey currently maintains an active in/outpatient practice with the Community Health Centers of Salt Lake City. She is a graduate of the University of Illinois-Chicago School of Medicine and completed her residency at the University of Utah.

Positively Impacting the Health of a Community

Mother with Sons

As a community physician and a staff member at HealthInsight, I believe I am uniquely positioned to positively impact the health of my community. On a daily basis I am working with improvement teams to advance data transparency, community and consumer engagement, and quality processes that lead to best outcomes for patients.

Over the last 18 months, I have been honored to participate in the Institute for Healthcare improvement (IHI) 100 Million Lives initiative. This initiative is an unprecedented collaboration of change agents across sectors who are pursuing an unrivaled result toward better health. In my role, I represent the Network for Regional Healthcare Improvement (NRHI), and the Collaborative Health Network in coaching a vanguard of teams bringing the 100 Million Lives initiative to their communities.

Our mission is to see 100 million people living healthier lives by 2020 and to measure health through what matters to people. The 100 Million Lives initiative asks "Whose life is getting better because we are here?" and looks at physical health, mental health, social well-being, spiritual well-being, life expectancy, and health equity. The initiative promotes sustainable change by asking us to develop financing and workforces that allow for long-term impact. As part of this effort, the initiative has intentionally crafted a survey of health and well-being that is being considered by organizations as large as the Veterans Healthcare System, as a metric for success in improving the entirety of a person's health. The survey's seven questions can provide real-time data about a program's impact. For details about the survey, contact IHI at 100MLives@ihi.org.

What have I seen in my participation to date? Here are two examples: Henry Ford Allegiance Health in Jackson, Michigan is developing a sustainable financing model that will integrate the resources needed to care for at-risk youth such as health care services, behavioral health care and educational investment. This pool of resources can serve the youth and their families in the most appropriate and efficient ways possible. Henry Ford Allegiance Health is developing a system to coordinate a network of care around families of youth and will reinvest any savings into wellness and prevention services and maintain those resources in the community for families right in Jackson.

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Five Things That Hit Me as I Read the MACRA Proposed Rules

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The health care world has been buzzing with discussion about the newly proposed rules around the landmark Medicare Access and CHIP Reauthorization Act (MACRA) legislation that passed in April 2015 with bipartisan support. One year later, the Centers for Medicare & Medicaid Services (CMS) unveiled a proposed implementation plan for this new law. MACRA aims to move the U.S. health care payment system from volume-based care to value-based care. The final rule is expected by year-end, which highlights the need to know a bit more about our road to value. I recently spent some time traveling, so I decided to dive in to the 962-page proposed rule. Here are five things I found interesting and wanted to share.

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“What is Important to You?” Take Time at the Holidays for Important Conversations about End of Life Wishes

Holding hands

Holidays are a time of family and togetherness with some of the people closest to us. We send greetings and try our best to catch up with people that we love. We honor traditions, we engage in meaningful reflection, we love to share meals and we share gifts. This season, I am committed that my family adds an important conversation to our holiday activities, a conversation about our wishes for end-of-life care.

In last week's blog, Fern mentioned several resources to help in end-of-life care planning and making your wishes known, but how do we begin?

I'd like to share a resource that can make these conversations easier to start.

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A Window Into the Future? Utah Practices Share Their Medicare Accountable Care Organization Experiences

Doctor with Patients

Recently, I was fortunate to host a Utah Partnership for Value (UPV) panel featuring local clinics participating in the Medicare Shared Savings Plan Accountable Care Organization (MSSP ACO) program, a federal program that pays providers for delivering better outcomes and lowering cost as appropriate, rather than just paying for each item of service. UPV was also privileged to have a national perspective assist in the discussion, with Tom Merrill, a senior research partner with Leavitt Partners and expert on ACOs, joining the panel. These MSSP value payment arrangements started in 2012, and Utah clinics—Granger, Exodus and Revere—were able to share some of the earliest lessons and suggestions for Utah's success in this new arena of paying medical providers not just for volume of services, but for the best possible outcomes and quality at the right cost.

So what did they say? Not surprising was the value of capturing and sharing data from electronic health records, knowing about the kinds of patients and conditions represented in a practice, communicating to others about the care delivered, and locating a patient's medical information wherever they seek care. Data helps providers understand patient needs so they can assist them more efficiently. It was also no surprise that the data that Medicare provides these clinics, as they participate in the MSSP ACO, shows them places where they need to develop new processes. For instance, one clinic is now addressing their post-acute care relationships and communication.

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Unlocking Patient Self-Management: the Employment Effect

Doctor with Patient

When I am not working as a medical director with HealthInsight, I am a part-time family physician in a community-based clinic in Salt Lake City. Last week, I was lucky enough to see a long-time patient, a man that has multiple chronic conditions, including high blood pressure, anxiety, depression and asthma. He cares for his chronically ill wife, and has been intermittently employed since I have known him. During our appointment, I was pleasantly surprised how well he was doing, considering all that is going on in his life.

Eighteen months ago, his chronic conditions were not managed. He was in the emergency department at least once a month, was experiencing significant stress, and was unable to pay for some of his more expensive medications. He fell into a health care coverage gap, unable to pay for insurance and not disadvantaged or ill enough to be disabled or on Medicaid. The Federally Qualified Health Center programs were doing what they could to help him, but it was not enough.

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Medical Home: Is it a Value Tool? How is the Market?

Doctor with patient

Recently, I was invited to talk with a group of physicians about the medical home in Utah. Medical homes are primary care practices that know their individual patients, coordinate their patients' care and make sure they can get in for visits, and strive to improve how they care for all well, sick and chronically ill in their practice. So this sounds good, but we all want to know about the medical home as a model for value-based care: health care that maximizes health and patient satisfaction for every dollar spent. After some time researching the topic, it remains clear that commitment to the medical home is vital to better primary care in Utah and throughout the U.S.

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Engaging with a Trusted Medical Advisor Increases Smoking Cessation Success

Break The Cigarette Habit According to the Centers for Disease Control and Prevention, cigarette smoking causes over 480,000 deaths each year in the United States (about one in five deaths). Smoking-attributable economic costs in the United States per year (estimated for 2009–2012) were more than $289 billion, including $133 billion for direct medical care of adults and more than $156 billion in lost productivity.

As a primary care physician, I have found that the prompts in our electronic health record have made it easier for my care team to remember to ask, “Are you a current smoker?” or “Have you ever smoked?” We can efficiently record the data and, if they smoke, briefly assess readiness to quit. I am happy to say that we are much more likely to capture this information thanks to the electronic record and good workflow processes that we have gained through the Meaningful Use program.
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When More Isn't Better

iStock little girl with DrImagine if your mechanic offered to do additional work fixing your car, your hairstylist offered an extra hair treatment, or your plumber offered to spend extra time scoping out the pipes in your home—all at no additional cost to you. In most cases, this would be a great deal that few of us would pass up. That’s why the message that more health care isn't necessarily better can be confusing to many consumers. It runs counter to our experience with most of the other services we purchase, and in health care it doesn’t help that consumers are often shielded from the cost of such services.

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Defining Medical Home - Utah Partnership for Value Workgroup Sets Medical Home Standards for Utah

iStock 000010012895XSmallPatient-centered Medical Homes (PCMHs) are a cornerstone of comprehensive health reforms being implemented across the nation. The PCMH is a model of care delivery in which primary care providers, families and patients work in partnership to improve the health and quality of life for patients, especially with chronic conditions. PCMHs put the patient at the center of care; develop proactive approaches through personalized care plans; and offer more continuity through care coordination. The medical home model has been shown to reduce un-needed emergency department visits and hospitalizations, and patients report significant satisfaction in this type of practice.

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