You will have heard by now that my partner and our colleague James Hereford will be leaving Group Health in the near future. While I know we will continue to move forward as an organization, I can't sugar coat the sense of personal loss that I feel.

James has been a fabulous partner and great friend. He has managed to merge high-level strategic thinking with detail-oriented operational processes in a way that is exceedingly rare and reflects remarkable gifts. James has taught me a great deal, challenged my thinking, enhanced my leadership, and at the same time met my humanity. We have had a deep personal connection as well as a great working relationship. I believe this has helped move our delivery system into a very strong position.

I’m thinking a lot about our future, and I’m sure you are too. Scott and I are working on an interim leadership plan for the Group Practice Division that will help maintain our strong momentum in the short term. We agree that finding a long-term fit for James’ role could take several months. It’s important to be thoughtful and deliberate so we find the right mix of talent and cultural fit.

As James and Scott and I all know, change is often a way of life. It’s not always comfortable, but we will find a way through that will serve us well. We owe it to each other, and to our patients, to keep working toward the goals we’ve created together.

I wish James well. I know he will contribute enormously in his next job, and as I told him I expect to cross paths with him again in my life. I will always keep a deep sense of appreciation for James Hereford as a leader and a partner.

Questions or comments? Respond to Open Mike 

Our recent announcement that the doctors of Columbia Medical Associates have signed a letter of intent stating their intention to join Group Health Physicians has generated plenty of staff questions.

CMA doctors have been seeing Group Health patients for many years as part of our extended network of providers. We know they are dedicated to high-value care for the patients they serve, and are excited to work in new ways in Spokane.

The next steps for the two groups include finalizing a contract, and getting to know more about each others’ interests, challenges and day-to-day lives as primary care doctors.

Your questions

How does this change the way Group Health works with CMA?
For the immediate future, each company will conduct business as usual. When a contract is finalized, more specific collaborative work will begin in phases, focusing on areas such as practice guidelines, and use of technology.

How do Columbia Medical Associates doctors benefit from joining Group Health Physicians?
Our groups plan to learn from each other as colleagues, to advance the use of evidence-based clinical practices, to maximize Group Health’s technology resources, and focus their medical practices on the best long-term outcomes for patients.

How does this impact Group Health members in Spokane?
Group Health members who currently see a doctor in a Spokane-area Group Health Medical Center can continue to do so. Group Health members who have been seeing a CMA doctor can continue to do so.

What changes will this bring for patients of CMA doctors?
Patients of CMA doctors can continue seeing their doctors as usual. CMA intends to keep its current health insurance contracts in place, with no disruption in service to patients.

Will CMA doctors continue to take payments from health plans other than Group Health?
CMA intends to keep its current contracts with other carriers intact. Some patients who visit CMA doctors have a Group Health coverage plan. Patients of CMA doctors who have health insurance other than Group Health will not have to change their health insurance.

Does this mean Group Health is going to begin taking payments from other payers?
Group Health does not plan to change to a fee-for-service model. Part of the work ahead will be for CMA and Group Health to design a business structure that allows for participation by multiple health plan payers. Both organizations are interested in a care delivery design that will bring overall cost savings to Spokane area patients.

What effect will it have on the non-physician staff in CMA doctors’ practices?
Nurses and office staff at CMA practices will remain CMA employees. CMA does not plan to change the job status of non-physician staff at CMA locations.

Will CMA doctors be moving to a Group Health facility?
CMA doctors will become Group Health Physicians doctors, but will remain at their current locations retaining the current clinic names. There are no facility or location changes involved in this agreement.

Questions or comments? Respond to Open Mike 

There’s a unique collaboration to be found at Group Health’s Central hospital, where Group Health and community-based midwives, obstetricians, family medicine residents and doctors team up to welcome new Seattleites into the world at our Family Beginnings Birth Center.

The professional teamwork among our midwives and physicians here is so strong—and so significant to women’s health—that it recently brought national recognition from the American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM).

Successful Models of Collaborative Practice in Maternity Care is the organizations’ joint initiative whose goal is publication of winning papers in ACOG’s 2011 “Issue of the Year”, an annual special edition commonly known as “The Green Journal”. To build national awareness of their policy position on collaborative obstetrical care, the two groups solicited scholarly papers nationwide, asking interdisciplinary teams of obstetricians and nurse-midwives how they exemplify the spirit and practice of collaboration in caring for women and families.

The winning entry was written by Group Health’s certified nurse-midwife Kelly McBroom, GHP obstetrician Susan Warwick, MD, and certified nurse-midwife Ann Darlington from community partner Neighborcare Health Midwifery and Women’s Health Services. Their entry topped the field of over 60 competitive submissions, and is now under peer review for publication by ACOG.

Ann Darlington says that in her decades as a midwife in a variety of practice settings, she’s experienced supportive, progressive attitudes while helping her clients give birth at Family Beginnings that differ significantly from most health care delivery sites. “Each professional is unthreatened and open to learning from each labor and birth. As midwives we are respected as independent practitioners with the full support of obstetrical, nursing, anesthesia and pediatric services. Everyone’s approach is to do what’s truly best for the client,” she says.

“ACOG created this project in the spirit of health care reform, looking for models of what really works and could be replicated in maternity care,” says Warwick. Darlington adds: “Our delivery outcomes demonstrate that with less competition between physicians and midwives, and less financial pressure to move women quickly through labor, there’s more time and space for birth to happen.”

Family Beginnings birth outcomes compare favorably with Washington state and national trends, as well as with the US Department of Health and Human Services Healthy People 2020 objectives. The 2020 national aim is to reduce first-time cesarean sections from the 2007 baseline of 26.5 percent to 23.9 percent. Family Beginnings’ 2010 primary c-section rate was just 18.5 percent. The national objective for vaginal births after c-section (VBAC) is an increase from the 2007 baseline of 8.2 percent to 18.3 percent. At Family Beginnings the VBAC rate was 31.8 percent in 2010.

ACOG and ACNM recognize the importance of options and preferences of women in their health care, and recently issued a joint statement on practice relations that said, in part: Quality of care is enhanced by collegial relationships characterized by mutual respect and trust, as well as professional responsibility and accountability.

“I am so very, very proud of this team’s work, and the choices Group Health is able to provide to our communities here in Seattle,” adds Women’s Health and Maternity Child Clinical Service Chief Jane Dimer, MD. “This kind of innovative practice model really works, and it can contribute nationally to overcoming cost and access barriers to high-quality maternity care.”

Questions or comments? Respond to Open Mike 

If you missed Group Health’s first-ever Innovations Conference on March 25, take the next two minutes to check out the highlight video. Your colleagues wowed conference guests like State Health Officer Maxine Hayes, MD, King County Executive Dow Constantine, thought leaders from Puget Sound Health Alliance, and fellow doctors from Polyclinic, PacMed, Franciscan Hospital and dozens of other groups.

Dr. Michael Soman welcoming attendees

Pioneering researcher, professor, and author John E. Wennberg, MD, MPH gave the keynote address on “Tracking Medicine: A Researcher's Quest to Understand Health Care.”

Group Health created this event as a day of industry learning. It was a chance to share things we do know about transforming delivery systems, and more importantly, to talk about the things we have yet to learn.

Speakers challenged the health care and political leaders in the room to keep their eyes and minds open to new possibilities. Collectively, our region has the talent, the values, and the will to engage our patients and colleagues in solutions for the American crises of access, quality and cost.

GHP’s Matt Handley, MD, associate medical director for quality and informatics was blogging about our work on patient-centered medical home, transitions in care, high-end imaging, and shared decision making (full post here). “Those of us who have been involved in them tend to see them as yesterday’s news – we forget how unusual and special these efforts have been, and how much our patients and the organization have benefited from them,” he wrote.

“Group Health staff are remarkable, and we work in what is essentially an incubator for innovation. And it is innovation for patients’ sake, rather than just toying around with the next cool thing.”

Questions or comments? Respond to Open Mike 

Robert (Rob) Reid, MD, PhD, has a new role as Group Health’s first-ever associate medical director of health services research & knowledge translation. It’s half-time, funded by Group Health Physicians. He’ll remain a Group Health Research Institute associate investigator, as he has been since 2003, working on various externally funded research projects, including examining domestic violence, genetic testing, cancer screening, and the medical home clinics.

His goal is to identify strategic research opportunities early, by discussing current and planned innovations with Group Health leaders and managers. He’ll be identifying the “sweet spots” where we can use external research funding to develop and evaluate transformative innovations to help Group Health and others.

Here’s more from Rob:

Please tell us about your new job.
It’s about better integrating the science of Group Health Research Institute (GHRI) into the Cooperative’s operations—specifically in designing, implementing, and evaluating innovations to learn what works and for whom. So we can bring research findings into “real time” to improve how care is organized, financed, and delivered.

I want to deepen the partnerships between research and operations that we’ve created with the patient-centered medical home, shared decision making, and our value-based insurance plan for Group Health employees, Total Health. The goal is to bring the best science to bear as Group Health continues to innovate for better health.

Each of those initiatives used seed funding from the Group Health Foundation or the Cooperative and leveraged it into external grant dollars—improving Group Health while producing leading-edge research useful to other systems and populations in this nation and beyond.

Does that mean creating “a learning health care system”?
Yes. It’s where research and practice influence each other, and we translate research into practice and policy more quickly. We also orient research better around the key questions for which decision makers need answers. It’s a model for innovation as policymakers seek to improve health care while making it more affordable and patient centered.

How does your background inform your new role?
I’m both a primary care and public health doctor at heart. I’ve always been interested in promoting health for individual patients—and by extension for populations. My background in primary care and preventive medicine helps me focus on whether system changes will work on the front lines: for patients, clinicians, and care teams.

What are the funding challenges and opportunities?
Translational research has been difficult to fund, and the lagging economy constrains funding. But the Accountable Care Act has created some opportunities for us, including the new Patient-Centered Outcomes Research Institute and the Center for Medicare and Medicaid Innovation.

But most of the Institute’s work will remain more basic, right?
Yes. Most research at Group Health Research Institute continues where we’ve traditionally excelled: exploring patterns and determinants of disease and care; doing comparative effectiveness research; and using randomized trials to test advanced innovations that aren’t ready for strategic wholesale implementation at Group Health. Likewise, many innovations happen at Group Health that don’t need to involve GHRI.

How have your interests evolved?
I practiced in Canada, where primary care was mostly small fee-for-service practices, with no overarching system supporting them—aside from paying them. I realized we could benefit from new ways to coordinate care, through a systems approach.

So I got trained at Johns Hopkins with an MPH in epidemiology and a PhD in health policy and management. After my training, I joined the faculty of the University of British Columbia and worked on health reform in Canada. But health care research and policy are often far removed from each other in Canada, so I jumped at the chance to join Group Health with its long history of integrating research into day-to-day practice and policy.

Questions or comments? Respond to Open Mike 

Bremerton has long had the distinction of coordinating the nation's largest and longest-running Armed Forces Day Parade on the third Saturday of May. Group Health Physicians is proud to be sponsoring our first-ever marching group in this community event that honors active-duty service men and women, veterans and their families from the Kitsap Peninsula and beyond.

Want to join the fun? Group Health Physician Assistant Judy Bond is your contact at bond.j@ghc.org.

We’re marching to…

• Recognize and thank our colleagues who have served in the Armed Forces.
• Reach out to the large number of military personnel in the Puget Sound area to let them know we appreciate their service to our country.
• Let military personnel in our communities know we are here for their families while they are deployed and will be here for them when they return.

Contact Judy Bond by May 15 with your T-shirt size and number of participants (must be over 12 years old to march). Participants who are members of veteran’s organizations are encouraged to wear their uniform hats.

63rd Annual Armed Forces Day Parade
10:00 a.m. Saturday, May 21, 2011
Downtown Bremerton

Subscribe to the Group Health Connects blog for updates on community events coming throughout the spring and summer.

Questions or comments? Respond to Open Mike