During the last week of July I traveled to the Colorado Health Foundation’s annual symposium in Keystone, CO. It was an honor to represent all of you in front of 425 people from the worlds of policy, government, business, and health care who want to make a positive difference. What follows are some highlights from the conference. You should know that national thought leaders have a great interest in what you do every day.

The speakers were very high quality—people like former U.S. Surgeon General Dr. Richard Carmona and Dr. Elliot S. Fisher of the Dartmouth Institute for Health Policy and Clinical Practice.

Sessions are archived on the Colorado Health Foundation's Ustream.tv page, and my fellow speakers and I have posted our presentation slides. The Colorado Health Foundation also blogged about all of the major panels and speeches.

It’s not the same as being there, but I hope you can enjoy parts of these great exchanges.

A few conference highlights

A chance to talk up your good work. The people I met had all heard of Group Health and have great respect for us. They want to know how we do it. What policies could promote the kind of care we provide? There are so few examples of integrated systems that actually have aligned incentives, created the vision, and built the infrastructure to create better health—and a better value— for patients.

A panel called "Prevention: A Cure for What Ails Health Care?" looking at preventive care from different points of view. Policy folks are clear that though the new health reform act will "cover preventive services" it is unclear how that will play out in the real world of health care delivery and reimbursement, especially with a dearth of research about how prevention saves money.

An evening debate— Resolved: ObamaCare gives the federal government too much control over Americans’ health care. It was a rousing exploration, in particular of the “Individual Mandate” which has been the lightning rod for the constitutionality of the act. Even so, constitutionality was not the biggest concern in the room. Effectiveness of the act, and its impact on costs, was.

A preview of a documentary to feature Group Health. Journalist and documentary creator T.R. Reid (Sick Around the World) previewed his yet-unfinished film about areas of the country that have found a way to give better care at lower costs. Producer Lisa Hartman came to Group Health about a month ago to interview people related to this documentary, and Mr. Reid is coming later this month.

It's broke — now how do we fix it?

Follow the link above for the panel I spoke on—my portion starts about 25 minutes in to the video clip. The presentation started with moderator Dr. Jay Want, President and CEO of Physician Health Partners. He gave a context-setting picture of what's wrong: mostly that our entire system is designed not to enhance health and wellness, but to produce billable events. He closed with that great quote from Jerry Garcia of the Grateful Dead: "Somebody has to do something, and it's just incredibly pathetic that it has to be us."

Each of the four panelists got 20 minutes to speak. The idea was to start with the most high level and theoretical and get down to a system (ours) that has actually done some of these things. In that vein, they asked me to "bat cleanup.”

• John Rother, Executive Vice President of Policy and Strategy, AARP, talked about the patient/consumer point of view, and how the system just isn't delivering what patients want and need. 

• Jason Hwang, MD, Executive Director of Health Care, Innosight Institute, talked about "disruptive innovation" in other industries over the last century and how that is playing out in health care. He is the co-author of the highly acclaimed book The Innovator's Prescription: A Disruptive Solution for Health Care. 

• Harold Miller, Executive Director, Center for Healthcare Quality and Payment Reform, is an expert in payment systems and paying for value instead of volume. He talked about the health care "non-system," various perverse incentives, and how we might align incentives and policy to actually give better care and lower costs to our patients.

• I talked about our Medical Home (that's what I was asked to do) but also touched on other delivery system reforms. I put our work in the context of our 63-year history, our unique marriage of finance and care, and our founding mission in 1947: to serve the greatest number (and to remove affordability as a barrier to high quality care).

I closed with…
"We are in a struggle for the soul of American medicine. Don't underestimate that struggle or your role. The system will implode if we don't fix it. 
We can only do this together by crossing our tribal boundaries, political parties, health plan/delivery system boundaries, and primary care/specialty boundaries.
We need to learn together with open minds, unwavering principles, and unflinching focus.
We can do this."

Then we fielded an hour of Q&A with the 350 or so folks in the audience. They were clearly fascinated by what we have done—and are doing—and how we look at our work. There are so few models that work. Our work at Group Health was so appreciated.

Questions or comments? Respond to Open Mike

by Paul Flugstad, MD, Chair, Group Health Permanente Board of Directors

Over the next several months, you will begin to hear the name Group Health Physicians more often. The Permanente Board has voted to adopt Group Health Physicians as our company’s DBA name.

The initials DBA stand for the legal term “doing business as.” Adopting a DBA name allows you to use a name for promotional and marketing purposes that is different from your legal business name.

The Group Health Physicians concept has been developed and discussed over several years, and the time is right to move forward with it. The Permanente Board felt strongly that from a marketing perspective, it is in our best interest to adopt the DBA name.

Fully implementing the use of Group Health Physicians will take a while. Specific how-tos and tools for implementing the name will be coming throughout the fall.

For now, I want to address what this all means for Group Health Permanente as an independent company.

What doesn’t change

• Using a DBA name doesn’t change our corporate structure.

• Using a DBA name doesn’t change our valued relationship with The Permanente Federation. We take great pride in that relationship, and will continue to partner with our Permanente colleagues around the country.

• Using a DBA name doesn’t eliminate or replace our legal business name, Group Health Permanente.

How a DBA name helps us 

• It’s a simple and memorable way to promote physicians at the center of the Group Health experience—and grow our group practice.

• We have heard from patients in focus groups that they are confused about the relationship between our medical group and the broader enterprise. Using Group Health Physicians shows how we relate to Group Health, reducing confusion.

• A DBA name gives us the choice to use Group Health Physicians where it adds the most value. We will keep and use our legal name, Group Health Permanente, with specific audiences.

• It creates a marketing identity for our medical group that's part of a broader strategy to make Group Health’s brand easier to understand. This included the rename of the Center for Health Studies last year to Group Health Research Institute.

Our choice to adopt this name is a choice for sustainability. It removes barriers that prevent understanding, and helps us work within a larger sales and marketing effort. And in a time of rapid changes in the health care landscape, it helps us all move forward from place of strength.

Questions or comments? Respond to Open Mike

Getting clear about where you’re going, and what to focus on. That’s the backbone of any strategic plan. The Permanente Board has been at work on a plan for GHP since Spring.

Eric Froines, MD, is a member of the GHP Board’s strategy subcommittee. “We’re timing this work so it can inform, align with and support the execution of Group Health’s overall five-year plan," he says. “We're operating together in a world of constant change, so this work helps us shape the future rather than just react to trends. It helps us be prepared for things like Accountable Care Organizations and reform-driven enrollment growth."

Reconfirming GHP’s basic values is part of the process too. “We’re thinking of GHP’s values in the most practical ways,” adds Permanente Board Chair Paul Flugstad, MD. “Our values help us make daily decisions. They’re guideposts, not just for what we do, but how we do it, and who we are. Knowing our values keeps us from going in fifty different directions.”

The subcommittee reconfirmed the company values in a May workshop, and created the following value statements for your consideration and feedback.

GHP Core Values
Spring 2010 Workshop Draft

• Innovation We are pioneers in population-based medicine, creators of nationally-adopted care models, and advocates of tools to improve lives everywhere.

• Stewardship We are careful with resources and motivated not by profits, but by our patients’ medical needs, preferences, and values.

• Compassion We treat each interaction as an opportunity to demonstrate service, kindness, and respect.

• Collaboration We work together, and with our medical community partners, leveraging Group Health’s integrated strengths in research, care delivery, technology and contributions.

• Excellence Our patients’ well-being depends on our consistent professionalism, commitment to ongoing learning, and personal integrity.

What do you value most? Respond to Open Mike with your thoughts about GHP’s value statements, or join a discussion on the topic at a Fall Business Meeting.

The nomination period opens August 15 and closes Sept 15. 

There are two new awards this year: the Teaching Excellence Award, and the Outstanding
Community Service Award. The Don Miller Award for Innovation has been revised to honor not just innovation, but also research.

You can see last year’s award recipients and use the online nomination form on InContext (Group Health's internal website). Nominations will also be accepted via e-mail. Send them to Rosemary Ryan at ryan.r@ghc.org.

The award categories are:

Outstanding Leadership Award in honor of Jerome F. Beekman – for a physician who consistently demonstrates an exceptional level of leadership competency

Clinical Excellence Award in honor of Ward C. Miles – for outstanding performance in one or more of the following: complex diagnostic treatment excellence; patient education and treatment compliance; clinical population management; and joint clinician-patient decision making

Service Quality Award in honor of Jesse Mantel – for outstanding performance or significant improvement in: access; communication; competence; courtesy; coordination of care; reliability; responsiveness; and/or understanding patient needs

Outstanding Non-Physician Clinician Award in honor of Steven Turnipseed – for a non-physician clinician for outstanding performance or significant improvement in: access; communication; competence; courtesy; coordination of care; reliability; responsiveness; and/or understanding patient needs

Innovation/Research Award in honor of Don Miller – for contributing to the organization through research or innovation that will improve the care of patients

Teaching Excellence Award – for consistently demonstrating a commitment to teaching through but not limited to: continuing medical education and graduate medical education

Outstanding Community Service Award – for consistently promoting an awareness of the Group Health mission within the community through their commitment to community service or volunteerism locally, regionally, or worldwide

Lifetime Award – an individual who has been an irreplaceable asset to their patients, peers, and the organization – who has had a career with GHC/GHP of no less than 20 years

Team Excellence Award – a team who is recognized as a highly functioning team, maintaining high patient satisfaction, a willingness to change, and mutual respect for each other.

Questions or comments? Respond to Open Mike

There’s still time to nominate an outstanding young physician for a Tomorrow’s Medical Leaders Grant. The program recognizes future leaders by providing grants to be used on a wide range of professional development projects aligned with Group Health's strategic direction and promotion of innovation in health care.

Two $10,000 grants will be awarded to two grantees in 2010. These are funded by the Tomorrow's Medical Leaders Endowed Fund from Group Health Cooperative, Group Health Foundation, and Dr. Howard and Stephanie Kirz.

Nomination and Award Process
Candidates must be physicians nominated by fellow GHP medical staff.

Nomination forms (available on InContext) are due by September 1, 2010

Candidates will then be interviewed by a committee of GHP and Group Health Foundation leaders. Grant recipients have one year from the date of the award to use the funds.

Award Criteria
The Tomorrow's Medical Leaders Annual Award may be awarded to any physician who consistently demonstrates influential qualities:

• Courageous leadership
• Innovative and independent thinking
• Ability to motivate others

2009 recipient Wellesley Chapman, MD, is using his grant award to support cultural development at Burien Medical Center, with emphasis on visual tools and A3 Thinking. “This financial resource helps us explore and develop new ways of working that benefit us all,” says Chapman. “Spare funds in our system are hard to come by. Support from the Foundation has allowed the Burien clinic to create a space to learn and experiment.

Questions or comments? Respond to Open Mike