Elliott Fisher, MD, MPH, a health policy researcher and alumnus of the Robert Wood Johnson Foundation Clinical Scholars program (1983-1985), was recently named director of the Dartmouth Institute for Health Policy & Clinical Practice. Fisher coined the term “Accountable Care Organization” (ACO). In this Clinical Scholar Health Policy podcast, he discusses the origins of ACOs and the effort to develop them in the nation’s health care system. Watch his interview with RWJF Clinical Scholar Chileshe Nkonde-Price, MD, (2012-2014). The video is republished with permission from the Leonard Davis Institute.

This blog post offers perspectives from seven Robert Wood Johnson Foundation Nurse Faculty Scholars who attended TEDMED 2013 last week.

Seeing things in new and different ways will advance nursing practice, research, and education.  We need to think of creative strategies to raze perceived boundaries. One way for nurses to enter new frontiers is to engage in interprofessional dialogue with consumers, health care providers, researchers, entrepreneurs, technology experts, designers, and artists. We experienced this interchange at TEDMED 2013—an interprofessional conference for sharing and exploring solutions to health care’s most pressing challenges.

Collaboration is Key
Adejoke Ayoola: The opportunities to explore new advances in technology and interact with innovators remind me of an African Proverb, “If you want to go fast, go alone; if you want to go far, go together.” The outcome is more fulfilling with collaboration. By collaborating with stakeholders (e.g., community residents, community health workers, local agencies), research not only becomes more effective, it becomes more relevant to societal needs. Collaboration with my nursing colleagues promotes scholarly growth and may involve writing manuscripts or conducting smaller studies associated with a bigger study.

Nicholas Stine, MD, and Dave Chokshi, MD, MSc, writing on behalf of the New York Academy of Medicine Primary Care and Population Health Working Group.

The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders* in primary care and population health. In the first of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.

Defining Population Health: Many discussants cited the definition of population health developed by David Kindig, MD, PhD, as a reference point: “health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Regardless of specific vantage point, there was a generally shared sentiment that population health should be thought of broadly and in common terms by a range of clinical and non-clinical stakeholders.

More discussants described a baseline framework of a clinical delivery system oriented around patients in a practice, in contrast with a public health system oriented around geographic communities. A more clinical, or “population medicine,” perspective often centered around evidence-based interventions and disease management categories so as to triage and allocate health care resources in a cost-effective manner.

Susan B. Hassmiller, RN, PhD, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing and director of the Future of Nursing: Campaign for Action, will be a featured speaker when the Institute for Healthcare Improvement hosts a webinar this Thursday, January 10. The webinar will explore how nurse practitioners or advanced practice nurses are being deployed and woven into new, interdisciplinary, team-based delivery designs.

Other panelists will include Patricia Gerrity, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and a Raise the Voice Edge Runner. Gerrity is the director of Eleventh Street Family Health Services of Drexel University, and the associate dean for community programs at Drexel’s College of Nursing and Health Professions.

The webinar will be held from 2:00–3:00 p.m. EST.

Register for the webinar.
Read more about Gerrity’s work.

The Robert Wood Johnson Foundation (RWJF) recently released a video showcasing its Human Capital portfolio, which invests in innovative, diverse and inspired people who will shape health and health care research, policy and delivery for years to come. Watch the video below to learn more about RWJF Human Capital programs and the scholars and alumni who participate in them.

While policy-makers in Washington and in state capitals across the nation have been embroiled in a debate over health care reform, many aspects of the health care system have been evolving in response to economic and demographic pressures. The latest issue of the Robert Wood Johnson Foundation’s ongoing Charting Nursing’s Future (CNF) series of policy briefs highlights a number of examples of that evolution, all related to nurses’ changing role in primary care.

The Institute of Medicine’s landmark report, The Future of Nursing: Leading Change Advancing Health, noted that nurses “are poised to help bridge the gap between coverage and access, to coordinate increasingly complex care for a wide range of patients, to fulfill their potential as primary care providers to the full extent of their education and training, and to enable the full economic value of their contributions across practice settings to be realized.” In fact, as the CNF brief points out, “Nurses are already leading the way in keeping patients healthy, managing their diseases, and reducing their use of costly hospital care by increasing the availability and scope of primary care services.”

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

By Nancy Fishman, BSN, MPH and Maryjoan Ladden, PhD, RN, FAAN. Fishman and Ladden are senior program offers at the Robert Wood Johnson Foundation

Spring is blooming all around us here in central New Jersey and that means nice weather, flowers and a constant search for allergy solutions! For those of us on the Robert Wood Johnson Foundation (RWJF) Human Capital team, this brings up several questions about how to use the primary care workforce more creatively. In this scenario, who in the primary care office could help us with our common allergy symptoms? How would we feel if we went in for a visit and didn’t see a health professional but were instead counseled about common over-the-counter treatments by the medical assistant according to standard protocol?

These are questions that seem practical and every day, but tie back to some basic questions about the primary care workforce and how we could be more creative in using all members of that workforce to improve patient access to care and the value of that care.

At the Robert Wood Johnson Foundation, we are all aware of the shortage of primary care providers – but short of producing a large number of physicians, nurse practitioners and physician assistants this instant – we need to get creative with what we have.

To that end, we are thrilled to be launching a new program to identify those practices that are already creatively using their whole office teams in new ways. This program “The Primary Care Team: Learning from Effective Ambulatory Practices” (LEAP) will first identify and then study sites that have succeeded in providing high quality health care and involving all staff in new and creative ways.

We believe that studying these sites will provide us with insights that we can share with other practices that would like to make changes.

The Robert Wood Johnson Foundation (RWJF) yesterday announced the launch of a new program designed to make primary care more accessible and effective by identifying practices that maximize the services of the primary care workforce.

The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project) will identify primary care practices that use health professionals and other staff in ways that maximize access to their services, so these workforce models can be replicated and adopted more widely. Its goal is to identify and then study the innovative staffing arrangements of up to 30 high-functioning primary care practices.

With millions more Americans poised to enter the health system as the Affordable Care Act is implemented, the new program will identify changes in policy, workforce, culture, education and training related to primary care that can improve the way practices function. “The nation will not be able to train new primary care providers quickly enough to meet the need, so part of the solution must be to use the workforce we have more effectively. This new program will identify ways to do that,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group.

The LEAP Project will be directed by Ed Wagner, MD, MPH, and Margaret Flinter, PhD, APRN, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center and Flinter, a family nurse practitioner by clinical background, is senior vice president and clinical director of the Community Health Center, Inc., a statewide Federally Qualified Health Center in Connecticut and director of its Weitzman Center for Innovation. She is an alumna of the RWJF Executive Nurse Fellows program.

Learn more about the new program here.

Related websites

• Learn more about RWJF funded Improving Chronic Illness Care
• Group Health Research Institute

By Laura Sadowski, MD, MPH, and Romina Kee, MD, Robert Wood Johnson Foundation (RWJF) Clinical Scholar alumnae

Becoming homeless is distressing for anyone, and it is especially challenging for people with chronic health problems who need ongoing care.

The face of America’s homeless population is changing. When the job market collapsed a few years ago, millions of families were forced out of their homes. A 2009 national survey of organizations providing services to the homeless found that an estimated 10 to 19 percent had become homeless in the past year due to foreclosure. Nearly one percent of the U.S. population experiences homelessness each year.

Previous research on the health/medical, legal, housing and social services costs accrued by people who are homeless has focused on subsets of the population—those with mental illnesses, substance abuse problems, or the “chronic homeless” (those who have been without stable housing for 24 or more months). But they comprise a small portion of America’s homeless population. The chronic homeless, for instance, represent just 18 percent.

So how do we ensure that all homeless patients – regardless of their individual circumstances – get the care they need, while reducing costs?

In our study published in a special edition of Health Services Research: Bridging the Gap Between Research and Health Policy, we looked at a novel, broader sample: homeless adults with chronic conditions. Unlike previous studies, the majority of our study subjects were not mentally ill, substance abusers, HIV infected, veterans, or frequent users of the health care system.