Tulsa World: Health-care reform, Tulsa-style

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Health-care reform, Tulsa-style
Med school here aims high

Jeremy Van Dusen, a licensed practical nurse, checks the blood pressure of a young patient at the Pediatric Clinic of the OU School of Community Medicine on the OU Tulsa Schusterman campus. SHERRY BROWN/Tulsa World file

By JANET PEARSON Associate Editor
Published: 8/2/2009 2:28 AM
Last Modified: 8/2/2009 4:15 AM

"If you pull this off," a faculty recruit recently told Dr. Gerry Clancy, "you will transform medicine."

The University of Oklahoma School of Community Medicine may already be well on its way to pulling that off.

If Clancy, OU-Tulsa president and medical school dean, and like-minded leaders have their way, this one-of-a-kind school may do more than transform medicine. It may help lay the groundwork for transforming the entire nation's health-care system, the way we think about and approach health care — even the way we design our cities and run our schools. Already, significant progress toward transforming health-care practices and delivery has been made right here in Tulsa.

But first, the University of Oklahoma School of Community Medicine — made possible by a $50 million gift from the George Kaiser Family Foundation — has to train a new generation of health providers who can put these grand ideas into action. These medical practitioners of tomorrow will be trained to tackle not only individual medical needs, but community-wide health-care issues. Put another way, these doctors will not only treat a patient's diabetes or heart condition, but also pursue steps to address the root causes of diabetes and heart disease in the patient's community. In the long run, the entire community will be healthier, and health-care costs will be better managed.

This past week, scores of first- and second-year medical students, physician assistant students, and students studying social work, pharmacy and nursing took part in the second annual Summer Institute at Tulsa's OU School of Community Medicine, a gathering unlike any other medical school orientation in the country.

The students, along with faculty mentors, spent an intense week examining community health needs from a range of perspectives, with special attention paid to the social and economic aspects of health care, and began to craft solutions to some of the problems. The students fanned out across the community, interviewing leaders and stakeholders, spending time in clinics, even shadowing patients as they sought treatment. For many, this experience is an eye-opening, even life-changing experience.

Treating the community

The community medical school concept, the first of its kind in the U.S., was the brainchild of Clancy, who believes that health providers of the future must be prepared "to solve health problems in entire communities."

To do that, he told students in the institute's opening ceremonies, "We will need a deeper understanding of the social determinants of health, for example, prejudice, culture, education, crime and poverty, in order to have a significant and long-lasting impact on health."

Tomorrow's doctors not only need "excellent one-on-one patient care skills, but ... also the ability to be systems engineers, improving how the health-care system works."

To affect community-wide health issues, providers will have to be willing to tackle the prejudices and inequities that have produced the poor health outcomes plaguing particular communities — Tulsa's north and west sides, for example. Clancy believes the only way to produce doctors with such commitments is to reinforce and preserve one of the most passionate traits of doctors-in-training: their altruism.

Not so coincidentally, what Clancy has in mind dovetails perfectly with what America's leadership also has in mind: reinventing medicine to improve outcomes, control costs and provide all Americans access to decent health care.

"There is no more timely, relevant or personal topic to many Americans at this time than the present crisis in health care in our country," said Clancy in announcing this year's institute. "As business and government debate the answers, this important gathering at OU-Tulsa will be deeply engaged in the same questions. Our goal is that everyone attending leave with the knowledge, perspective and motivation to become a part of reshaping health care in our community and country."

Leading the way

In various ways in recent years, health-care reform has been occurring in bits and pieces, including here in Tulsa and Oklahoma.

Clancy outlined some of the more significant changes which, interestingly, reflect ideas currently being debated at the national level.

Expanded health-insurance coverage, made possible through the state-subsidized Insure Oklahoma program, has enabled OU's system of clinics to reach and enroll about 41,000 previously uninsured area residents. This insurance program has traits of the hybrid public option currently under debate at the congressional level. Without this public alternative and the outreach provided by an extensive network of clinics, these individuals likely would still be uninsured today.

Continued expansion of primary care and specialty clinics, including OU's evening clinic on the Schusterman campus, the chronic-care clinic at Hillcrest Medical Center, multiple school-based clinics that reach entire, unserved families, and the Tisdale specialty clinic, now under construction, which will provide advanced specialty care such as cancer treatment and cardiac services.

Use of the patient-centered medical home model for the uninsured and Medicaid populations, another key concept under discussion nationally. "We may have 30,000 patients signed on to our patient-centered medical home program," said Clancy. "I think this is probably the largest group of uninsured and Medicaid patients using this model anywhere in the country." This treatment and care approach "utilizes great primary care, interdisciplinary teams of providers and health information" to anticipate patient-care needs.

A companion to the medical-home concept, the use of health information technology at OU-Tulsa helps to greatly improve efficiency of care and contain costs. Clancy estimates OU's online consultation program has reduced the need for face-to-face specialty care by 52 percent.

The Tulsa medical school also just entered into a pioneering partnership with IBM for development of an information-based, interconnected, primary-care practice model. A top priority of President Obama's administration, this concept calls for centralizing medical records from many different locations — hospitals, physician offices, ambulance services, fire departments and patients, among others — so that health-care providers can easily access them when needed. The approach should be another major step toward streamlining health-care delivery and reducing costs.

Over time, community medicine as envisioned by Clancy will come to mean much more than just health-care delivery. Already, the Tulsa school is incorporating early childhood education, social work and urban planning into the long-term vision because, after all, those disciplines have major impacts on human well-being.

"My wish for all of you is that you have a ... rapid transformation experience this week," Clancy told his students, "that you are changed in how you view this community, how you view yourself in this community and how you view health. ... Before you learn the anatomy of the human body, I want you to learn the anatomy of our community — the community that those bodies live, learn, dream and die in."

Janet Pearson 581-8328
janet.pearson@tulsaworld.com By JANET PEARSON Associate Editor

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	Report Comment fumblerooski, tulsa (8/2/2009 10:31:51 AM) While I applaud the OU-Tulsa Community Health model, I don't believe it will work effectively as long as it is a program aimed at the poor only. The poor will continue to perceive that their care is inferior to the medical care received by the middle class and wealthy who's care is covered by private insurance. Health care needs to be like education--a basic level accessible to all. And just like education, some will avail themselves effectively of the public school systems and others will opt to pay privately--but out of their own pockets. And not shirk their responsibilities as taxpayers for the welfare of the whole.
	Report Comment Loki, Broken Arrow (8/2/2009 10:52:00 AM) Having gone through a "Transformation" effort in the Department of Defense, the keenest observation I heard was that "Everybody wants transformation, nobody wants to change." The above quote speaks to overcoming the inertia of the status quo, and an inherent resistance to change. This initiative is taking on some very important issues and I am really hoping they succeed. Broadening medicine's aperture from a transaction economic model won't be easy, but it has to be done. Oklahoma is a good petri dish for this effort. Rampant lifestyle issues, economic stratification and our share of the boomer demographic hitting end-of-life combine to underscore the core problems. This is good news and I wish them all the best.
	Report Comment Tulsonian, (8/2/2009 11:07:43 AM) So now we are going to have a bunch of "Health care" officials telling us we can't eat that cheeseburger for lunch? If you don't do what we tell you then you don't get health care because you caused your problems yourself by making bad decisions. We we need is a single payer system to provide health care to everyone. The problem is with private insurance companies. You pay them money. The State pays subsidies. Then Blue Cross Blue Shield denies you claim because the "Health Care Police" saw you eating lunch at Jumbo's Grease Burgers.
	Report Comment reckless abandon, Tulsa (8/2/2009 11:14:21 AM) Really Tulsonian, there are medications that can help you with your paranoia.
	Report Comment Tulsonian, (8/2/2009 11:31:39 AM) What ever. It would be nice to have access to health and be able to get any medications
	Report Comment tried, (8/2/2009 12:36:10 PM) Well, that all sounds very nice but seems very unlikely. My daughter has been going to the clinic at OU since St. Francis dumped all disabled kids from its insurance program. She has seen medical students who ask me lots of questions and don't even touch her. There has been little to no follow up. After giving up for a couple of years we went back and saw an actual doctor. We were promised referals to specialists for her eyes, ears, liver and heart. It has been 11 months and she finally has an appointment with a cardiologist. If we go back to the clinic to get x-rays first. That may be another frustration exercise in waiting. Perhaps OU should do what it should already be doing before it bites of even more.
	Report Comment Bullhead, Nicut (8/2/2009 12:49:24 PM) My daughter hasn't had a problem at the OU medicine clinics. I hope she continues to have a smooth experience with them. She has a physical disability and seen a urologist there with no problem.
	Report Comment human1, A change is gonna come someday (8/2/2009 3:39:31 PM) The Insure Oklahoma Program only helps small businesses provide health insurance for their employees nothing more. I am glad to hear they also got that contract as well as the contract for Sooner Care. They must be happy! There is still NO help for someone technically employed, or even unemployed who is waiting for Social Security to approve a diability claim and needs medical care! There also is NO health care reform in Oklahoma for anyone who is unemployed with out insurance, or for people the corrupt insurance industries refuse to insure due to pre-existing conditions. I am sure that OU Med College will do a good job of providing care for those that qualify for their services and can afford to pay full cost for testing.
	Report Comment Bedazzled, (8/2/2009 3:53:53 PM) A majority want to change the Heatlh Care System but only 52% want to do something about it. So far I haven't seen real reform. The insurance companies own us.
	Report Comment human1, A change is gonna come someday (8/2/2009 7:56:48 PM) Bedazzled..The insurance companies own us. I thought the same thing when I paid my car insurance, house insurance, med insurance, insurance on credit card, etc, etc, etc,
	Report Comment 52favoriteteacher, Washburn--used to be Broken Arrow (8/4/2009 5:15:15 PM) The China financial wizards own us....
	Report Comment doesntmatter, (8/5/2009 9:22:43 AM) *Health Care People....this is what obama is trying to get passed in the new health care plan, this is unbelieveable!!! (I can not post a link here.) 1) Go to fred thompson show dot com. 2) On the home page, click on "show library", 3) On the calendar, go to "" 07/16/09 date"", 4) Halfway down the page is an interview with * Betsy McCaughey****. This is a 8 min. radio interview. Please listen to this, this will SHOCK YOU! The people who put the new health care plan together dont have a caring bone in their bodies! You got to listen to this.....Wake up American!

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