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VOL. 7, NO. 1 MARCH/APRIL 2

Dr. KevinGrumbach,MD, FAAFPProfessor and Chair

Dept. of Family andCommunity Medicine,UCSF

Optometry and Primary Care

CAPCI: Urgently RevitalizePrimary Care



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1 Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare Fee-for-Service Program. New England Journal of Medicine, 2009; 360:1418–1428.

2 Lynn J, Teno J, et al. Perceptions by family members of the dying experience of older and seriously ill patients. Annuals of Internal Medicine, 1997; 126:97–106.

3 Miller S, Mor V, et al. Does receipt of hospice care in nursing homes improve the management of pain at the end of life? Journal of American Geriatrics Society, 2002; 507–515.

4 Casarett D, Karlawish J, Morales K, Crowley R, Mirsch T, Asch DA. Improving the use of hospice services in nursing homes: A randomized, controlled trial. Journal of the American

Medical Association. 2005;294(2):211–217.

5 Gozalo PL, Miller SC. Hospice enrollment and evaluation of its causal effect on hospitalization of dying nursing home patients. Health Services Research. 2007; 42(2):587–610.

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TA B L E O F C O N T E N T S

Notes From The President 5 Names In The News 14

Upcoming Events 17

Members List 18

CAPG Member Spotlight 22

CAPCI Aims to UrgentlyRevitalize Primary Care 7Optometry:A Visible Contributorto a Primary Care Team 15

A Vision for CAPCI 20

DEPARTMENTS:Publisher Valerie Okunami

CAPG Health Editor-in-Chief:Don Crane

Managing Editor:Lura Hawkins, MBA

Contributing writers:Blair BrysonDon CraneK evin Grumbach, MDElissa MaasWells Shoemaker, MD

Art Director Paul Galang

CAPG Health Magazine is published

byValerie Okunami MediaP.O. Box 674, Sloughhouse, CA 95683Phone 916.761.1853www.capghealth.org

Please send press releases and all other information related to this issue of CAPGHealth to [email protected] and /or c/o CAPG Health915 Wilshire Blvd., Suite1620Los Angeles, CA 90017

For advertising send email [email protected]

Subscription Rates:$32 per year; $58 two years; $3.00 single copy. Advertising rates on request.

Bulk third class mail paid inJeferson City, MOEvery precaution is taken to ensure theaccuracy o the articles published inCAPG Health Magazine.

Opinions expressed or acts supplied byits authors are not the responsibility o CAPG Health Magazine.

Copyright 2013, CAPG Health Magazine.All rights reserved. Reproduction inwhole or in part without writtenpermission is strictly prohibited.

FEATURES:

COVER STORY:Dr. Kevin Grumbach, MD, FAAFPProfessor and ChairDept. of Family andCommunity Medicine, UCSF 11



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N O T E S F R O M T H E P R E S I D E N T

- am extremely proud to an-

nounce the creation o the Caliornia

Advanced Primary Care Institute (CAPCI),

a CAPG-sponsored nonproit educational

501(c3) oundation, which you can read

about in this issue o CAPG Health. The

new Foundation is supported by a broad

coalition o organizations rom the private

and public sectors as well as rom many segments o the healthcare community.

We believe this is the most comprehensive

collaborative eort ever to address the

alarming shortage o primary care physi-

cians. We also believe that the work we do

together will strengthen our structured

healthcare system and beneit society as

a whole.

Let me stress that CAPCI is an education-

al entity, not a political or lobbying organi-

zation. It brings together organizations as diverse as physician groups, health plans,

military and VA delivery systems, academ-

ics, hospitals and government agencies.

CAPG’s membership has already shown

its conidence in CAPCI by responding en-

thusiastically to a voluntary assessment to

help jumpstart the Foundation.

As exciting as this news is, we have

more. The 2013 CAPG Healthcare Coner-ence is certain to be a standout. Our ros-

ter o speakers is headed by President Bill

Clinton and includes a number o national

experts on healthcare. Please review the

advertisement in this magazine and sign

up early. The Conerence is June 6-9 at

the JW Marriott at L.A. Live in Downtown

Los Angeles. I look orward to seeing you there.

Sincerely,

Donald CranePresident and CEO

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For information about advertising or special promotions, contact Valerie Okunami at 916-761-1853.For editorial guidelines, email [email protected]



6

CAPG Healthcare Conference

10TH ANNUAL

JUNE 6–9, 2013JW MARRIOTT AT LA LIVE IN DOWNTOWN LOS ANGELES

WWW.CAPG.ORG/CONFERENCE2013

Presented by the California Association of Physician Groups

E XCI TI NG

N E W V E N U E!

Registration Is Now Open!



7

CAPCI Aims to Urgently RevitalizePrimary Care

continued on next page

By Wells Shoemaker, MD,

CAPG Medical Director

4 rimary Care is the cornerstone

for all of CAPG’s and, indeed, all of California’s healthcare delivery systems. Primary care also

sets the foundation for virtually every goal of

healthcare reform. Sadly, California faces a serious erosion of primary care workforce

at the same time that our state braces for a

daunting bulge in chronic illnesses and the long awaited opportunity to serve millions of

previously uninsured individuals and families

through reform.

In January, 2013, a new, broadly inclu-sive organization, the California Advanced

Primary Care Institute (CAPCI), launched a

multi-pronged effort to improve the appeal

of primary care as a career choice and elevate

the performance of our primary care teams to

respond to society’s pressing needs.

California’s primary care workforce willshrink by 30% in the next 5-8 years as a conse-

quence of two converging misfortunes. Baby

Boomer primary care physicians, for years the

load-bearing stalwarts among the internists,

family physicians, and pediatricians, are retir-ing. Newly trained clinicians have been pro-gressively choosing other medical disciplines, cutting the “reinforcements” down to half what they were 15 years ago.

Given the time it takes to train doctors,

advanced practice nurses, and physician’s as-sistants, this impending shortfall cannot be

entirely avoided.

Restoring the “numbers” is not realistic, and

we can’t solve this crunch but installing new

bearings on the old hamster wheel. We will

have to use scarce resources in smarter ways, many of them embedded in the concept of the MedicalHome…with new “street smarts.”

California’s primary care doctors will need

to practice team care in deed, not just PR,

sharing responsibilities intentionally. They

need information technology that answers questions and opens doors without exasper-ating time waste. They need to view patient empowerment as perhaps the most powerful

of allmedical tools. They’ll need to feel proud

of their work and simultaneously accept the humble culture of continual improvement.

That’s asking a lot from folks who are work-ing until8 PM already! They’llneed better cen-

tral support and fewer non-clinical demands

upon their time. To avoid hypocrisy in “well-

California Advanced

Primary CareInstitute Opened Operations In

January, 2013

CAPCI willmarshal California’s collective experience in educa-tion, clinical science, coordinat-ed care, ethical management, and cultural responsiveness to drive sustainably improved per-formance of our primary care delivery systems for all people

who live in our State.

• By expanding the medicalhome promise to make ad-vanced, patient-centered care a reality on a community wide scale, CAPCI willhelp to restore the appeal of primary care as a career choice for promising young professionals.

• CAPCI will serve as the State’s best informed, most inclusive source of knowledge to agen-

cies seeking to further the Triple Aim of Better Health, Better Care, and Better Af-fordability.

• CAPCI recognizes the urgency of this mission as the threat-ened constriction in work-force overlaps with the wel-come opportunity to serve millions of newly covered in-dividuals through healthcare reform.



8

The list o CAPCI’s Steering Coun-cil and Executive Management Committee’s members reads like a “Who’s Who” o primary care in Caliornia. They have the will, the experience, and the juice to get things done. CAPCI’s goals are

congruent with our organization’s strategic plan, especially transorm-ing medical practices to the Patient Centered Medical Home (PCMH) /team-based model o care.

Susan Hogeland, CAE Executive Vice President,California Academy of Family Physicians

Conspicuously, no previous California

effort has succeeded in changing primary care workforce dynamics on a large scale.

What is CAPCI doing that offers hope for a different outcome? Two answers: Inclu-sivity and Scope.

1. Inclusivity. Instead o looking through the keyhole o a single in-terest, CAPCI has engaged private sector delivery systems, community clinics, military and VA systems, and independent doctors. However, reining the delivery system is not

Kick Starting Primary Care: How it happened

CAPG sponsored a statewide

consensus meeting in April, 2012, eaturing the “Big Tent”philosophy o attention to as many angles as possible.

The core development team emerged rom that meeting, and ater 6 months work, CAPCI emerged with its name, its mis-sion, and early unding.

CAPCI convened its irst ple-nary Steering Council meeting in January, 2013, and all “Four

P’s” now have active work-groups.

CAPCI is chartered as a non-proit 501c3 oundation under the sheltering wing o the CAPG Educational Foundation. CAPCI has received kick-start unding through a contribution rom each o CAPG’s member groups, ollowed by a plan-ning grant rom the Caliornia HealthCare Foundation. Sub-

sequent unding through The Caliornia Endowment and the Caliornia Academy o Family Practice has put CAPCI deinite-ly “on the road.”

enough. CAPCI will also eature es-

sential voices o academic teaching centers, primary care academies (am-ily practice, internal medicine, and pediatrics), advanced practice nurse clinicians and physician’s assistants. Add Health Plans private and public, public health, employers, state and ederal government, quality improve-

ment organizations, and healthcare oundations to reach a critical mass. CAPCI is committed to hearing and heeding the Patient Voice early in every strategy.

Redesign Is Now Essential:Lance Lang MDIt is exciting to accept the chal-

lenge to support practice redesign eorts across Caliornia. The core o this eort will include team based care, improved access to care, and enhanced partnership with pa-tients…all with the goal o a more eective and satisying practice.

Lance Lang MD, Medical Direc-tor, CAPCI and also CaliforniaQuality Collaborative

continued from page 7


The Right People: Susan Hogeland

ness” counseling, these workers need a healthi-er, more family-friendly work-life balance.

The training environment is going to

change, and Dr. Grumbach is lighting the way.

“If we are going to transform primary care to provide superb, patient-centered

care to every Californian, we will need

to fundamentally change our approach

to training the people who work in pri-mary care. CAPCI represents an unprec-edented partnership between practice

organizations and training institutions to

equip the workforce for the innovative

care models that will drive excellence

in primary care throughout California.”Kevin Grumbach, MD, Professor and Chair,UCSF Department of Family and Commu-nity Medicine.



9

Revitalizing primary care is para-mount for all of us. In San Diego, multiple stakeholders have come together to create “systems” of care that serve the entire popula-tion and improve care in each sec-tor. K ey participants have included

the four major delivery systems (K aiser, Scripps, Sharp, and UCSD), the military health systems (Navy andVA), our Councilof Community

Clinics (FQHCs), San Diego County

Health and Human Services, and a number of commercial, senior, and

Medi-Cal health plans.

We have focused centrally on

advancing primary care through

patient-centered medical home

models. Allmembers of this multi-stakeholder collaborative agreed

that primary care must be the foundation for our health system, provided in a team-based fashion,

with an emphasis on management of chronic disease, prevention, and

improved access. For perhaps the first time these typically separate entities have:

• shared practice innovations as well as disappointments,

• collaborated on initiatives to enhance team-based ap-

Primary Care as a Community Endeavor: John Jenrette MD

proaches to care,

• identified community resourc-es to improve case manage-ment efforts,

• focused on identification and

management of patients with chronic disease and behavioralhealth needs.

CAPCI promises to extend col-laborations of this nature throughout other parts of California.

John Jenrette MD, CEO SharpCommunity Health Group, and Chair, CAPG Board of Directors

Never has such a broad platform been

established, and none too soon. With

the crunch bearing down, every one of those parties “has a dog in this race.”

2. Ambitious Scope of Engagement. Previous efforts have looked at only

one or two facets of the challenge, for

example, payment disparities or pa-perwork burden. CAPCI believes that simultaneous efforts need to be made

in 4 distinct areas in order to turn this

around.

We call those the “Four P’s.”

1. Pipeline. Change the training

environment and the appeal of primary care as a career choice

for physicians and other clinical

professionals. (See Dr. Grumbach’s

detailed analysis elsewhere in this issue.)

2. Practice redesign. Practice

with team mentality for greater efficiency, better information, modern communication, and

central attention to the patient experience. This is the promise of the Medical Home, but it needs to

expand beyond individual offices to reach community wide scale. In

California, any effort to redesign

must centrally embrace California’s unique cultural diversity.

3. Payment. Bluntly, this is all talk unless payment is aligned with the

modernized practices to deliver the core of healthcare reform. In

California with literally dozens of payors, hundreds of benefit designs, a mix of capitation and

fee-for-service, no one approach

has enough “heft” to inf luence

behavior change at the practice

level. CAPCI aims to reach a “tip-ping point” of purchaser strategies, building upon the “United Nations”

forum of the Integrated Healthcare Association and expanding that to

additional stakeholders.

4. Policy. American healthcare policy has been pinning so many tails on

the donkey over the last 60 years that we can’t see the donkey any more. The hodgepodge of as-sumptions, regulations, and “con-ventional wisdom” has landed the

USA lower than 20th in the world

in nearly every public health meas-ure. Intelligent policy, this time

informed by a broad-based con-

sensus of contributors with prag-matic experience, will need to help

policy makers become enablers for progress.

Why does CAPCI believe simultaneous thrusts on all Four P’s are necessary? Previ-ous efforts failed because they only touched

several of these key underpinnings. Having

gone through med school owning a small

foreign car of some notoriety for reliability, I’d say that rest restoring California’s primary care workforce is like reviving a disabled car. You can repair the engine and change the

oil, but without 4 good tires, reliable brakes, and a steering wheel, you won’t get very far.

Primary care revitalization needs all of the Four P’s.

Notably, many of these elements overlap

with Governor Brown’s Let’s Get Healthy California initiative, starting also in 2012

under Secretary Diana Dooley’s leadership

with with Don Berwick’s key support, is now

auspiciously drilling deeper in 2013. The

System Redesign workgroup will share a great deal of torque with CAPCI.



10

CAPCI GovernanceFebruary, 2013

Executive Management Committee:

Alan Glaseroff MD, Professor, Director Stanford Coordinated CareDavidNace MD, President, Patient Centered Primary Care Collaborative (PCPCC)Diane Stewart, Pacific Business Group on HealthDonCrane, CEO, CAPG

John Jenrette MD, CEO of Sharp Community MedicalGroup in San DiegoKevin Grumbach MD, Professor and Chair, Department of Family Practice, UCSFLance LangMD, MedicalDirector, CaliforniaQuality Collaborative (CQC)

Sharon Levine MD, The Permanente Medical GroupSusan Hogeland, EVP, California Academy of Family PhysiciansTomWilliams DrPH,CEO, Integrated Healthcare Association (IHA)Wells Shoemak er MD, MedicalDirector, CAPG,& co-chair, CQC

Steering Council includes the EMC members and:

Angela Minniefield MPA, Charles Drew University of Medicine& ScienceBeth Grivett PAC, American Assn of Physicians AssistantsBetsy StapletonRN FNP (Patient leadership strategy consultant, Humboldt County)Betsy Thompson MD DrPH MedicalDirector CMS Pacific Region

BobMoore MD,CMO, Partnership HealthPlan of California (Medi-CalManaged Care)DavidQuack enbush, California Primary Care Association (CPCA)Heather Young RNPhD, Dean, UC Davis School of NursingHector Flores MD, White Memorial & Family Care SpecialistsLarry Shore MD, MedicalHome Pilot, Brown& Toland Physicians, SFLaura Dolata, MSN, FNP-BC, Director, Ambulatory & Specialty Programs, San Diego VA

Mary Fermazin MD, MedicalDirector, HSAG, California’s MedicareQIOMary FoleyRNPhD, Director, UCSF Center for Nursing Research and Innovation

Mik eBelman MD, Senior MedicalDirector, Anthem Blue CrossMollyCoye MD, UCLA Innovations Officer, former CA Health Services Director

Neil Solomon MD, Senior MedicalDirector, Health NetRonChapman MD, Director, California Department of PublicHealthSunnyRamchandani MD LCDR, US Navy Medicine West



11


By Kevin Grumbach MD, FAAFP

%ter decades o neglect, the nation has rediscovered that primary care is the oundation or high perorming health care.

President Obama understands that suc-cessul implementation o the Aordable Care Act depends on robust primary care.

In a health reorm town hall in 2010, he stated, “It used to be that most o us had a amily doctor; you would consult with that amily doctor; they knew your history, they knew your amily, they knew your children, they helped deliver babies. How do we get more primary physicians, number one; and number two, how do we give them more power so that they are the hub around which a patient-centered medical system exists? ”

We need to answer the President’s ques-tions!

Leaders o corporate America, strug-gling with how to purchase better value health coverage or their employees, also

“get it.” Testiying beore the House Ways and Means Committee in 2009, Randy McDonald, Senior Vice President at IBM, commented, “What is the single most im-portant thing to ix in health care? Primary care. Strengthen primary care–transorm it

and pay dierently using a model like thePatient Centered Medical Home.”

But here is the problem: What i primarycare medical homes become an impera-

tive, but there is no one home at the medi-cal home?

Primary care aces the challenge o adepleted and oten demoralized primarycare workorce. Only hal as many US medi-cal school graduates are entering amilymedicine residency programs today as 15

years ago. During the same period, thenumber o residents completing training ininternal medicine and planning to practiceas general internists rather than enteringsubspecialty ields dropped by 50%. Simi-lar trends are occurring among graduateso physician assistant programs.

While policymakers do not agree on theexact extent o the primary care workorceshortage, most agree that it is large. TheAssociation o American Medical Collegesprojects a shortage o 29,800 primary care

C O V E R S TO R Y

Restoring the Joy of Primary Care

“...physicians have amongthe highest rates of profes-sional burnout of all special-ties. Far too many primary care practices are ill-designed

to meet the demands of high performing, 21st Century primary care, with the conse-quence that patient needs arebeing inadequately met.”



12

physicians in 2015, growing to a deicit o 65,800 in 2025. Our own research in Cali-ornia conducted or the Caliornia Health-Care Foundation indicates that only 16 o the state’s 58 counties currently meet the minimum supply o primary care physi-cians considered adequate--at least 1 pri-mary care physician or every 1700 people. As millions o Caliornians gain insurance coverage in January, 2014, the state aces a major challenge assuring there will be adequate primary care capacity to deliver access to care or the newly insured.

Why is this happening?

What explains the decline o the primary care workorce? Some o it is undoubtedly attributable to a medical education culture at US medical schools that celebrates spe-cialization and biomedical research and discourages student interest in primary care. I continue to hear rom medical stu-dents about a aculty member or resident in a non-primary care ield telling them that they were “too smart” to become a amily physician. But almost certainly the most powerul actors in luencing medi-

cal student career choices are those in the

practice environment.

A key environmental actor is physician compensation. Students don’t make it into medical school without being able to count, and the growing income gap between primary care and specialist physi-cians is not lost on students.

A study reported in JAMA ound that residency match rates are highly correlated with the average earnings o physicians in the specialty; the higher the average earn-ings o a specialty, the more likely the spe-cialty is to ill its residency programs with US medical school graduates. Another

study perormed or the ederal Council on Graduate Medical Education showed that over the past 30 years, the percentage o medical graduates planning careers in pri-mary care ebbs and lows in parallel with therelative earning power o primary care physicians relative to specialists.

The Aordable Care Act took some mod-

est steps to enhance payments or primary care, including a 10% Medicare bonus or primary care. Eective this year, ACA man-

dates that Medicaid programs pay at least Medicare rates or primary care. However,

continued from page 11 physician groups in Caliornia will need toask what they can do to address the prima-

ry care-specialty income gap to recruit newphysicians into primary care. Some largemedical groups are already reaching wellbeyond the 10% Medicare bonus to attractnew primary care physicians. For example,the Permanente Medical Group is oeringsalaries to new primary care graduates wellabove community standards, along withinterest-ree loans contingent on retentionin the group.

The second major discouraging practiceenvironment actor is the dysunctionalnature o many primary care practices. It

is not uncommon or UCSF medical stu-dents to remark to me about their amilymedicine clerkship, “I so admired the no-ble work being done by my primary carepreceptor. She is a wonderul doctor. But Icould never see mysel working so hard…in such an unsupportive environment.”

A recent national study conirmed thatprimary care physicians have among thehighest rates o proessional burnout oall specialties. Far too many primary carepractices are ill-designed to meet the de-




13

mands o high perorming, 21st Century primary care, with the consequence that patient needs are being inadequately met. The primary care clinicians know that, and they are experiencing rustration and burnout.

Transorm the ability to deliver the pa-tient service doctors envisioned when they made their career choice, and the doctors will respond.

Mak e that a Quadruple Aim

The wave o transormation o primary care has been condensed into the Triple Aim o better health, better patient experi-ence, and more aordable costs. I believe that the transormation o primary care is really about achieving the a ourth aim: Make primary care a joyul and sustainable career.

Call it what you will—Patient Centered Medical Homes, Advanced Primary Care, or just Darn Good Primary Care—the goalis clear and essential or meeting the needs o the public and renewing the primary care workorce. The transormation in-cludes several elements—what my UCSF colleague Tom Bodenheimer reers to as the “Ten Building Blocks o High Perorm-

ing Primary Care.” These include:

1. engaged practice leadership

2. data-driven improvement

3. new team-based models where health proessiona ls and allied health workers share the care and practice at the top o their skill

4. innovative approaches to coordinat-ing care or complex, high risk and high utilizing patients, and

5. moving beyond ace-to-ace encoun-

ters towards a more encompassing view o patient touches that includes web-enabled virtual visits and other modalities.

There is Hope

The spirit o innovation and improve-ment inusing primary care is starting to kindle renewed excitement and inter-est in primary care among students and residents. Trainees are eager to engage in the process o reinventing primary care—helping to create their own uture as the

next generation o primary care clinicians.

Those o us who are educators are keenly interested in ensuring that our learners are trained in practices that embrace innova-tion and advanced primary care models. We

need training sites that demonstrate that primary care is a highly satisying and do-able job …and engage learners in practice improvement. We look to physician groups in Caliornia to partner with us in the educa-tional enterprise and make their exemplary primary care practices teaching sites.

For our own part, we recognize the need to transorm primary care practices in academic health centers—many o which are hardly paragons o advanced primary care. But even academic health centers are inected with the spirit o primary

care transormation. The University o Caliornia Oice o the President is hosting leaders rom all ive University o Caliornia medical centers and medical schools in March or an unprecedented UC summit on primary care delivery reorm. Last year, the Stanord School o Medicine appointed its irst ever Assistant Dean o Primary Care. Schools o nursing, pharmacy, dentistry and allied health are also actively involved in reorming their training and practice models to align with the principles o high perorming primary care.

The Interdependent 4Ps

I am pleased to serve as a member o thesteering committee or the newly ormedCaliornia Advanced Primary Care Institute,and delighted that CAPG is playing such

a pivotal role in launching CAPCI. As aneducator, I am particularly interested in thePipeline component that is one o CAPCI’s“4P” priority areas.

But in truth, advances in the primarycare workorce pipeline will be highlydependent on success in CAPCI’s other 3Ps: Payment reorm, Practice Redesign,and Policy. Strengthening the primary

care pipeline will require new methods orcompensating primary care physicians andclosing the primary care-specialty earningsgap, transormed practice models thatmake primary care a proessiona lly reward-

ing job, and the policy changes needed tosupport reorms in payment and practice.Physician groups in Caliornia have a criti-cal role to play in renewal and reorm oprimary care in the state.

Dr. Grumbach is Professor and Chair, De- partment of Family and Community Medi-cine at UCSF. A frequent contributor to the

national primary care literature and debate,he helped to craft CAPCI’s approach to pri-mary care revitalization and serves as Chair of CAPCI’s broadly inclusive Steering Council.



14

USC RECRUITS TWO RE-NOWNED NEUROSURGEONS TO BOLSTER MULTIDISCIPLI-NARY SPINE CARE CENTER

The University o Southern Caliornia an-

nounces the recruitment o two esteemed spine surgeons who will play critical roles in expanding a multi-disciplinary, academic-based spine center at the K eck MedicalCenter o USC. John C. Liu, M.D., and Frank Acosta, M.D., join other neurosurgical and orthopedic spine experts at USC and began seeing patients on February 1, 2013.

Liu, a recognized leader and considered a pioneer in minimally invasive surgicaltechniques or the spine, has been named proessor o neurosurgery and director o the spine division at the K eck School

o Medicine o USC. Acosta, a ellowship-trained neurosurgeon in complex spine deormity, has been named associate pro-essor o neurosurgery at the K eck School.

JEFFREY WASSERMAN NAMED NEW VICE PRESIDENT AND DIRECTOR OF RAND HEALTH

Jeffrey Wasserman, a health policy expert who has led efforts to strengthen the Unit-ed States’ preparedness for a major health

event, has been named vice president and

director of the health research division at the RAND Corporation, RAND President and

CEO Michael D. Rich announced.

Wasserman is a longtime RAND re-searcher and a widely recognized expert on health policy issues. He has led eorts to create the National Health Security Strategy, a ederal project to prepare the nation’s health system to respond to large-scale incidents, such as a terrorist attack or

N A M E S I N T H E N E W Sa pandemic disease outbreak that could pose a major threat to the public’s health.

He was co-principal investigator o RAND’s Comprehensive Assessment o Re-orm Eorts (COMPARE) initiative, created

to help evaluate healthcare reorm propos-als. The health system models created by that project are being used by many gov-ernment agencies to help guide adoption o the ederal Aordable Care Act.

NEW CEDARS-SINAI CLINICPROVIDES EXPERTISE INPEDIATRIC NEUROGENETIC, NEUROMUSCULAR DISORDERS

Southern Caliornia pediatricians, pedi-atric neurologists and parents o children

with inherited neurological diseases or nerve-related muscle disorders have a new resource or expert diagnostics, genetictesting, and state-o-the-art research and treatment acilities: Cedars-Sinai’s newly opened Pediatric Neurogenetics and Neu-romuscular Clinic.

Many pediatric neurological disorders –especially rare ones – are hard to diagnose because symptoms can be nonspeciic and routine tests inconclusive, according to clinic co-directors Robert H. Baloh, MD, PhD , who treats and studies neuromuscular dis-orders, and Tyler M. Pierson, MD, PhD , an expert in child neurology who researches genes and molecular mechanisms that cause neurological disorders.

“When an inant or child shows signs o a disorder o the brain, spinal cord, nerves or muscles, a pediatrician or pediatric neu-rologist in the community usually would like to reer them to a specialty clinic at a large treatment and research center, but many o these disorders have overlapping

symptoms, making it diicult to knowwhich clinic is most appropriate. Our clinicremoves this burden because research andtreatment experts rom several disciplinesevaluate each child’s case to develop test-ing and ollow-up strategies. As we reach a

diagnosis, the appropriate expert takes thelead, coordinating ongoing care with thereerring physician,” said Baloh, directoro Neuromuscular Medicine in the Depart-ment o Neurology.

Pierson said the clinic is designed toefficiently help parents coping with unex-pected and often heartbreaking situations.Physicians or parents may find out moreabout the PediatricNeurogenetics and Neu-romuscular Clinic by calling (310) 248-8960.

OUTDOOR FAST-FOOD ADS LINKED TO OBESITY

Researchers rom the University o Cali-ornia, Los Angeles ound that people livingin areas with the most outdoor ood adver-tising were more likely to be obese thanresidents o areas without these signs andbillboards. Although they didn’t say the adscause weight gain, they did note a “modest

but clinically meaningul increased likeli-hood o obesity.”

“Obesity is a signiicant health problem,so we need to know the actors that con-

tribute to the overeating o processed ood,”Dr. Lenard Lesser, who conducted the studywhile he was a Robert Wood Johnson Foun-dation clinical scholar in the UCLA Depart-ment o Family Medicine, said in a Universitynews release.

For the study, published online January10 in the journal BMC Public Health, the re-searchers examined 200 census tracts romtwo densely populated areas. One area wasin Los Angeles, the other was in New Orle-ans. High- and low-income individuals livedin both places.

They detected an increased likelihoodo obesity in neighborhoods with the mostoutdoor ast-ood ads. “For instance, in atypical census tract with about 5,000 peo-ple, i 30 percent o the outdoor ads weredevoted to ood, we would expect to ind anadditional 100 to 150 people who are obese,compared with a census tract without anyood ads,” explained Lesser.

The researchers said more studies areneeded in other locations to investigate thelink between outdoor ast-ood ads and riskor obesity. UCLA team members monitor antibiotic use. CAPG’s Case Studies in Excellence 2013 coming in May.



15

8 he future of primary care in the

United States is team care...where all mem-

bers practice close to the limits of their train-

ing and experience, with rapid information

exchange and tightly coordinated respons-

es. We have superb examples in California

for the shared responsibility between MD’s,

DO’s, PharmD’s, Podiatrists, Advanced Prac-

tice Clinicians, RD’s, educators, and other

disciplines.

K arin Meng OD has practiced clinical op-

tometry in the Bay Area for 27 years, and we

shared this dialogue regarding the potentialrole for optometrists (OD’s) in the expanded

primary teams of the next decade.

Dr. Shoemaker: Dr. Meng, can you de- scribe the differences between ophthal-mology and optometry in training and daily work?

Dr. Meng: Sure. After obtaining an under-

graduate degree, ophthalmologists earn an

MD degree after 4 years of medical school.

This is followed by a 1 year transitional in-

ternship, which can be in any branch of med-

Optometry: A Visible Contributor toa Primary Care Team

icine, followed by a 3 year surgical residency.

Many ophthalmologists pursue additional

fellowship training, such as retina, glaucoma, cornea, or neuro.

Doctors of optometry (OD’s), after com-

pleting an undergraduate degree, complete

4 years of optometry school and frequently

a 1 year non-surgical residency. Years 1 and

2 include course work very similar to general

medical education. Many programs involve

adjunct faculty from medical programs pro-

viding instruction in anatomy, physiology,

and clinicalmedicine. Years 3 and 4 focus on

clinical education. Students graduate with

2,500-3,000 patient encounters. Additional

residency adds at least 1,200 patient en-counters to that count. These include a mix

of post-surgical, medical, and routine visits.

• The central focus of ophthalmology is

surgery and management of complex

diseases of the eye. These specialists do

precious work, and their schedules are

typically heavily committed, including

time in the OR.

• Doctors of optometry provide the lion’s

share of routine care (>70% of all eye

care visits) with a growing focus on

medical and primary care adjunctive

evaluations such as diabetes. Most OD’s

spend 20% of their clinic day on medical

and post-surgical conditions, althoughsome run much higher.

Dr. Shoemaker: For many physicians,the eye is a mysterious place...with its ownarcane nomenclature, elaborate tools of the trade, and huge stakes as possibly ourmost treasured organ system. All primarycare physicians use a hand held ophthal-moscope, which is rather limited, frankly.Very few PCP’s have access to a slit lamp...or know how to use one. What are the toolsthat allow an optometrist to accuratelyidentify problems that a PCP struggles to

see?

Dr. Meng: All OD’s routinely employ

a slit lamp. This instrument offers a 3 di-

mensional, magnified view of the anterior

segment of the eye to detect corneal abra-

sions, foreign bodies, conjunctivitis, iritis,

cataracts, etc. We use f luorescein staining to

distinguish conditions such as early herpetic

keratitis. It’s hard to make these distinctions

with a hand held ophthalmoscope, which

offers only a 2 dimensional view. The cor-

rect treatment for these conditions...and the

avoidance of damaging complications...can

depend completely on making the correctinitial diagnosis.

OD’s also use a condensing lens to view

the retina and optic nerve in great detail...

critical for diabetic exams, retinal tears, and

hypertensive retinopathy. A gonioscopy

lens is employed to check the angles of the

eye for glaucoma. A tonometer is an at-

tachment to the slit lamp that measures the

pressure of the eye. K eratometers are also

standard equipment, which measures the

curvature of the cornea. This device is useful


An interview with

Wells Shoemaker, MD

Karen Meng, OD



16

for fitting contact lenses and also detecting

keratoconus. That’s not the whole list, but

you get the picture.

Dr. Shoemaker: OK, optometrists cer-

tainly prescribe glasses and contacts, and these are typically low stress, scheduled appointments. But beyond that...can youdescribe the capabilities in every optome-trist’s office to diagnose and manage acutediseases of the eye?

Dr. Meng: All OD’s in California can diag-

nose mild to severe eye problems such as

serious eye infections, inf lammations of the

eye, trauma, foreign bodies, and glaucoma,

using the tools we described earlier.

Most visits for acute problems can be

treated by the OD, but others are referred. The OD recognizes the urgency of certain

situations and can communicate effectively

with the ophthalmologist when time is of the

essence.

We see our patients more frequently than

you might think. Current statistics indicate

that 99.4 million eye exams are performed

yearly as compared with 27.5 million general

physical exams nationwide. Routine exams

address known issues, such as diabetes, but

in many cases they can detect early signs of

eye disease and ocular signs of systemic con-

ditions such as hypertension or dyslipidemia.

Dr. Shoemaker: It sounds like a great opportunity for an OD, using an integrated

record system, to reinforce sound medical advice and identify patient concerns that

might go on for months otherwise. What would it look like if an optometrist were aformal member of a modern primary careteam?

Dr. Meng: Clear task definition and lines

of communication, for starters. In the past,

OD’s have not actively forged relationshipswith primary care medicine, and that would

take some personal work to change. The

The healthy retina

Macular Degeneration Diabetic Retinopathy is one of the leading causes of blindness.





17

U P C O M I N G E V E N T SCAPG Contracts Committee (No Cal)March 21, 2013

Oak land, CA*

CAPG Contracts Committee (So Cal)March 28, 2013

Los Angeles, CAPG Oice *

CAPG Health Information Technology CommitteeApril 9,2013

Web-ex /Teleconerence *

CAPG Public Relations/MarketingCommitteeApril 16,2013


CAPG Inland Empire Regional

CommitteeApril 17, 2013

Riverside, CA *

CAPG Human Resources CommitteeApril 23,2013


CAPG San Diego Regional CommitteeApril 24,2013

San Diego, CA *

CAPG Pharmaceutical Care CommitteeApril 30,2013


CAPG General Membership (So Cal)May 7, 2013


CAPG State Government ProgramsCommitteeMay14,2013


CAPG Medical Policy CommitteeMay14,2013


CAPG General Membership (No Cal)May16,2012

Oak land, CA *

2013 Annual CAPG HealthcareConferenceJune 6-9, 2013JW Marriott, LA LIVE

www.CAPG.org /conerence2013

2013 Health Care Provider ConferenceJune 13-14,2013 The Westin, San Diego

www.hasc.org /2013WellnessConerence

* For more inormation contact CAPG at (213) 642-CAPG


potential is definitely there.

Given the geographic distribution and

spread among urban, suburban, and rural ar-

eas, OD’s are well positioned to enhance the

primary care network. Utilizing the roughly

5,000 doctors of optometry, even to a partial

degree, would help soften the impact of the

impending PCP workforce shortage.

Dr. Shoemaker: Interesting! If such a

remodeled team were tested, what would

you suggest might be an optimum ratio of

primary care physicians to OD’s?

If the intended use for OD’s is specialty

care and routine eye care, that ratio would

likely range from 15:1 to 10:1. That might

change if OD’s were included in more team-

based chronic care management.

Dr. Shoemaker: Sounds like an worthy

study! CAPG’s member groups uphold carecoordination as their key contribution tobetter care. Fully integrated groups could relatively quickly create “pods” of primary care doctors with optometrists in the samebuilding or campus for same day consulta-tion. But...how might that look in an IPA?

IPA’s could create a virtual “eye home”

where OD’s and ophthalmologists work in a

protocol-defined partnership to offer a cost

efficient model. A fair number of the routine,

chronic care visits as well as common acute

eye problems would easily fit with forms that

could be electronically shared and incorpo-

rated into a shared medical record.

There are definitely a number of clinical

problems where the right tools and the right

diagnosis can make a big difference in pa-tient outcomes...and these generally require

reliable, same day visits. OD’s in a “medical

neighborhood” would need to guarantee

this!

Dr. Shoemaker: Thank you, Dr. Meng.

In my 25 years in primary care pediatrics,I used to shudder with the child with theunilateral inflamed eye. Once burnedby missed herpes or intentional trauma,always anxious. I would definitely havewelcomed this kind of help. We’ll see whatthe future holds!

If you have an event to submit for this column, please do so at [email protected] Please includethe name of the event, the date, location and where to get additional information.



18

O R G A N I Z A T I O N AORGANIZATIONAL MEMBERS

Accountable HealthCare IPAGeorge M. Jayatilaka, MD, President& CEODruvi Jayatilaka, Vice President

Advanced MedicalManagement, Inc.K athy Hegstrom, President

• Access Medical Group • Future Care IPA • Pre-mierCare IPA • Seoul Medical Group • Southern Caliornia Medical Coalition •

Afnity MedicalGroupRichard Sankary, MD, PresidentScott Ptacnik, COO

AllCare IPA*Randy Winter, MD, PresidentMatt Coury, CEO

All Care MedicalGroupSamuel Rotenberg, MD, Medical DirectorCraig K aner, Administrator

Allied Physicians of California Thomas Lam, MD, CEOK enneth Sim, MD, CFO AltaBates Medical Group *Richard L. Oken, MD, President and Chairman of the BoardEvan Moore, Vice President, East Bay Region AltaMed Health ServicesCorporation*Martin Serota, MD, Chie Medical OfcerCastulo de la Rocha, JD, President /CEO

AppleCare Medical Management*Surendra Jain, MD, Chie Medical OfcerVinod Jivrajka, MD, President /CEO

Arch Health PartnersScott Flinn, MD, Chie Medical OfcerVictoria Lister, CEO

Bak erseld Family Medical CenterJu Hwan Lee, MD, Medical Director

BayValley MedicalGroup, Inc. *Eric K ohleriter, MD, President /Medical DirectorShelley Horwitz, Chie Executive Ofcer

Beaver Medical Group *Charles Payton, MD, VP Medical Administration /CMOJohn Goodman, President /CEO Brown& Toland Physicians *Andrew M. Snyder, MD, Chie Medical OfcerRichard Fish, CEO

California Pacic Physicians MedicalGroup, Inc.Dien V. Pham, MD, Chie Executive OfcerCarol Houchins, Administrator

CareMore MedicalGroupDonald Furman MD. Chie MedicalOfcer

Tom Tancredi, Dir. o Practice Operations

Catholic Health Initiatives*Stephen Spare, MD, President and CMOJames Slaggert, VP Physician Practice Management

Cedars-Sinai Medical Group *Stephen C. Deutsch, MD, Chie Medical Director

Thomas D. Gordon, CEO

Children’s Physicians MedicalGroup Tanya Dansky, MD, CEO and Medical DirectorLeonard K ornreich, MD, Board President

Chinese Community HealthCareAssociationEdward A. Chow, MD, Executive DirectorPolly Chen, Director o Operations

Choice MedicalGroup IPAManmohan Nayyar, MD, PresidentBlair Bryson, IPA Administrator

Cigna MedicalGroupJames Burrell, MD, Chie Medical OfcerEdward K im, President and General Manager

CMSCAP Management SystemsMegan North, CEO

• AK M Medical Group • Amvi Medical Group •Exceptional Care Medical Group • Family Choice Medical Group • Family Health Alliance • Huntington Park Mission Medical Group • Medicina Familia Medical Group • New Horizon MedicalGroup • Noble Community Medical Associates • OmniCare MedicalGroup • Premier Physician Network • United Care Medical Group •

Community HealthCenter Network Melissa Marshall, MD, Chie Medical Ofcer Ralph Silber, CEO DCHS Medical FoundationDean M. Didech, MD Chie Medical OfcerErnest Wallerstein, CEO

DesertOasis Healthcare*Marc Hofng, MD, MedicalDirectorDan Frank, Chie Operating Ofcer

Dignity HealthK arl Ulrich, MD, Chie Physician Executive

Bruce Swartz, SVP, Physician Integration

Empire Physicians MedicalGroup*Steven Dorman, MD, PresidentYvonne Sonnenberg, Executive Director

Facey Medical Foundation *Erik Davydov, MD, Medical DirectorBill Gil, President /CEO

GoldenEmpire ManagedCare, Inc. *c. Vincent Phillips, MD PresidentRobert Severs, CEO

Good Samaritan MedicalPracticeAssociationNupar K umar, MD, MedicalDirector Cynthia Guzman, CEO

GreaterNewport Physicians MedicalGroup, Inc. *Alan Puzarne, COODiane Laird, CEO

HealthCare Partners*Robert Margolis, MD, Managing Partner, CEOMatthew Mazdyasni, Executive Vice President

Heritage ProviderNetwork *Richard Merkin, MD, PresidentRichard Lipeles, Chie Operations Ofcer

• Afliated Doctors o Orange County • Bakerseld Family Medical Group • Caliornia Coastal Physician Network • Caliornia Desert IPA • Desert Oasis Healthcare • Greater Covina Medical Group • Heritage Physician Network • Heritage Victor Valley Medical

Group • High Desert Medical Group • Regal MedicalGroup • Sierra Medical Group •

High Desert MedicalGroupCharles Lim, MD, FACP, Medical DirectorAnthony Dulgero , MD, Assistant Medical Director

HillPhysicians MedicalGroup, Inc. * Tom Long, MD, Chie Medical OfcerDarryl Cardoza, CEO

Independence MedicalGroupArmi Lynn Walker, MD, Medical DirectorGary M. Bohamed, Executive Director

Inland HealthCare Group, Inc.Carey Paul, MD, PresidentLisa Perko, Controller

John Muir Physician Network Ravi Hundal, MD, Medical DirectorLee Huskins, Interim CEO /Sr.VP / COO Lak eside Community Healthcare

K erry Weiner, MD, Chie Medical OfcerJonathan Gluck, Counsel

Lak eside Medical Group, Inc.

Lak ewood IPAStevenVillalobos, MD, Medical DirectorCynthia Guzman, CPA, Chie Executive Ofcer

• Alamitos IPA • St. Mary IPA • Brookshire IPA •

Loma LindaUniversity HealthCareJ. Todd Martell, MD, Medical DirectorJane Arden, Director, Quality Management

MaxiMed IPAAlejandro Gonzalez, DO, Medical DirectorJacob Tchamanian, CEO

McKinley MedicalGroup, Inc.Stanley Schwartz, MD, PresidentJohn Mukherjee, CEO

MED3000Gary Pro ett, MD, Medical DirectorLynn Stratton Haas, CEO

• SeaView IPA • Valley Care IPA •

Med Point ManagementRick Powell, MD, Medical DirectorK imberly Carey, Administrator

• Apollo Healthcare • Bella Vista MedicalGroup IPA •Centinela Valley IPA • El Proyecto Del Barrio, Inc. •Global Care MedicalGroup • HealthCare LA IPA •

Mission Community IPA • Riverside Family Health Medical Group • Watts Health Care Corporation •

MemorialHealthCare IPARonald Zent, MD, Medical DirectorK urt Tamaru, MD, CMO /Interim CEO

MemorialCare MedicalGroup *Mark Schaer, MD, Chie Medical OfcerPatrick E. K apsner, CEO Meritage Medical Network J. David Andrew, MD, Medical DirectorJoel Criste, CEO

Midcoast Care Inc., AMedicalGroupJohn Okerblom, MD, PresidentBarbara Cheever, Executive Director



19

Molina Medical Centers Steve O’Dell, Regional Vice President Gloria Calderon, Vice President

Monarch HealthCare *Bart Asner, MD, CEOJay Cohen, MD, President /Executive Chairman

Muir MedicalGroup, IPASteve K aplan, MD, PresidentUte Burness, RN, CEO NAMMCalifornia*Leigh Hutchins, President, COOElizabeth Haughton, Vice President, Legal A airs

• Coachella Valley Physicians o PrimeCare, Inc., •Mercy Physicians Medical Group • Primary Care Associated Medical Group, Inc. • PrimeCare MedicalGroup o Chino • PrimeCare o Citrus Valley •PrimeCare o Corona • PrimeCare o Hemet Valley Inc• PrimeCare o Inland Valley • PrimeCare o Moreno Valley • PrimeCare o Redlands • P rimeCare o Riverside • PrimeCare o San Bernardino • PrimeCare o Sun City • PrimeCare o Temecula • Redlands Family Practice Medical Group, Inc. •

Omnicare MedicalGroupAshok Raheja, MD, Medical Director

Toni Chavis, MD, President

Pacic IPA Thomas Chiu, MD, PresidentPeder Lindblom, Executive Director

The Permanente MedicalGroup, Inc.Oakland(North)*Sharon Levine, MD, Associate Executive DirectorGerard Bajada, VP /Director, Financial Services

Physicians DataTrustAnthony Ausband, President Lisa Serratore, Chie Operations Ofcer

•Greater Tri-Cities IPA •Noble AMA IPA • St.Vincent IPA •

Physicians MedicalGroup of SantaCruz*Marvin Labrie, CEONancy Greenstreet, MD, Medical Director

PIH Health PhysiciansK athleen Barry, MD, Sr. MedicalDirector, ClinicalOperations

Tom Mahowald, President

Pioneer MedicalGroup, Inc. *Jerry Floro, President John K irk, CEO

Preferred IPAof CaliforniaMark Amico, MD, Medical Director

Zahra Movaghar, Administrator Prospect Medical GroupPrasad Jeereddi, MD, ChairmanMark Marten, COO

• AMVI /Prospect Health Network • Gateway MedicalGroup • Genesis Healthcare • Nuestra Familia MedicalGroup • Prospect Corona • Prospect HealthSource •Prospect Huntington Beach Prospect Northwest Orange County • Prospect Orange County • Prospect Proessional Care • Prospect Van Nuys •

Providence MedicalManagement ServicesMarvin K anter, MD, Chie Physician Integration OfcerJoan Rose Baranov, Chie Operating Ofcer

• K orean American Medical Group • Providence Care Network •

River City MedicalGroup, Inc.Jose Abad, MD, President /Medical DirectorLoren Douglas, CEO

Riverside Medical ClinicSteven Larson, MD, ChairmanJudy Carpenter, President /COO Riverside Physician Network Paul Snowden, COOHoward Saner, CEO

St. Joseph Heritage HealthcareK haliq Siddiq, MD, Chie Medical OfcerC.R. Burke, Chie Executive Ofcer

SanBernardino MedicalGroup Thomas Hellwig, MD, PresidentJames Malin, CEO

San Diego Physicians MedicalGroup

James Cordell, MD, PresidentJoyce Cook, CEO

San LuisObispo Select IPABarbara Cheever, Executive Director

Sansum Clinic *K urt Ransoho , MD, Medical Director /CEOVince Jensen, COO SantaClaraCounty IPA (SCCIPA)*J. K ersten K rat, MD, President o the BoardRandall Frakes, Chie Executive Ofcer

SantéHealth System, Inc Daniel Bluestone, MD, Medical DirectorScott B. Wells, CEO

ScrippsCoastalMedical Center*Louis Hogree, MD, APC, Chie MedicalOfcer

Tracy Chu, Assistant Vice President o Operations

SharpCommunity MedicalGroup *John Jenrette, MD, Chie Executive OfcerChristopher McGlone, Chie Operating Ofcer

• Graybill Medical Group SharpRees-Stealy MedicalGroup *Donald C. Balour, III, MD, Chie Medical OfcerStacey Hrountas, Senior VP & Chie Executive Ofcer

Southern California Permanente MedicalGroup*Mark Bird, MD, Sr. Physician ExecutiveJames Malone, Medical Group Administrator

Sutter Health Foundations & Afliated Groups *Je rey Burnich, MD, SVP & Executive Ofcer, Sutter Medical Network Brian Roach, President, Mills Peninsula Division o PAMF

• Palo Alto Medical Foundation • Sutter MedicalFoundation • Sutter North Medical Foundation •Sutter West Medical Group • Sutter North MedicalGroup • Sutter Medical Group • Sutter Region MedicalFoundation • Sutter Independent Physicians • Solano Regional Medical Group • Sutter Gould Foundation •Camino Medical Group • Sutter Gould Medical Group • Santa Cruz Medical Clinic • Sutter MedicalFoundation—North Bay • Sutter Medical Group o the Redwoods • Physician Foundation—Caliornia PacicMedical Center •

SynerMed, Inc. *George Ma, MDJames Mason, President & CEO

• Angeles IPA • Crown City Medical Group • EHS Inland Valleys IPA • EHS Medical Group – CentralValley • EHS Medical Group – Los Angeles • EHS

Medical Group – Sacramento • Employee Health Systems • MultiCultural IPA • Southern Caliornia Children’s Network •

Talbert MedicalGroup *K eith Wilson, MD, President& CEO Torrance Hospital IPANorman Panitch, MD, PresidentStephen J. Linesch, CEO U.C.L.A. MedicalGroup *Sam Skootksy, MD, MedicalDirectorDavid Hartenbower, MD, COO

USC Care Medical Group, Inc.Donald Larsen, MD, Chie Medical OfcerK eith Gran, CEO

CORPORATE PARTNERS

Adventist Health Physicians Network Anthem Blue Cross o CaliorniaBoehringer Ingelheim Pharmaceuticals, Inc.Merck & Co.Novartis PharmaceuticalsNovo Nordisk SCAN Health Plan

ASSOCIATE PARTNERS

abbvie

ActavisAmgen Inc.AstraZeneca PharmaceuticalsCardiovascular Consultants, LTDCrescent Healthcare, Inc.Daiichi SankyoEisai, Inc.GenPath DiagnosticsGenomic HealthGlaxoSmithKlineJohnson & Johnson Family o CompaniesK indred Healthcare, Inc.NORCAL Mutual Insurance CompanyPzer, Inc.Ralphs Grocery CompanySanoSunovion Pharmaceuticals Inc.Vitas Healthcare Corporation o Caliornia

AFFILIATE PARTNERS

AlturaAscender Sotware, LLCClarity Health ServicesChildrens Hospital Los Angeles Medical GroupDPS HealthMedVentive Inc.MedVision, Inc. MZI HealthCare, LLCRedlands Community HospitalSaint Agnes Medical GroupSullivan /Luallin, Inc.Unlimited Innovations, Inc. Ventegra, LLC

M E M B E R S & P A R T N E R S



20

. oining the CAPCI team is truly an honor. For the last 36 years, I have been

drawn to eorts about change, ocusing

on campaigns to both improve the pub-

lic’s health and the quality o healthcare

patients receive. CAPCI provided the op-

portunity to jump in and take on one o

the greatest challenges or healthcare and

health in general: revitalizing primary care

in Caliornia.

It’s Personal & Professional

My husband is a pediatrician who or

most o his proessional lie worked in solo practice in the San Joaquin Valley. He was

able to “be there” when our twin daugh-

ters were born, but didn’t get to be there

with them much over the next ew years

o their lives as he built his practice. Our

amily enjoyed its irst vacation when our

daughters were almost seven.

He loved what he did and his patients

loved him. However, he wasn’t home or

most meals with the amily and didn’t see

our daughters much on weekends either.

While he loved the time with his patients,

he wasn’t getting to be Dad. He eventu-ally made a change and joined a group

practice, not to change his income, but to

improve the quality o lie or himsel and

his amily.

I’ve lived the challenges oten described

or primary care. I want to see primary care

attract a new group o clinicians who value

the critical role it plays in our healthcare

and health systems. I want to see primary

care become an exciting, livable specialty

that is valued by those who train our clini-

cians, by those who make the policy deci-

sions, and by those who choose clinicalmedicine as their lie course. That’s where

CAPCI comes in.

CAPCI as an Organization

Our nation is poised to undergo the

most dramatic change in its healthcare sys-

tem since the start o Medicare almost ity

years ago. A key element o this change

process will be recasting the role and unc-

tion o primary care. Caliornia provides

the model or this change through its in-

tegrated healthcare in community health

By Elissa Maas, MPH

Executive Director CAPCI

A Vision for CAPCIcenters, chartered private organizations,

and military systems.

As CAPCI’s Executive Director, I want to

see us drive the agenda that primary care

is the oundation or healthcare delivery.

With our credibility and credentials, we can

play a lead role in helping policy makers,

healthcare providers, patients, and payors

develop and embrace new approaches to

organize the primary care team. To make

this happen, CAPCI will bring together

organizations rom a broad spectrum o

interests to share their experiences and

expertise to strengthen and revitalize pri-

mary care through our 4P’s: Pipeline, Prac-

tice Redesign, Payment, and Policy.

CAPCI’s Impact

CAPCI is embarking upon both a short

and a long-term transormation o primary

care.

i We envision that CAPCI will help to

inorm policies that anchor and

sustainably support primary care

practice.

i Members o the healthcare team,

working at the top o their game, willbecome the norm or primary care,

with the patient as the heart and soul

o that team.

i Primary care physicians, with

sophisticated supports, can expand

their roles to manage patients with

more complex health needs.

i Organizations which in the past may

have worked in separate silos…or

which competed without cooperat-

ing…will nd success by working in

partnership to strengthen primary

care in their communities.

i

Community initiative can accelerate collaboration among local healthcare

systems and improve overall health.

A change o this magnitude will require

the entire healthcare community to sup-

port one another’s eorts so that individu-

als and communities receive the care they

need. We have plenty o work in store!

Partnership WorksWe intend to engage our many partners to build an eective,

diverse, primary care workorce providing quality, culturally re-sponsive, aordable care across the continuum o care…on a community-wide scale. CAPCI will provide the training, tools, and support or healthcare organizations to implement advanced pri-mary care principles and practices.

Elissa Maas MPH, Executive Director, CAPCI



21

A breakout session will look at the Advanced Primary Care and Medical Home concepts through three lenses:

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KEVINGRUMBACH MD, eatured in this issue,

will expand upon the “Pipeline”issues involving the training envi-ronment. Beyond improving the

raming and appeal o primary care, what must be changed in tradi-

tional training to prepare new PCPs or the team roles and system thinking o the next decade.

JOHN JENRETTE MD, principal in one o

Caliornia’s six pioneer ACO’s, willdescribe Advanced Primary Care as a community wide interest, eaturing the cross-linking in-

novations o San Diego County’s community clinics, public health, private sector organizations,

military, and VA.

DAVID NACE MD,

President o the Patient Centered Primary Care Collaborative and senior leader in McK esson, willdescribe industry’s

multi-state stake in the success o modernized

primary care.



22

Advertisers Index:

BROWN & TOLAND....Outside Back Cover

HILL PHYSICIANS..........Inside Front Cover

VI TAS......................................................Page 3

Blair Bryson, AdministratorChoice Medical Group

Blair Bryson, Administrator

Choice Medical Group

& lair resides in Riverside, CA, is

married, and the ather o our children. He

is a graduate o Brigham Young University,

where he earned a degree in Accounting.

Prior to his career in healthcare, Blair

worked in public accounting, banking and

as an analyst evaluating and integrating

business acquisitions. He stumbled into

healthcare by accident when he was hired

as a consultant by an Inland Empire physi-

cian who had ormed an IPA. He was given the task o creating a business plan or the

new IPA. That engagement has led to 17

years o experiences in healthcare man-

agement in the Caliornia managed care

industry. Lacking a clinical background, Blair has used his experience in other in-

dustries to ocus on healthcare systems

and processes. He noted that many other

industries had already deployed more ma-

ture and consistent processes than man-

aged care had in the nineties.

In 1999, Blair teamed with the ounders

o Unlimited Innovations to create one

o the irst online portals widely used or

healthcare inormation technology. He

created the use case architecture that pio-

neered online access or eligibility, reerrals

and claims management, which enhanced the timely delivery o care. This system is

still in use or more than 300,000 patients.

Blair’s company, Raven Resources, provides

administrative, compliance and technol-

ogy support to medical groups that serve

more than 100,000 patients contracted

with every major health plan in Caliornia.

Blair is currently serving as the Adminis-

trator or Choice Medical Group. Choice

has been recognized as having achieved

“Elite” status with the Caliornia Associa-

tion o Physician Groups in our o the last

ive years, including 2012. Blair continues to enjoy the challenges o making “health-

care processes work ”. As Administrator

or Choice, he sees the challenges the PCP

aces as an independent provider, and

believes that now more than ever, IPAs

can serve the PCP and the patient by lev-

eraging best practices and technologies

to achieve improvements in quality and

proitability. Blair is a committed advocate

o participation in CAPG, CQC and other

industry groups through which solutions

are shared.

C A P G M E M B E R S P O T L I G H T

“...now more than ever,IPAs can serve the PCP and the patient by lever-aging best practices and

technologies to achieveimprovements in quality and profitability. “



23

VOL.4,NO.3

Dr. Keith WilsonStayingThe Course -navigatinghealthcare today

Transportation Creates HealthierCommunities

Preventing Hospital Admissionsand Re-admissions

SPRING 2010|SPECIAL CONFER

Reserve Your Ad SpaceNow InCAPG Health’sHigh Profile,

AnnualConferenceEdition

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For more informationemail [email protected] call 916.761.1853

IMPORTANT: Ad deadline is Friday, May 1, 2013!

VOL.4,NO. 3 SPRING2010 SPECIAL CONFER

VOL. 5, NO. 3

The InnovationCenter: The JourneTo Lower Costs AndBetter CareRichard Gilfllan, M.D.

Healthcare Mergers AndAcquisitions

Employers View OnHealthcare Reorm

Creating a Common VisionO Accountable Care

SPECIAL CONFERENCE EDITIONVOL. 5, NO. 3 SPECIAL CONFERENCE EDITION

VOL. 6, NO. 4 MA

The Ever-ChanginHealthcareLandscapeDonald Berwick, MD

Demystiying ComplexCare Management

Pioneer ACO Creation &Implementation

SPECIAL CONFERENCE EDITION

Conference 2013 Theme: REFORM, INNOVATION

AND ACCOUNTABILITY THE FUTURE IS NOW



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Documents

CAPGMarApr2013 OD Article(3)