hi i'm joel bloom president of new jersey institute of technology. at njit we believe that all not only our students but all citizens needs to be informed about the issues facing higher educaiton. as new jersey's science and technology university njit is proud to support the important programming produced by the caucus educational corporation and their partners in public television. patient centered care and the new model for health next on caucus new jersey funding for this edition of caucus new jersey has been provided by barnabas health life is better healthy new jersey's credit unions banking you can trust the new jersey education association working for great public schools for every child new jersey natural gas proud to support education in our communities united water making the planet sustainable is the best job on earth johnson and johnson and new jersey sharing

network dedicated to saving lives through organ and tissue donation promotional support provided by the star ledger powering nj.com and commerce magazine [music playing] [music playing] welcome to caucus new jersey i'm steve adubato you know across the nation healthcare is adopting a more preventative patient centered model of care joining us here in the studio to discuss this new and very important approach we have doctor terry shlimbaum medical director delaware valley and phillips-barber family health center doctor steven peskin senior medical director for horizon's healthcare innovations christine stearns vice president of health and legal affairs new jersey business and industry association and finally doctor joel cantor distinguished professor and director of the center for state health policy at

rutgers university i want to thank all of you for joining us and talking about patient centered care a new model for health by the way you'll see several websites throughout this program check those websites out valuable information by the way are we talking about this really a new model of care? so steve that's a great question i would say it's new and it's old so ostensibly the best care that people were receiving from their family doctor their general internist their pediatrician would be like what we want it to be today care got fragmmented care got fragmented in the 70's and the 80's technology we're putting the pieces back together so here's the thing i think the language is we were doing fee for service right joel? right we go from fee for service to patient centered care so give me you know i said before we got on the air i'm big on examples concrete examples of people going oh that's what you're talking about give me fee for service you go in i've got give me an ailment that i'm

likely to have no never mind that [laughter] [laughter] diabetes no not that one don't give me something really bad okay so i go on high lipids okay i got high lipids i got problems i got high lipids you know i got a blood pressure thing cholesterol yeah okay i go in just treat me for that doc sure that's fee for service what happens? so the old model the doctor gets paid when you show up doesn't get paid if he needs to or she needs to give you a call if you call in and ask for advice it's a burden you don't get paid for it uh they don't get paid to keep track of how you're doing they don't get paid to find out when you're in the hospital and immediately get on top of it this is fee for service? that's the fee for service go ahead keep going t's just... you know you pay for he visit that's it the new model patient centered...? patient centered model the medical practices are expected to do more have more hours be more accessible be available by phone by email have computerized medical records so that for example you don't fill your prescription just want... hold on... well no

stay on this joel i just went in for the high blood pressure i say doc treat me for the high blood pressure okay patient centered care would cause what to happen? so let's take your high blood pressure so say you get a prescription you're supposed to stay on that prescription i'm good doctor leave me alone let me get out of here does that feel good? right you make a mistake i feel good i don't think i need the drug anymore not true so then the doctor's office gets a flag in their computer system and they have a nurse or an assistant call you and say steve you didn't fill your prescription why not? they're calling me? they're calling you and you say well i feel better they say no no no no you got to stay on the med for life go fill your prescription that can avoid a stroke a year or two down the road but i never talked to them about a stroke doctor i only talked about this one thing no? well that certainly would be one of the discussion topics that you would have but i would look at it also in a different way you get your blood pressure taken care of and what joel is referring to could happen but you also

might walk out with a referral for a colonoscopy that you needed 'm sorry what... how did i get a colonoscopy? [laughter] [laughter] [laughter] okay you turn 50 and stuff happens right? right right so let me get this straight hey ask me i go for a... i go in for high blood pressure and they're gonna ask me when was my last colonoscopy? yeah are you serious? i am serious. it can happen. let me give you another example steve whya re you shaking your head like i need a colonoscopy [laughter] you know too? so you're saying that's patient centered care? we want people to get the right care when they need it and that is where the healthcare system needs to go you know cause employers we've always complained about the high cost of healthcare but really where the trend is heading is to make sure that people are getting high value health care that we're paying for the right things but hold on i'm confused because i don't see how that reduces healthcare costs because if i and this is not about me this is about whomever goes in you go in but if they're gonna give you the colonoscopy or they're checking for these other things and i only went in for the high blood pressure

then how is that potentially educing costs it seems like it's more no? let me give you an example of what you asked the first time and you asked us to be use plain language so a woman that i work with her boss center to me without it you know go talk to peskin about your experience she has been with her doctor for 40 years she likes this person she trusts this person this practice became a medical home so we pay them to do things like doctor cantor like joel is saying so what's a medical home? so the medical home is not a nursing home it's not a mobile van got it it's your health home got it where everything should be organized and coordinated so she said to me you know i really like my doctor 40 years she trusts him it's better it's better well why is it better? it's better because they followed up with me because they had this nurse who works in the office they didn't work there before she talks to me in plain language with all due respect to my doctor to sometimes use these big words that i don't understand it's better and that's patient centered? that's patient centered

and then the second question you asked about cost yes great question a hard question so what joel said about the inpatient so that we can now take patients who are in the hospital and move them more quickly more effectively safely appropriately out of the hospital one of the biggest problems that has saddled our system is people go in the hospital and then they go back into the hospital and why do they go back in the hospital? because they get all these instructions that they don't understand they're sick they don't feel good and then they're kinda wheeled out now we get them back into their primary care doctor's office let me go over these things with you let me why did you end up in the hospital? but isn't it also because again i'm trying to understand this as a layperson isn't it also doctor if you get if i go in and i get that colonoscopy and i in no intention it was not my intention to get it but a thorough examination by using the medical records right joel? mm hmm says hey wait a minute when was the last one oh you haven't had it yeah you should

the potential exists to find a situation potentially that would help me but also potentially save money to the healthcare system am i missing something? this is front side more expensive backside way less expensive so in other words what you're saying your preventative care is cost effective [laughter] backside economics [laughter] [laughter] yeah backside... bad choice of words not my backside but [laughter] bad choice of term but enough about me let's talk about the economics [laughter] so really you're saying are you saying that it may be more a front cost to save in the long run is that what you're saying? yes so we have to remember that half of the healthcare costs in this country are generated by just five percent of people five percent of the sickest people generate half the costs that's do that again joel five percent of people the sickest five percent cost... generate half of the healthcare costs in this country and so if we can do a better job if the

medical practices can do a better job with... those are the patients that are cycling in and out of the hospitals yes right they have multiple chronic conditions they have heart failure high blood pressure and diabetes they are the real cost drivers if we can improve care for them and this model does that there's plenty of evidence then they will cost a litle bit less a patient centered medical home really really addresses chronic care that's a big thing patient centered medical home addresses the chronic care issues that joel was just talking about right so if a diabetic comes into our office and maybe they come in for a sore throat we will have the resources to be able to address the problems that they that you know they may not have come into the office for a diabetic check but we're gonna do a long term checkup of the blood sugar or we're going to check their feet we have all our diabetics take their shoes shoes and socks off and why do you do all those things? is it because that is better medicine? smarter medicine? more economical in the long run all those

reasons? yes mm hmm why does the business community care about this? the cost of coverage has been one of the biggest complaints of the business community for decades. we're in a time now where we're seeing a transition from paying doctors every time they sort of touch the patient to paying them for keeping people healthy for really taking greater responsibility overall for their health. and i think being able to do that without spending more money so that when we spend the money that we have in the system more efficiently that get better outcomes and i think that is a good thing for employers it's a good thing for our employees that they're gonna have better health outcomes you know employers buy health insurance you know to attract and retain good employees sure to keep people healthy and productive to reduce absenteeism so this all fits together but it's a difficult transition it's hard to change a system that is somewhat dysfunctional and hard to understand it's going to be hard for employers and

employees to figure out this new model excuse me is it even harder for smaller businesses? small businesses are having a very hard time right now in buying health insurance you know the aca has been the aca the affordable care act? the affordable care act has been disruptive for them disruptive? disruptive by the way check out our website cause we did an entire segment with joel talking about the implementation of the affordable care act which is airing on our one on one program and on capitol report really good stuff but go ahead you say it's been disruptive? it's been disruptive employers are seeing new plans on the market as we transition to the metal tiers so they're buying bronze or silver that has changed these are different levels of service and... but you pay more depending upon the coverage that you're seeking? you do. your out of pocket is changing and for some of those plans significantly higher out of pocket they're getting greater benefits the aca added go ahead more benefits so what's the confusion? um it you know sometimes they liked what they had and they kind of wanted to keep it [laughter]

okay i'm not gonna make this show about the aca i don't want to get there but there is but what does that have to but hold on what does that do so that with the patient centered care? i think what they're seeing with the new plans that are coming onto the market that they actually are at a good price point... for premiums but aren't premiums coming down to some extent here? for patient centered care? mm hmm we are offering to her members a product... the business and industry association? to small businesses small businesses a product that is i just want to be clear so it's not a special deal? it's not a special process i just want to clarify that all small businesses have the opportunity to buy these plans but would you meet the need of what they've been looking for which is affordable premiums but also assessing this kind of higher quality care this certain value come back in talk to us so fifteen percent less so that on our best on horizon's best product before this cost will be fifteen percent less and going to great doctors like doctor shlimbaum choosing patient centered medical home fancy term but choosing a primary

care doctor maybe that makes it easier for folks to understand and then you will pay less out of pocket got it you steve adubato will pay less out of pocket and that would be a lower cost to your employer affordability right higher quality so why... it sounds like it makes sense so someone watching right now is thinking okay so why wouldn't i want hat a and b if i don't have that what do i do about it? well you have to call your insurance company and ask them about it and they ask for something called patient centered care? or patient centered medical home is that the termiology? that's the jargon okay that's right and you know horizon's out front offering discounts and advertising these plans but i want to be clear others it's... others do this yeah this is a movement right it's a real movement in the industry? they are at the front end of it but it is a movement in the industry and the whole system is moving in this

direction but doesn't it have to change though this is interesting i keep talking to our producers before we came in here and getting ready for this and i kept thinking this has to change the relationship the dynamics the communication between physicians and their patients because first of all the physician doctor has to be much more proactive in what he or she is raising in terms of whatever hey wait a minute i'm just... first i have to be looking at the medical records of the patient they have to care enough to do that they have to have a system and a staff to do that and the patient has to be responsive when he or she hears that information to do something about it that's an incredible shift in the existing paradigm correct? well in the past we had to manage our care manage our patients in a way that was very difficult because it was... we didn't have the resources to do it so patient cenered medical home is a way to provide us with some of those resources so as steve had said earlier that long discussion that would prevent us from seeing

other people can now be handled by a care manager what have you those things are so different and so much better for our patients and so what else is needed? so physicians really want to do a better job and this is an opportunity for us to be able to do it we're talking about sorry for interrupting are we talking about other than physicians the other clinical the other medical staff we're talking about who are they? care coordinators we could have in our office we have previsit planners what are these people doing? o a previsit planner is a person who looks over the electronic record before a person comes in flags the... flags it for the doctor so that it's very seamless and easy for us to be able to do better things so it's not the doctor doing this alone right this is a team of people i'm sick of going so the doctor's sitting there looking at the record? they said... we have been remiss by not using the word team earlier in the yes conversation yeah because i'm sitting there i know i don't do this alone i mean there's a great team of people behind the scenes so... terry described... team based... so you have a team of people care is a huge part of it are doing all these things? team is attendant to this whole thing so that by the time the doctor sits down face to face with a

patient he or she has all this information they know the right questions to ask they know what they're track ecord is the history if you will of this patient and so they're truly patient centered right fair to say joel? that's right also as we see more and more people gaining coverage under the affordable care act it puts a lot of pressure on these practices cause there's more volume well you lost me there what's the connection between the aca and this? so the aca is covering more people and the coverage of ot it in nj do the numbers again thousands... you did this on our one on one program why don't you go ahead so you know so at least 300,000 and growing in nj there's 300,000 more people right at least that have...? that have private health insurance... because of the aca because the aca and that number is gonna grow uh and those people now have a card and they're gonna want to go to the doctor need to go to the doctor so how do you absorb all of that without it takes ten years to educate a doctor and we're not gonna just expand the physician supply it was already stressed before all these expansions so this is a way

of leveraging the doctor's talents with the nurses talents and the other workers as a team to use people to the best of their abilities like highest level of their lisence so to speak to deliver the care that's needed now that makes sense to me but i'm also envisioning a smaller staff a physician with a smaller staff and he or she is saying watching this program because we have a huge audience of physicians watching public broadcasting and he or sure that's where... he is saying are you kidding me? [laughter] that sounds great but i can't pull that off right and that is a great point and it's a really difficult situation it's a legitimate point right very much so the payers such as horizon are now giving us some of those resources they are providing a care coordinator and helping us out with those resources so that the burden isn't so great on the small physician side so you do acknowledge doctor that a smaller operation that may want to do

these things really doesn't have the resources as they are currently constituted they don't very often i don't acknowledge that you don't? if they really wanted so i don't really fault... to do you think they could? for the following reason is that we have a number of solo family physicians solo? they're by themselves? single s.. yes go ahead and with some addition very modest additions so maybe half of a full time equivalent they have been able to transform their office with tools that we provided the things that they have learned from the nj academy of family physicians from other leaders mentors like terry and they've been able to do really great job a really gre... ut they have to... you're making it... one thing you're making it clear here is that they have to be committed to acknowledging that the status quo is absolutely not an option mm hmm and the reason it's not... they know it? they know that i mean medical practice has gotten

harder and harder the reimbursement rates don't keep up with expenses the fee for service as terry's saying doesn't pay for the things you really feel like you need to do right i think they're ready for this job so do you sense it mm hmm they're ready? i think so yes and so a physician wanted to do this the resources are there to do it and the long term benefit is clearly there and again the alternative is i can't stay in business just not gonna be able to stay in business and the patients go back to the other side of this since we're calling this patient centered care see what it is doctor that's gonna require of patients? so we want patients to appreciate what they should expect so we do want them steve to genuinely have a higher expectation the experience of care we talk about we want them to see that the experience f care is better i'll give you a great example... you ask... do you ever is this the deli is the deliu example that you told our producers?

yes you're gonna go with it? yeah [laughter] cause it's... cause i heard it's great go ahead cause i haven't heard it o i... okay okay alright alright [laughter] i hear you have a great deli example go for it [laughter] so a person who is a patient of a doctor that was actually profiled in the new york times last week marty is his name and marty said you know what? i used to come to the doctor's ffice i felt like i was taking a ticket in a deli counter and now they know my name and now they say oh marty how are you sir nice to see you yes we've prepared... planned for your visit so that is huge it's a... number versus marty? person is that symbolic of what we're talking about here? that is emblematic of what we're talking about here that in previous to this more patient centered approach he felt like a number for many people? the economics of the practice of medicine forced physicians to see a lot of patients for a short period of time and we've been through and so this is

the shift that needs to happen and i think something that purchasers have been pushing for you know this is where we need to get to that we can use the resources that we have to get people healthy give them the care that will maybe keep them healthy probably get them right you know i don't want to go to far um well you could try um and you know provide the level of care to consumers that they're expecting to try to give support physicians with the team that they need and to try to keep health coverage affordable because otherwise it was really at risk of becoming unaffordable for a lot of folks you know a lot of what you describe is what happens when the patient begins to interact with this physician and the physician team and this new model this new paradigm whatever you want to call it patient centered care situation but i keep asking myself well what about for all those patients who resist even going in the first place?

right all the people watching who are saying but htey don't even say it they just resist it yeah right great question so this is about taking care of a whole group of patients whether they come into the office or they don't and actually we reach out to those people the diabetic hasn't been in for a certain length of time we have people who are calling them up and saying you really have to come in um... if they're diabetics why aren't they coming in? it's a funny thing patients don't always do what we ask them to do and so we sometimes they need a little prodding so patients i'm gonna understand something patient centered care also means that medical professionals are much more proactive in reaching out to patients who aren't even coming into the office? right mm hmm and saying what? to this diabetic? it could be a diabetic who could be anything stay on that yeah well we're saying... they say to the diabetic what we haven't seen you? yeah we haven't seen you in three months you know what why not? i ask that question diabetic says hey mind your own

usiness i'll come in when i want well some people will do that but most of the time people receive that as saying wow they're really interested in me i forgot mm hmm i forgot which is huge that's more likely yeah a response? yeah don't bother me [laughter] some people might say don't bother me but the truth is most people i'm thinking in reality are probably thinking these guys they're actually thinking about me yeah and that's joel i's gotta be a good feeling well it sends a message and the truth is that we as individuals as patients we bear some responsibility for our health talk about that as well and to the extent that the system hasn't been responsive to us it sort of breeds that complacency now that i know they're gonna know about me when i get there it's gonna be i'm gonna say okay that's how it goes you know and maybe i'll take a little more responsibility for my diet for my exercise and maybe i'll even get some more advice than i would have before about how to do that so you know this is shared responsibility and the reality is to start this

where we just to finish this up we actually did get a letter from a physician who had a great relationship with who said to me right you have not been in for a certain period of time and you are due for a certain test and you should come in for that test because it's time for you to come for that test and i have that sitting right there and i know i have to do that becuase if i don't it's not on him that's on me so m... the bottom line for this is also that patient centered care requires patient centered responsibility that's right doesn't it? absolutely activitation's part of it instead of like you help me you fix me when i wait too long i don't want to do anything and then i'm really in trouble right? mm hmm but the other thing that we are seeing in that sort of approach a minute left go ahead is that we're learning how to deal with that better what do you mean? as providers as physicians we are actually learning how to motivate people better because we'd recognize that's so important and motivational interviewing is a whole concept

that's now coming out of patient centered motivational interviewing how to invite me into that test? yes so that i don't feel like you're forcing me but rather you're trying to help me? yes there's a whole art to that? yes that's fascinating understanding what motivates you as opposed to what motivates me we are different people and people are motivated by different things well on public broadcasting we're still you know learning how to motivate people to contribute dollars i won't do it here but you get the idea [laughter] [laughter] [laughter] listen there's a lesson here there's a lesson here [laughter] [laughter] thank you listen at rutgers you're still learning it isten i want to thank all of you for joining us you've done a reat... well we're all trying to support the state university i want to thank all of you for joining us you've done a great service the preceding program has been a production of the caucus educaitonal corporation celebrating over 25 years of broadcast excellence and thirteen for wnet njtv and whyy funding for this edition of caucus new jersey has been provided by barnabas health new jersey's credit unions the new jersey education

association new jersey natural gas united water johnson and johnson and by new jersey sharing network transportation provided by air brook limousine serving the metropolitan new york new jersey area caucus new jersey has been produced in partnership with tristar studios my daughter passed away nine years ago and i had to quit my job to raise my twin grandsons who have special needs i need a car to get them to the doctor's appointment so my credit was bad and i couldn't get approved for a loan so i turned to the credit union and everything changed they showed me how to fix the problems i had and help me get approved for the loan i needed since then my credit got better and i can take care of my grandsons i don't know where i would be without the credit union [music playing] [music playing]

captioning sponsored by macneil/lehrer productions >> woodruff: the u.s. and partnering arab nations launched air and cruise missile strikes across syria aimed at crippling islamic state militants. good evening. i'm judy woodruff. gwen ifill is away. also ahead this tuesday: as world leaders gather in new york, climate change takes the spotlight. we talk with the woman leading the united nations' efforts, former irish president mary robinson. plus, a different breed of hackers breach the genetics of living things to create what was once only imagined. >> as an engineer working with biology, i view biology not as a science, but as a platform