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Senin, 30 September 2013

Postcards from the Road: Casper, Wyoming



I just returned from my first trip to Wyoming where I gave the plenary presentation in Casper at the first ever joint meeting of the Wyoming Business Coalition on Health, the Wyoming Hospital Association and a local community hospital, the Wyoming Medical Center.  About 200 people attended this multiple stakeholder event to discuss the future of the payment landscape for medical care in their rural state. Considering that the population of Wyoming is just over 575,000, an audience of  200 people was quite a turnout! 

My presentation focused on how to practice population-based care in order to deliver the best outcome at the most cost-effective price; a panel of local experts reacted to my presentation and to questions from the audience. The panel included the President of the Wyoming Medical Society, the CEO of Wyoming Medical Center, the CEO of two other critical access hospitals, the local Assistant City Manager for the City of Casper and the Medical Director of the unique Wyoming Integrated Care Network. The Wyoming Integrated Care Network is a loose alliance of 28 Patient-Centered Medical Homes from across the state. These 28 PCMH’s represent over half of all of the primary care doctors practicing in Wyoming! 

I was struck by several take home messages from this trip to Casper. First, imagine bringing together comparable stakeholders in your regional environment? I have little confidence that we could have achieved this kind of all-encompassing meeting even in Philadelphia!  Another theme emerged, in that these groups seemed genuinely willing to work together, to share data on patient-level outcomes, and to find a way to broaden the population health agenda.  Surely there are many obstacles, but the mere fact that they were all sitting together in one room is very impressive to me.

Rural states face particular challenges as they attempt to implement the core tenets of the Affordable Care Act.  When your patients may be hundreds of miles away, it’s awfully difficult to think of ways to effectively engage them.  It seems quite challenging to imagine how they will implement bundled payment or related innovative schemes, but our colleagues in Casper appeared undeterred.  We could all learn something from our colleagues in a rural state as they look inward and find new ways to collaborate, innovate, and thrive in this challenging new environment. 

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