Welcome to Recovery Month! In celebration of primary care’s role in addiction care, we are featuring a show about caring for patients with addiction. Our guests this week are Adele Ojeda, the office based opioid treatment (or OBOT) nurse for Barre Family Health Center and Dr. Stephen Martin. Dr. Martin is Associate Professor of Family Medicine and Community Health at University of MA Medical School and a faculty physician at Berry Family Health Center, and affiliate faculty for the HMS Center for Primary Care. They share their experiences caring for patients with OUD in the primary care setting, and we also discuss an article Dr. Martin published with several colleagues in Annals of Internal Medicine in November 2018 entitled The Next Stage of Buprenorphine Care for Opioid Use Disorder that focuses on a number of widely accepted, yet not evidence-based, and potentially harmful practices in buprenorphine care. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

Welcome to Recovery Month! In celebration of primary care’s role in addiction care, we are featuring a show about caring for patients with addiction. Our guests this week are Adele Ojeda, the office based opioid treatment (or OBOT) nurse for Barre Family Health Center and Dr. Stephen Martin. Dr. Martin is Associate Professor of Family Medicine and Community Health at University of MA Medical School and a faculty physician at Berry Family Health Center, and affiliate faculty for the HMS Center for Primary Care. They share their experiences caring for patients with OUD in the primary care setting, and we also discuss an article Dr. Martin published with several colleagues in Annals of Internal Medicine in November 2018 entitled The Next Stage of Buprenorphine Care for Opioid Use Disorder that focuses on a number of widely accepted, yet not evidence-based, and potentially harmful practices in buprenorphine care. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

RoS: Opioid Use Disorder Care in Primary Care 

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

RoS Reprise: Understanding the Association of Primary Care Physician Supply and Mortality in the US

Margot Kushel

Our guest this week is Dr. Margot Kushel, a Professor of Medicine at UCSF and Director of the UCSF Center for Vulnerable Populations, as well as the Director of the UCSF Benioff Homelessness and Housing Initiative. Dr. Kushel’s research focuses on homelessness among older adults and the adverse health effects associated with homelessness. She developed and continues to follow the HOPE HOME cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness among adults 50 and over in Oakland, CA. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

Our guest this week is Dr. Margot Kushel, a Professor of Medicine at UCSF and Director of the UCSF Center for Vulnerable Populations, as well as the Director of the UCSF Benioff Homelessness and Housing Initiative. Dr. Kushel’s research focuses on homelessness among older adults and the adverse health effects associated with homelessness. She developed and continues to follow the HOPE HOME cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness among adults 50 and over in Oakland, CA. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

RoS: Understanding the Health Effects of Homelessness with Dr. Margot Kushel

Steven Woolf

Our guest this week is Dr. Steven Woolf. He is the C. Kenneth and Dianne Wright Distinguished Chair in Population health and Health Equity at VCU as well as Director Emeritus and Senior Advisor to the VCU Center on Society and Health. He joins us this week to talk about his work improving our understanding of the increasing death rates among mid-life Americans, on which he published a crucial paper about in 2018 in BMJ, entitled Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics, as well as authoring in an extensive report entitled US Health in International Perspective: Shorter Lives, Poorer Health. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.

Our guest this week is Dr. Steven Woolf. He is the C. Kenneth and Dianne Wright Distinguished Chair in Population health and Health Equity at VCU as well as Director Emeritus and Senior Advisor to the VCU Center on Society and Health. He joins us this week to talk about his work improving our understanding of the increasing death rates among mid-life Americans, on which he published a crucial paper about in 2018 in BMJ, entitled Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics, as well as authoring in an extensive report entitled US Health in International Perspective: Shorter Lives, Poorer Health. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at <a href="http://reviewofsystemspodATgmail.com" rel="nofollow" target="_blank">reviewofsystemspodATgmail.com</a>.

RoS: Understanding Increasing Mid-Life Mortality in the US with Steven Woolf

Chris Morley

Christopher Morley joins us this week to talk about prior authorizations, or PAs – a bureaucratic headache well known to anyone in primary care in which a physician’s office must complete additional paperwork or phone calls to a patient’s insurance company in order to get a medication or procedure covered by the insurance. This used to be a fairly rare occurrence, but it has dramatically increased in frequency over the last 20 years or so. Dr. Morley set out with some colleagues to try to quantify how much the PA process may cost, and moreover, to help us all think about who pays those costs in reality – ultimately, it is our patients. Dr. Morley is the Chair of the Department of Public Health and Preventive Medicine at SUNY Upstate Medical University, as well as the Vice Chair for Research in the Department of Family Medicine. He is a medical social scientist with principal interests in health disparities, particularly those that occur in primary care settings; health workforce development and medical education. Review of Systems is a podcast hosted by Audrey Provenzano featuring conversations about the changing healthcare landscape from the Harvard Center for Primary Care. Check out our website, primarycare.hms.harvard.edu to find our podcast library, subscribe in your favorite podcast app, and find us at @rospodcast and @audreymdmph Tweet us feedback and suggestions or email us at reviewofsystemspod@gmail.com. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues.

Christopher Morley joins us this week to talk about prior authorizations, or PAs – a bureaucratic headache well known to anyone in primary care in which a physician’s office must complete additional paperwork or phone calls to a patient’s insurance company in order to get a medication or procedure covered by the insurance. This used to be a fairly rare occurrence, but it has dramatically increased in frequency over the last 20 years or so. Dr. Morley set out with some colleagues to try to quantify how much the PA process may cost, and moreover, to help us all think about who pays those costs in reality – ultimately, it is our patients. Dr. Morley is the Chair of the Department of Public Health and Preventive Medicine at SUNY Upstate Medical University, as well as the Vice Chair for Research in the Department of Family Medicine. He is a medical social scientist with principal interests in health disparities, particularly those that occur in primary care settings; health workforce development and medical education. Review of Systems is a podcast hosted by Audrey Provenzano featuring conversations about the changing healthcare landscape from the Harvard Center for Primary Care. Check out our website, <a href="http://primarycare.hms.harvard.edu" rel="nofollow" target="_blank">primarycare.hms.harvard.edu</a> to find our podcast library, subscribe in your favorite podcast app, and find us at @rospodcast and @audreymdmph Tweet us feedback and suggestions or email us at reviewofsystemspod@gmail.com. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues.

RoS: Understanding the Costs of PAs with Chris Morley

Stacey Chang

Our guest this week is Stacey Chang. He is the executive Director of the Design Institute for Health at Dell Medical School. He joins us today to talk about design in medicine and how we can use design thinking as a tool to improve healthcare, and in particular how he and colleagues went about designing a series of clinics at Dell Medical School without any waiting rooms! I hope you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.

Our guest this week is Stacey Chang. He is the executive Director of the Design Institute for Health at Dell Medical School. He joins us today to talk about design in medicine and how we can use design thinking as a tool to improve healthcare, and in particular how he and colleagues went about designing a series of clinics at Dell Medical School without any waiting rooms! I hope you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at <a href="http://reviewofsystemspodATgmail.com" rel="nofollow" target="_blank">reviewofsystemspodATgmail.com</a>.

RoS: Design Thinking & Clinics with No Waiting Rooms with Stacey Chang 

What happens when a medical complex young person turns 18, and then, suddenly, they make their own medical decisions rather than their parents? How does one navigate the sometimes very thorny issues of sexual health and fertility? What about insurance issues? This week, we have a very special show for you featuring a number of guests on this topic talking about the Weitzman Family Bridges Adult Transition Program at Boston Children’s Hospital and how the program addresses these questions. We have Kitty O’Hare, a practicing med-peds primary care physician and Assistant Professor of Medicine and Pediatrics, Harvard Medical School; Ahmet Uluer, the Medical Director of the Weitzman Family Bridges Adult Transition Program; Amy, a patient who helped give input in the design of the program, helped to write the transition in care guide One Step at a Time, and has gone on to become a nurse; Susan Shanske, MSW, LICSW, the Director of Transitional Care Support; and Julia Roboff, a Nurse Practitioner with the program. Thanks for listening!

What happens when a medical complex young person turns 18, and then, suddenly, they make their own medical decisions rather than their parents? How does one navigate the sometimes very thorny issues of sexual health and fertility? What about insurance issues? This week, we have a very special show for you featuring a number of guests on this topic talking about the Weitzman Family Bridges Adult Transition Program at Boston Children’s Hospital and how the program addresses these questions. We have Kitty O’Hare, a practicing med-peds primary care physician and Assistant Professor of Medicine and Pediatrics, Harvard Medical School; Ahmet Uluer, the Medical Director of the Weitzman Family Bridges Adult Transition Program; Amy, a patient who helped give input in the design of the program, helped to write the transition in care guide One Step at a Time, and has gone on to become a nurse; Susan Shanske, MSW, LICSW, the Director of Transitional Care Support; and Julia Roboff, a Nurse Practitioner with the program. Thanks for listening!

RoS: Transitions in Care from Pedi to Adult Care for Medically Complex Patients

Eugenia South

Michelle Kondo

In this reprise episode,  Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop me a line at contactATrospod.org.

In this reprise episode, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop me a line at <a href="http://contactATrospod.org" rel="nofollow" target="_blank">contactATrospod.org</a>.

RoS The effects of neighborhood greening on mental health with Eugenia South & Michelle Kondo

Allison Hess

This week, we are joined by Allison Hess, VP of Health for the Steele Institute for Innovation at Geisinger to talk about Geisinger’s Fresh Food Farmacy, a program that provides food insecure patients with poorly controlled diabetes access to fresh healthy foods as part of a comprehensive diabetes care plan. Read more about the Fresh Food Farmacy and also check out the feature about their program on Care Zooming, a social enterprise company aimed at connecting healthcare professionals and disseminating innovative programs. Tweet us your thoughts at @RoSpodcast or you can email us at contactATrospod.org.

This week, we are joined by Allison Hess, VP of Health for the Steele Institute for Innovation at Geisinger to talk about Geisinger’s Fresh Food Farmacy, a program that provides food insecure patients with poorly controlled diabetes access to fresh healthy foods as part of a comprehensive diabetes care plan. Read more about the Fresh Food Farmacy and also check out the feature about their program on Care Zooming, a social enterprise company aimed at connecting healthcare professionals and disseminating innovative programs. Tweet us your thoughts at @RoSpodcast or you can email us at <a href="http://contactATrospod.org" rel="nofollow" target="_blank">contactATrospod.org</a>.

RoS Addressing Food Insecurity among diabetic patients at Geisinger with Allison Hess

Russ Phillips

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices.  He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

RoS: Understanding the association of primary care physician supply & mortality in the US with Russ Phillips

Love! I’m working in the developing field of complex care and find this highly relevant. Thanks!

Great!

Really does a great job surveying important new concepts at the edge of innovation in primary care.

Brilliant

RoS: Review of Systems

Jeffrey Brenner

Jeffrey Brenner is best known for his ground-breaking work with high-need patients in Camden, New Jersey, where he founded the Camden Coalition and changed how we all think about caring for this subset of our patients. He joins us this week and talks with us about how a shooting and subsequent relationship with the Camden police led him to a physician breakfast club and then the coalition; what it was like to catapult to fame after being featured in Atul Gawande’s hotspotter article in The New Yorker; his decision to join United Health Care to continue his work caring for the most vulnerable patients; and what he thinks the future of primary care should look like. I’d like to thank the Harvard Center for Primary Care for helping to facilitate this interview; and just a warning in case you are listening around young ears, there is some adult language in this episode. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Jeffrey Brenner is best known for his ground-breaking work with high-need patients in Camden, New Jersey, where he founded the Camden Coalition and changed how we all think about caring for this subset of our patients. He joins us this week and talks with us about how a shooting and subsequent relationship with the Camden police led him to a physician breakfast club and then the coalition; what it was like to catapult to fame after being featured in Atul Gawande’s hotspotter article in The New Yorker; his decision to join United Health Care to continue his work caring for the most vulnerable patients; and what he thinks the future of primary care should look like. I’d like to thank the Harvard Center for Primary Care for helping to facilitate this interview; and just a warning in case you are listening around young ears, there is some adult language in this episode. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Caring for high need, high cost patients with Jeffrey Brenner

This week, we are discussing an article from the Journal Women’s Health Issues, entitled: Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status, by Pooja Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, and Sindhu Srinivas. Pooja Mehta, the lead author of the study, joins us for our conversation. You can find the interview with Dr. David Buck referenced in our conversation here. Dr. Mehta is Director of Maternal &amp; Women’s Health Policy for the Consortium for Health Care Transformation, and Assistant Professor of Health Policy and Systems Management and Obstetrics and Gynecology at the Louisiana State University Health Sciences Center, advising the Louisiana Department of Health and Medicaid Program. Dr. Mehta’s interests are in the use of health care delivery innovation and community-engaged accountable care models to reduce reproductive health disparities, pregnancy-associated mortality, and low-value care, and to support patients with complex health and social needs. Her research has been supported by the Health Resources and Services Administration, the American College of Obstetricians and Gynecologists, and the Leonard Davis Institute of Health Economics. If you like the show, please rate and review us on itunes, google play, stitcher or your favorite podcasting app, which makes the show easier for others to find; and share us on social media. We tweet at @RoSpodcastand are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at audrey@rospod.org. We’d love to hear from you. Listen at the end of the episode for a promo code to receive 15% off registration fees for an upcoming conference from the Harvard Center for Primary Care: Primary Care in 2020 – Future Challenges, Tips for Today.

This week, we are discussing an article from the Journal Women’s Health Issues, entitled: Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status, by Pooja Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, and Sindhu Srinivas. Pooja Mehta, the lead author of the study, joins us for our conversation. You can find the interview with Dr. David Buck referenced in our conversation here. Dr. Mehta is Director of Maternal &amp; Women’s Health Policy for the Consortium for Health Care Transformation, and Assistant Professor of Health Policy and Systems Management and Obstetrics and Gynecology at the Louisiana State University Health Sciences Center, advising the Louisiana Department of Health and Medicaid Program. Dr. Mehta’s interests are in the use of health care delivery innovation and community-engaged accountable care models to reduce reproductive health disparities, pregnancy-associated mortality, and low-value care, and to support patients with complex health and social needs. Her research has been supported by the Health Resources and Services Administration, the American College of Obstetricians and Gynecologists, and the Leonard Davis Institute of Health Economics. If you like the show, please rate and review us on itunes, google play, stitcher or your favorite podcasting app, which makes the show easier for others to find; and share us on social media. We tweet at @RoSpodcastand are on facebook at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Please drop us a line at audrey@rospod.org. We’d love to hear from you. Listen at the end of the episode for a promo code to receive 15% off registration fees for an upcoming conference from the Harvard Center for Primary Care: Primary Care in 2020 – Future Challenges, Tips for Today.

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status – Mehta et al

Elisabeth Rosenthal

Elisabeth Rosenthal is a physician and a noted writer and Editor In Chief of Kaiser Health News. She recently published An American Sickness, a book exploring how the business of medicine has gotten in the way of doctors delivering great care to patients and made the system increasingly complex and expensive for patients to navigate. She joins us this week! If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

Elisabeth Rosenthal is a physician and a noted writer and Editor In Chief of Kaiser Health News. She recently published An American Sickness, a book exploring how the business of medicine has gotten in the way of doctors delivering great care to patients and made the system increasingly complex and expensive for patients to navigate. She joins us this week! If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS: How the system gets in the way of taking care of patients with Elisabeth Rosenthal

Andrew Morris-Singer

We are joined this week by Andrew Morris-Singer, a general internist and founder of Primary Care Progress. Primary Care Progress is a national non-profit organization dedicated to building a stronger primary care system. Working with current and future healthcare professionals from across disciplines and career stages – from students and faculty to providers and health systems leaders – PCP offers leadership development and support that emphasizes relational skills, individual resiliency, and advocacy. Andrew has a unique background as a community organizer with more than 15 years of experience. He is a lecturer in Global Health and Social Medicine at Harvard Medical School, an Assistant Professor in the Dept of Family Medicine at OHSU and an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah. He currently sees patients in Portland, Oregon. On the show, we talk about relational leadership,  advocacy and activism in primary care.

We are joined this week by Andrew Morris-Singer, a general internist and founder of Primary Care Progress. Primary Care Progress is a national non-profit organization dedicated to building a stronger primary care system. Working with current and future healthcare professionals from across disciplines and career stages – from students and faculty to providers and health systems leaders – PCP offers leadership development and support that emphasizes relational skills, individual resiliency, and advocacy. Andrew has a unique background as a community organizer with more than 15 years of experience. He is a lecturer in Global Health and Social Medicine at Harvard Medical School, an Assistant Professor in the Dept of Family Medicine at OHSU and an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah. He currently sees patients in Portland, Oregon. On the show, we talk about relational leadership, advocacy and activism in primary care.

Andrew Morris-Singer: Organizing & Advocacy

David Buck

This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012. You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here. Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine. He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012. You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here. Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

David Buck – Caring for High Need, High Cost Patients

Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society. We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US.  We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right. Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School. If you like the show, please subscribe on our website www.rospod.org, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society. We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US. We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right. Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School. If you like the show, please subscribe on our website <a href="http://www.rospod.org" rel="nofollow" target="_blank">www.rospod.org</a>, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Lauren A Taylor – Integration of Healthcare and Social Services

Joshua Freeman

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer.  He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions. This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered. Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS. Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer. He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions. This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered. Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS. Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

Joshua Freeman – Designing a Fair & Equitable Healthcare System

Bon Ku

This week we are joined by Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

This week we are joined by Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Please drop us a line at contact@rospod.org. We’d love to hear from you.

Bon Ku – Design Thinking in Healthcare

Dan Ciccarone

The opioid epidemic is the greatest public health crisis of our time. It is estimated that about 64,000 people died of opioid overdoses in 2016 – more than died in the Vietnam war or in 1 year at the height of the AIDs epidemic. Dan Ciccarone, our guest this week, and a Professor at UCSF School of Medicine, has spent his career trying to improve our understanding of substance use disorders and their health consequences. He and his collaborators look at this question both up-close, through ethnographic research in the community, and hours and hours of interviews with people who use injection drugs, and also by stepping back and sifting through huge datasets, looking at the larger epidemiologic and economic forces shaping the epidemic. He has spent years studying heroin specifically, and is currently the PI of the Heroin in Transitions study, which continues this vital work. We talk specifically about a study led by one of his collaborators, Dr. Sarah Mars, “Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting; his group’s study of trends in hospitalizations and what that tells us about the epidemic in a 2013 Plos One publication, Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993–2009. We also discuss his recent look at some of the larger factors influencing the epidemic with collaborators Nabarun Dasgupta and Leo Belitsky in Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. You can find more information about the book Dr. Ciccarone mentioned, Dreamland by Sam Quinones, here. And you can find the American Society for Addiction Medicine’s waiver training here. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

The opioid epidemic is the greatest public health crisis of our time. It is estimated that about 64,000 people died of opioid overdoses in 2016 – more than died in the Vietnam war or in 1 year at the height of the AIDs epidemic. Dan Ciccarone, our guest this week, and a Professor at UCSF School of Medicine, has spent his career trying to improve our understanding of substance use disorders and their health consequences. He and his collaborators look at this question both up-close, through ethnographic research in the community, and hours and hours of interviews with people who use injection drugs, and also by stepping back and sifting through huge datasets, looking at the larger epidemiologic and economic forces shaping the epidemic. He has spent years studying heroin specifically, and is currently the PI of the Heroin in Transitions study, which continues this vital work. We talk specifically about a study led by one of his collaborators, Dr. Sarah Mars, “Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting; his group’s study of trends in hospitalizations and what that tells us about the epidemic in a 2013 Plos One publication, Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993–2009. We also discuss his recent look at some of the larger factors influencing the epidemic with collaborators Nabarun Dasgupta and Leo Belitsky in Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. You can find more information about the book Dr. Ciccarone mentioned, Dreamland by Sam Quinones, here. And you can find the American Society for Addiction Medicine’s waiver training here. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Or, you can email me at <a href="http://audreyATrospod.org" rel="nofollow" target="_blank">audreyATrospod.org</a>. We’d love to hear from you, and thanks for listening.

Understanding the Opioid Epidemic with Dan Ciccarone

Kate Hilton

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest this week and next for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest this week and next for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at <a href="http://contactATrospod.org" rel="nofollow" target="_blank">contactATrospod.org</a>. Thanks for listening! This interview has been lightly edited for length and clarity.

RoS: The Psychology of Change with Kate Hilton of IHI, Ep 1

Mark Friedberg

Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous.  Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at contactATrospod.org. Thanks for listening!

Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous. Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014. If you enjoy the show, please rate, review &amp; subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at <a href="http://contactATrospod.org" rel="nofollow" target="_blank">contactATrospod.org</a>. Thanks for listening!

RoS: The Effects of Alternative Payment Models (APMs) on Primary Care with Mark Friedberg

This week we are featuring a reprise show with Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

This week we are featuring a reprise show with Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Please drop us a line at contact@rospod.org. We’d love to hear from you.

Reprise: Design Thinking with Bon Ku

Dave Chokshi

This week, we are joined by Dave Chokshi. Dave is the Chief Population Health Officer of OneCity Health and Senior Assistant Vice President at New York City Health + Hospitals—the largest public health care system in the U.S. He practices primary care at Bellevue Hospital and is a Clinical Associate Professor of Population Health and Medicine at the NYU School of Medicine. We talk about what population health is, how it is distinct from public health, and what value it adds to our healthcare system. We also talk about how in some ways it might contribute to the erosion of relationships between primary care providers and patients, how that can be remedied, and how the small 1 or 2 doctor practice may fit into a population health management vision. We talk about a piece he wrote with Neil Calman and Diane Hauser about what they call the “expanded denominator,” and how that may further goals of public health and accountable care. Lastly, we talk about population health approaches in urban and rural settings, and how we should think about the opioid epidemic from a population health vantage point. We reference a few articles throughout our conversation: Christine Sinsky’s already classic Annals paper detailing that physicians spend two hours on administrative tasks for every hour they see patients, and our journal club on that paper. Robin Williams’ and colleagues Health Affairs blog on utilizing the HIV cascade of care to battle the opioid epidemic, and Lawrence Casalino and colleagues work calculating what we spend measuring the care we provide. In addition, we reference the Surgeon General Vivek Murthy’s landmark report on addiction. A quick note about a word we use frequently but didn’t pause to define for listeners – attribution. Attribution is the assignment of a specific patient to a specific primary care physician in a health system. Once a patient is attributed to a PCP or health system, that PCP and health system is held accountable for the patient’s quality measures and healthcare costs within ACOs or other alternative payment contracts. This still applies patients who do not frequently access the healthcare system through traditional channels or most frequently see specialists, who perhaps have never seen the assigned PCP, and is therefore at times controversial. A little more background on Dr. Dave Chokshi: He was Assistant Vice President of Ambulatory Care Transformation at NYC Health + Hospitals and director of Population Health Improvement at NYU School of Medicine. In 2012-13, he served as a White House Fellow at the U.S. Dept. of Veterans Affairs, where he was the principal health advisor in the Office of the Secretary. His prior work experience spans the public, private, and nonprofit sectors, including positions with the New York City and State Departments of Health, the Louisiana Department of Health, a startup clinical software company, and the nonprofit Universities Allied for Essential Medicines, where he was a founding member of the Board of Directors. If you enjoy the show, please rate and review us wherever you listen, and share us on social media. Tweet us your thoughts @rospodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

This week, we are joined by Dave Chokshi. Dave is the Chief Population Health Officer of OneCity Health and Senior Assistant Vice President at New York City Health + Hospitals—the largest public health care system in the U.S. He practices primary care at Bellevue Hospital and is a Clinical Associate Professor of Population Health and Medicine at the NYU School of Medicine. We talk about what population health is, how it is distinct from public health, and what value it adds to our healthcare system. We also talk about how in some ways it might contribute to the erosion of relationships between primary care providers and patients, how that can be remedied, and how the small 1 or 2 doctor practice may fit into a population health management vision. We talk about a piece he wrote with Neil Calman and Diane Hauser about what they call the “expanded denominator,” and how that may further goals of public health and accountable care. Lastly, we talk about population health approaches in urban and rural settings, and how we should think about the opioid epidemic from a population health vantage point. We reference a few articles throughout our conversation: Christine Sinsky’s already classic Annals paper detailing that physicians spend two hours on administrative tasks for every hour they see patients, and our journal club on that paper. Robin Williams’ and colleagues Health Affairs blog on utilizing the HIV cascade of care to battle the opioid epidemic, and Lawrence Casalino and colleagues work calculating what we spend measuring the care we provide. In addition, we reference the Surgeon General Vivek Murthy’s landmark report on addiction. A quick note about a word we use frequently but didn’t pause to define for listeners – attribution. Attribution is the assignment of a specific patient to a specific primary care physician in a health system. Once a patient is attributed to a PCP or health system, that PCP and health system is held accountable for the patient’s quality measures and healthcare costs within ACOs or other alternative payment contracts. This still applies patients who do not frequently access the healthcare system through traditional channels or most frequently see specialists, who perhaps have never seen the assigned PCP, and is therefore at times controversial. A little more background on Dr. Dave Chokshi: He was Assistant Vice President of Ambulatory Care Transformation at NYC Health + Hospitals and director of Population Health Improvement at NYU School of Medicine. In 2012-13, he served as a White House Fellow at the U.S. Dept. of Veterans Affairs, where he was the principal health advisor in the Office of the Secretary. His prior work experience spans the public, private, and nonprofit sectors, including positions with the New York City and State Departments of Health, the Louisiana Department of Health, a startup clinical software company, and the nonprofit Universities Allied for Essential Medicines, where he was a founding member of the Board of Directors. If you enjoy the show, please rate and review us wherever you listen, and share us on social media. Tweet us your thoughts @rospodcast and check out our facebook page at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Or, you can email me at <a href="http://audreyATrospod.org" rel="nofollow" target="_blank">audreyATrospod.org</a>. We’d love to hear from you, and thanks for listening.

Reprise – Population Health Management with Dave Chokshi

Laura Gottlieb

These days, we hear about social determinants of health constantly – more of us are screening for social needs in our clinics and payers are searching for effective ways to address them as an avenue to improve outcomes and ideally reduce costs. Dr. Laura Gottlieb, a family physician and researcher at UCSF joins us today to talk about her research, which focuses on evaluating interventions to identify and address social factors in health care. You can find many of Dr. Gottlieb’s publications here, as well as the Health Affairs blog post by Drs. Toyin Ajayi and Iyah Romm mentioned in the podcast. You can also use this link to the SIREN website to find more resources on the intersection of social and medical care. A little more about our guest: Dr. Gottlieb is Associate Professor of Family and Community Medicine at the University of California, San Francisco and director of the Social Interventions Research and Evaluation Network (SIREN). Dr. Gottlieb’s current research focuses on evaluating interventions that identify and address social factors as part of health care delivery. These interventions include volunteer-powered social services Help Desks, payment reforms that support social programs, and other efforts that support responding to patients’ social needs in medical practice, like re-designing electronic medical records to incorporate social determinants data. Dr. Gottlieb also is an Associate Director of the Robert Wood Johnson Foundation Evidence for Action National Program and was a co-founder of HealthBegins, a non-profit organization providing education, consulting, networking, and technology services to health care providers interested in joining the effort to move medicine upstream. Prior to her current appointment, Dr. Gottlieb was a Robert Wood Johnson Health and Society Scholar at UCSF/UCB. She completed her MD at Harvard Medical School and both her MPH and residency training at the University of Washington. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

These days, we hear about social determinants of health constantly – more of us are screening for social needs in our clinics and payers are searching for effective ways to address them as an avenue to improve outcomes and ideally reduce costs. Dr. Laura Gottlieb, a family physician and researcher at UCSF joins us today to talk about her research, which focuses on evaluating interventions to identify and address social factors in health care. You can find many of Dr. Gottlieb’s publications here, as well as the Health Affairs blog post by Drs. Toyin Ajayi and Iyah Romm mentioned in the podcast. You can also use this link to the SIREN website to find more resources on the intersection of social and medical care. A little more about our guest: Dr. Gottlieb is Associate Professor of Family and Community Medicine at the University of California, San Francisco and director of the Social Interventions Research and Evaluation Network (SIREN). Dr. Gottlieb’s current research focuses on evaluating interventions that identify and address social factors as part of health care delivery. These interventions include volunteer-powered social services Help Desks, payment reforms that support social programs, and other efforts that support responding to patients’ social needs in medical practice, like re-designing electronic medical records to incorporate social determinants data. Dr. Gottlieb also is an Associate Director of the Robert Wood Johnson Foundation Evidence for Action National Program and was a co-founder of HealthBegins, a non-profit organization providing education, consulting, networking, and technology services to health care providers interested in joining the effort to move medicine upstream. Prior to her current appointment, Dr. Gottlieb was a Robert Wood Johnson Health and Society Scholar at UCSF/UCB. She completed her MD at Harvard Medical School and both her MPH and residency training at the University of Washington. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Understanding how to address social determinants of health with Laura Gottlieb

Harold Pollack

This week we are joined a few days early by Harold Pollack to bring you a timely update on the Affordable Care Act (ACA) repeal and American Health Care Act (AHCA) legislation that is moving quickly through congress. Harold has published widely at the interface between poverty policy and public health including the effects of health reform and the ACA. Today we talk about the current state of the repeal and replace effort in the Senate and what effects their bill would have in terms of individuals who would lose coverage or find it much more expensive should the bill pass. We also discussed the very dramatic changes the bill would likely make to Medicaid and how that might affect the poor and vulnerable people that the program serves, and in particular how it might impact the raging opiate epidemic. Lastly, we talk about what a bipartisan solution to many of the very real problems of the ACA might look like, and what impact individuals can have on policy by calling congress. You can find more information about the unusual legislative process here, and the lack of information available on the bill here. Read about the effects that changes to Medicaid might make for disabled individuals here, and listen to Matt Broaddus of the Center on Budget and Policy Priorities discuss block granting and per capita caps on Medicaid here. If you would like to reach out to your Senator to talk with him or her about the legislation and how it might affect you or your patients, you can find your Senator’s contact information here. Harold is the Helen Ross Professor at the School of Social Service Administration, an Affiliate Professor in the Biological Sciences Collegiate Division and the Department of Public Health Sciences and Co-Director of The University of Chicago Crime Lab and a committee member of the Center for Health Administration Studies (CHAS) at the University of Chicago. He tweets @haroldpollack. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

This week we are joined a few days early by Harold Pollack to bring you a timely update on the Affordable Care Act (ACA) repeal and American Health Care Act (AHCA) legislation that is moving quickly through congress. Harold has published widely at the interface between poverty policy and public health including the effects of health reform and the ACA. Today we talk about the current state of the repeal and replace effort in the Senate and what effects their bill would have in terms of individuals who would lose coverage or find it much more expensive should the bill pass. We also discussed the very dramatic changes the bill would likely make to Medicaid and how that might affect the poor and vulnerable people that the program serves, and in particular how it might impact the raging opiate epidemic. Lastly, we talk about what a bipartisan solution to many of the very real problems of the ACA might look like, and what impact individuals can have on policy by calling congress. You can find more information about the unusual legislative process here, and the lack of information available on the bill here. Read about the effects that changes to Medicaid might make for disabled individuals here, and listen to Matt Broaddus of the Center on Budget and Policy Priorities discuss block granting and per capita caps on Medicaid here. If you would like to reach out to your Senator to talk with him or her about the legislation and how it might affect you or your patients, you can find your Senator’s contact information here. Harold is the Helen Ross Professor at the School of Social Service Administration, an Affiliate Professor in the Biological Sciences Collegiate Division and the Department of Public Health Sciences and Co-Director of The University of Chicago Crime Lab and a committee member of the Center for Health Administration Studies (CHAS) at the University of Chicago. He tweets @haroldpollack. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Please drop us a line at contact@rospod.org. We’d love to hear from you.

Harold Pollack – ACA and AHCA Update

Asaf Bitton

Asaf Bitton MD, MPH is our guest this week. Asaf talks with us about what he sees as crucial steps in improving primary care in the US and what we can learn from primary care systems globally, particularly drawing on a recent healthcare system reform in Costa Rica which he wrote about last year in Health Affairs. We also talk about a noteworthy editorial he wrote in the Annals of Family Medicine laying out what he sees as a path forward in primary care, with parsimony and also being clear-eyed about the limits of current capitation efforts. Dr. Bitton is the Director of Primary Health Care at Ariadne Labs where he leads the Primary Health Care Performance Initiative, a joint effort with the Bill and Melinda Gates Foundation, The World Bank, the World Health Organization, and The Results for Development Institute. He is also a senior advisor to the Center for Medicare and Medicaid Innovation (CMMI) on their Comprehensive Primary Care Plus initiative. He practices primary care in the Boston area. We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimary care, leave us a message on facebook, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening! Audio Player

Asaf Bitton MD, MPH is our guest this week. Asaf talks with us about what he sees as crucial steps in improving primary care in the US and what we can learn from primary care systems globally, particularly drawing on a recent healthcare system reform in Costa Rica which he wrote about last year in Health Affairs. We also talk about a noteworthy editorial he wrote in the Annals of Family Medicine laying out what he sees as a path forward in primary care, with parsimony and also being clear-eyed about the limits of current capitation efforts. Dr. Bitton is the Director of Primary Health Care at Ariadne Labs where he leads the Primary Health Care Performance Initiative, a joint effort with the Bill and Melinda Gates Foundation, The World Bank, the World Health Organization, and The Results for Development Institute. He is also a senior advisor to the Center for Medicare and Medicaid Innovation (CMMI) on their Comprehensive Primary Care Plus initiative. He practices primary care in the Boston area. We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimary care, leave us a message on facebook, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening! Audio Player

Re-imagining primary care in the US & what we can learn from Costa Rica with Asaf Bitton

Dave Chokshi – Population Health Management

Sarah Wakeman

Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center. We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45). You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center. We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45). You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic. If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at <a href="http://www.facebook.com/reviewofsystems" rel="nofollow" target="_blank">www.facebook.com/reviewofsystems</a>. Please drop us a line at contact@rospod.org. We’d love to hear from you.

Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

This week, Thomas, Audrey, and David bring you a journal club featuring discussion of three recent papers: Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts by Davida M Shiff, Timothy Nielsen, Mishka Terplan, Malena Hood, Dana Bernson, Hafsato Diop, Monica Bharel, Timothy Wilens, Marc LaRochelle, Alexander Walley, and Thomas Land; Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics by Steven H Woolf, Derek Chapman, Jeanine Buchanich, Kendra Bobby, Emily Zimmerman, and Sarah Blackburn; and Association of Medical Scribes in Primary care with physician workflow and patient experience by Pranita Mishra, Jacquelin Kiang and Richard Grant. Links for our pearls: amazing fish and an excellent commentary from John Frey on loneliness.

This week, Thomas, Audrey, and David bring you a journal club featuring discussion of three recent papers: Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts by Davida M Shiff, Timothy Nielsen, Mishka Terplan, Malena Hood, Dana Bernson, Hafsato Diop, Monica Bharel, Timothy Wilens, Marc LaRochelle, Alexander Walley, and Thomas Land; Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics by Steven H Woolf, Derek Chapman, Jeanine Buchanich, Kendra Bobby, Emily Zimmerman, and Sarah Blackburn; and Association of Medical Scribes in Primary care with physician workflow and patient experience by Pranita Mishra, Jacquelin Kiang and Richard Grant. Links for our pearls: amazing fish and an excellent commentary from John Frey on loneliness.

RoS Journal Club Opioid OD among pregnant women, midlife deaths in the US & assn of scribes with MD workflow & patient experience

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