Minnesota Physician August 2012 by Minnesota Physician Publishing

Volume XXVl, No. 5

August 2012

The Independent Medical Business Newspaper

Reducing health inequities What physicians can do By Melanie Ferris, MPH, and Paul W. Mattessich, PhD

E MMXll

care delivery to payment models, organizational structure, government regulation, and health improvement programs. Many of the responses from health care leaders reflected both the promise and challenges of those changes. The responses also underscore the importance of another significant health care trend: teamwork and collaboration in achieving goals, whether in quality of care, efficiency in delivering care, or improving accessibility to care. A number of leaders lauded the efforts of their staff and colleagues, as well as the crucial role of patients in the health care equation. We wish this group of health care professionals the best in leading the state through these exciting and challenging times.

Recognizing excellence

Detriot Lakes, MN Permit No. 2655

PAID

100 LEADERS to page 14

PRSRT STD U.S. POSTAGE

innesota Physician Publishing is pleased to present this special feature honoring Minnesota’s health care leaders. Once every four years, we invite our readers to submit the names of colleagues whose outstanding work in health care might be acknowledged in this feature. We thank all those who participated in the nomination process and in submitting responses. Minnesota has long had a national reputation for excellence in health care. In an industry with so much talent and dedication, it is difficult to limit the number of leaders to only 100. The leaders selected for this feature represent a cross section of the breadth and depth of Minnesota’s health-care delivery system, from clinical care to health care policy, research, and management. Though the health care industry is always evolving, the past four years have seen sweeping changes at all levels, from

ven when physicians offer the best care possible, patients have unequal opportunities to experience good health outcomes. Factors largely outside of a physician’s control, at least in the short term, put large numbers of patients at a disadvantage, not because of their genes or their health behaviors, but because of where they live, the money they have, and the intended and unintended discrimination they experience. The World Health Organization labels such disadvantages “health inequities,” which result from unfair, unjust, and modifiable social conditions. A growing body of literature demonstrates that factors shaping the conditions were we live, work, and play—called social determinants— strongly influence our overall health and largely contribute to health inequities.

Minnesota: A healthy state for many, but not all

Minnesota shines nationally with an image of good health among its residents. The Kaiser Family Foundation INEQUITIES to page 12

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MC4106-159

CONTENTS

AUGUST 2012 Volume XXVI, No. 5

FEATURES 100 influential health care leaders Recognizing excellence

Reducing health inequities What physicians can do

By Melanie Ferris, MPH, and Paul W. Mattessich, PhD

T H I R T Y- E I G H T H

MEDICUS

INTERVIEW

Alan Page, JD Minnesota Supreme Court

SESSION

Background and Focus

DEPARTMENTS CAPSULES

MINNESOTAHEALTH HEALTH CARE ABLE MINNESOTA CAREROUNDT ROUNDTABLE

PROFESSIONAL UPDATE: NEUROLOGY Carotid artery disease 12 By Andrew Grande, MD, Ramachandra Tummula, MD, and Bharathidasan Jagadeesan, MD

HEALTH CARE AND THE LAW The Minnesota False Claims Act

The recent Supreme Court ruling on the Affordable Care Act clears the way for implementation of Health Insurance Exchanges. States have the option of creating their own exchange or joining one created by the federal government by January 2014. A Health Insurance Exchange would provide consumers a place to compare and shop for health insurance coverage. In Minnesota this idea was first proposed as part of the Assuring they are meaningful Pawlenty administration’s health care reform task force, Thursday, November 1, 2012 and Gov. Dayton is a strong 1:00 – 4:00 PM • Duluth Room supporter of creating a stateDowntown Mpls. Hilton and Towers run program. Though simple and compelling at first brush, creating a consumer-accessible, “apples to apples” website for comparing health insurance costs is challenging and very complex.

Health Insurance Exchanges:

By Brian Dillon, JD

Objectives

The Independent Medical Business Newspaper

We will define what a health care insurance exchange is and, considering the detailed and proprietary design of health insurance coverage, how it can be meaningful. Health insurance policies contain terms like “medically necessary,” “investigative,” “cosmetic,” “not medically necessary” and “contract/benefit exclusion”—all terms that are defined differently by different insurers. This alone makes it virtually impossible for anyone to compare plans effectively. Further, networks of providers vary, depending on whether you choose the “bronze,” “silver,” “gold,” or “platinum” option within a given insurer, as will access to hospital-based facilities, DME providers, and ancillary services. Throw in features like “deductibles,” “co-insurance,” “maximum out-of-pocket expenses,” “formulary design” and “covered preventive services,” and you have a bewildering mathematical matrix. We will offer suggestions as to how an insurance exchange can address these issues and provide a meaningful, consumer-friendly comparison service.

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AUGUST 2012 MINNESOTA PHYSICIAN

CAPSULES

Joint Effort Continues to Reduce Hospital Readmissions A pilot program to reduce hospital readmissions continues to exceed expectations, according to officials involved in the project. Two years after Fairview Health Services and UCare began the program, readmissions to two Fairview hospitals of enrollees from the UCare For Seniors Medicare Advantage health plan has dropped to at least half the national average. The program, a joint effort between UCare and Fairview Physician Associates (FPA), involves seniors who are admitted to Fairview Southdale Hospital and Fairview Ridges Hospital. So far, about 2,000 patients have taken part in the program. UCare estimates it saves $10,000 with every prevented readmission. The pilot project is designed to keep patients enrolled in UCare for Seniors Medicare Advantage from returning unnecessarily to the hospital within 30 days of discharge.

Seventeen FPA-member independent and Fairview-owned primary care clinics are participating in the pilot. Initially, FPA hoped to see a 20 percent reduction in readmissions. In fact, nine months into the project, efforts show between a 30 percent and 44 percent reduction, depending on measurement and definition of readmission, says William Nersesian, MD, FPA chief medical officer. â&#x20AC;&#x153;No one really knew how far we could reduce readmissions,â&#x20AC;? Nersesian says. â&#x20AC;&#x153;I was hoping for twenty percent, but weâ&#x20AC;&#x2122;re in the high 30s and low 40s.â&#x20AC;? Nersesian says the key to Fairview and UCareâ&#x20AC;&#x2122;s success is a 3-pronged approach that includes relatively quick followup visits to a patientâ&#x20AC;&#x2122;s primary care physicians in the week following discharge; an approach to pharmacy coaching that includes pharmacists going over all medications with the patient; and care managers that discuss issues with patients such as nutrition and transportation to

physician appointments. In addition, hospitalists with FPA now dictate their discharge summaries the day of discharge. This, Nersesian notes, seems like a simple thing but was not always done in the past. â&#x20AC;&#x153;Getting the discharge summary with complete information emailed out to the personal physician is an important part of the process,â&#x20AC;? he says.

State Ranked High In AHRQ Report Minnesota received the top overall score and was rated â&#x20AC;&#x153;strongâ&#x20AC;? in health care quality by the federal Agency for Healthcare Research and Quality (AHRQ) national report. The agencyâ&#x20AC;&#x2122;s annual stateby-state report finds that Minnesota does very well in the areas of cancer, diabetes, heart disease, and respiratory disease. For maternal and child health, along with home care, Minnesota rated below average. The state ranked first in the nation for flu vaccination among adults with diabetes and

second for both preventing pressure sores among nursing home residents and pneumonia vaccinations for adults older than 65. Its lowest rank was 44th in the nation, for vaccinations of young children.

Asthma Report Finds Higher Rates In Twin Cities A new report on asthma in Minnesota finds that some trends are encouraging but that the Twin Cities area still has a much higher rate of asthma cases than the rest of the state. â&#x20AC;&#x153;The good news is that hospitalizations have been trending down and that Minnesota has a lower prevalence of asthma than the nation,â&#x20AC;? says Minnesota Commissioner of Health Ed Ehlinger, MD. â&#x20AC;&#x153;But we need to do more to address this troubling difference between the Twin Cities and greater Minnesota and to make sure that children and adults are getting the most effective asthma care available.â&#x20AC;?

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The report from the Minnesota Department of Health (MDH) found that Minnesota’s adult asthma rate of 7.6 percent, or 302,000 Minnesotans, is lower than the national average of 9.1 percent. The state’s childhood asthma rate of 7.0 percent, or 90,000, is lower than the U.S. rate of 8.4 percent. The report finds that rates for adults and children re-mained relatively stable between 2000 and 2010. Hospitalizations due to asthma have steadily declined from 9.4 per 10,000 residents or 4,626 in 2000 to 6.7 per 10,000 residents or 3,553 in 2010. However, MDH officials raise concerns about higher rates of asthma hospitalizations in the seven-county Twin Cities metropolitan area, where rates are 50 percent higher among children and 30 percent higher among adults compared with rates for children and adults living in greater Minnesota. Similarly, rates of emergency department visits for asthma are 70 percent higher among children living in the seven-county Twin Cities metropolitan area than among children living in greater Minnesota, the report finds. “We are not sure what is causing this difference,” says Wendy Brunner, MS, PhD, MDH’s Asthma Program epidemiologist. “But we know a lot about what can trigger asthma episodes, such as secondhand smoke, mold, pet dander, and air pollution, and that theoretically, hospitalizations can be prevented when a person’s asthma is managed through medication and minimizing exposure to triggers.”

PhRMA Report Finds Minnesota Well Suited for Drug Trials Minnesota is well suited to host clinical trials of pharmaceutical drugs, a new report from PhRMA says. The report says Minnesota has an excellent infrastructure for testing pharmaceuticals, with major research facilities and health-care

delivery capabilities. Jeff Trewhitt, senior director of communications and public affairs for PhRMA, says the report shows that although pharmaceutical companies are not as highly visible in Minnesota as device manufacturers such as Medtronic or St. Jude’s, drug trials are still important to the state’s health care industry. “Although the biopharmaceutical research industry may not have a very prominent brick-and-mortar presence in Minnesota, it does, nevertheless, have a very positive impact on the state through its sponsorship and conduct of clinical trials,” Trewhitt says. “Not only are these trials that have been sponsored and conducted by [pharmaceutical] companies good for patients, they’re also good for the state’s economy as well as the advance of science.” According to the report, pharmaceutical companies have conducted more than 2,400 clinical trials of new medicines since 1999 in Minnesota. The report notes that the University of Minnesota and Mayo Clinic are sites of major research and the health care systems in the state are also excellent partners for research. Trewhitt points out there are a number of companies helping to conduct clinical trials in partnership with universities and health systems in Minnesota. The PhRMA report emphasizes the work of the Minnesota Clinical Research Alliance (MCRA), a coalition of research groups that formed one year ago to promote clinical trials in Minnesota. According to Trewhitt, PhRMA and MCRA are trying to get the word out about the importance of clinical trials. “At a time when so many trials don’t have enough patients, MCRA is doing a very good job of raising awareness and understanding of clinical trials of new medicines and medical devices.” CAPSULES to page 6

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CAPSULES Capsules from page 5

First Community Paramedic Class Graduates Hennepin Technical College (HTC) has graduated 13 students from its first-in-the-U.S. Community Paramedic training program. Community paramedics are a new model of health care providers recently approved by the state legislature. Community paramedics deliver primary care services such as case management, wound care, immunizations, and patient education in rural areas where access to physicians is limited. Health delivery experts say the model will save money by preventing emergency room visits and 911 calls for health issues that could be more appropriately addressed with preventive care. “The new certification is another demonstration of the leadership shown in Minnesota as we move forward to reform health care,” says O.J. Doyle, EMS consultant and lobbyist for

the Minnesota Ambulance Association, a group that supported the bill. “In addition, it provides a creative way to fill gaps in the health-care delivery system and will significantly reduce costs for health care providers and taxpayers. Also, it will provide a solution for preventing unnecessary hospitalization and ambulance transportation, which can average $4,000 a visit, and doesn’t compete with existing health care services.” To gain the necessary skills, traditional paramedics need extra training, and the program at HTC provides that. Minnesota is the first state to establish an official certification for community paramedics, with the passage of the Community Paramedics Bill in April 2011. The first training program, developed in partnership with the Minnesota Ambulance Association, began that May at HTC’s Eden Prairie campus. “This new career path for paramedics is really exploding,” says Kai Hjermstad, Customized Training Services Coordinator for emergency medical

2012-13 CME Activities (All courses in the Twin Cities unless noted)

FALL 2012 Pediatric Clinical Hypnosis (NPHTI) September 20-22, 2012 Psychiatry Review & Update October 1-2, 2012 North Central College Health Association Conference - Duluth, MN October 2-4, 2012 Twin Cities Sports Medicine October 5-6, 2012 Maintenance of Certiﬁcation in Anesthesiology (MOCA) Training October 20, 2012 Internal Medicine Review & Update October 24-26, 2012 Practical Dermatology for Primary Care - Duluth, MN October 26-27, 2012

services at HTC, who recently received his certification. “Community paramedics will take on various roles including outreach, wellness, health screening assessments, health instruction, dispensing of immunizations, disease management, recognition of mental health issues, wound care, safety programs, and functioning as an extension of physicians in rural clinics and hospitals.”

Mayo, U of M Sign Letter Supporting NIH Funding Mayo Clinic and the University of Minnesota have joined a national coalition of medical research institutions in urging Congress to maintain current funding levels for the National Institutes of Health (NIH). The letter asks Congress to maintain the FY 2013 funding of $32 billion for NIH. Officials note that recent years have seen cuts in NIH awards and the number of grants. In addition, a new salary cap for NIH workers

has raised concerns that some scientists will be driven away by the resulting 10 percent salary cut for NIH researchers. The letter asks that salaries be restored to previous levels. “We respect the difficult decisions you must make, and we urge you during those deliberations to view medical research as an investment in our nation’s health, security, and economy,” the letter says. “NIHfunded research happens in all 50 states, and occurs in large and small communities across the nation—strengthening the economy and creating jobs. The investment in NIH not only improves the health of the nation, but also benefits our economy in the short term and long term.” The letter is signed by Mayo Clinic and 18 other medical research institutions, including the University of Wisconsin, the University of California Health System, the University of Texas System, the New York University School of Medicine, the Duke University School of Medicine, and the Cleveland Clinic Lerner Research Institute.

www.cmecourses.umn.edu Emerging Infections in Clinical Practice & Public Health November 16, 2012 Geriatric Orthopaedic Fracture November 29-30, 2012 Maintenance of Certiﬁcation in Anesthesiology (MOCA) Training December 8, 2012

SPRING 2013 Maintenance of Certiﬁcation in Anesthesiology (MOCA) Training January 19, 2013 WORLD Symposium - Orlando, FL February 12-15, 2013 Maintenance of Certiﬁcation in Anesthesiology (MOCA) Training February 23, 2013 Lillehei Symposium April 4-5, 2013 Integrated Care Conference April 12, 2013

Chronic Pain April 19, 2013 Cardiac Arrhythmias April 26, 2013 Maintenance of Certiﬁcation in Anesthesiology (MOCA) Training April 27, 2013 Controversies in Cardiovascular Disease May 4-5, 2013 Global Health Training (weekly modules) May 6-31, 2013

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MINNESOTA PHYSICIAN

AUGUST 2012

Sarah Schram, MD, has joined the University of Minnesota Department of Dermatology, and will split her time between the University and Maple Grove clinics. Her interests include Mohs surgery, cosmetic and laser procedures, and general dermatology. She completed medical school, residency, and fellowship at the University of Minnesota. Schram has been active in research projects relating to skin Sarah Schram, MD cancer, Mohs micrographic surgery techniques, dermal fillers, laser treatment for photo rejuvenation, and allergic contact dermatitis. Russell Luepker, MD, MS, has received the 2012 Carole J. Bland Outstanding Faculty Mentor Award for the University of Minnesota Medical School. The award is given to faculty who have served as outstanding mentors to other faculty members. Since 1978, Luepker has mentored more than 100 individuals. He is a Mayo Professor of Public Health in the School of Public Health’s Division of Epidemiology and Community Health. Laura Andreson, DO, has joined the obstetrics and gynecology department at Altru Health System in Grand Forks, N.D. Andreson earned Laura Andreson, DO a doctor of osteopathy degree from Des Moines (Ia.) University Osteopathic Medical Center and completed a residency in obstetrics and gynecology at the University of Minnesota. She is board-certified by the American Board of Obstetrics and Gynecology and is a fellow of the American College of Obstetrics and Gynecology. Blue Cross and Blue Shield of Minnesota has announced the appointments of Paul Karazija, MD, as executive medical director for commercial and government programs, and Lawrence (Larry) Lee, MD, as executive medical director for provider relations and quality. In these roles, Karazija and Lee will provide direction and oversight of medical policies, credentialing, provider relations, and quality improvement programs. Karazija joined Blue Cross in May 2011 as senior medical director of key accounts. A board-certified internist, he has been in medical director leadership roles since 1996. Prior to joining Blue Cross, Karazija was chief medical officer at Wellmark Blue Cross Blue Shield of Iowa and South Dakota. Lee joined Blue Cross in February 2012 as medical director of provider analytics and clinical performance. He is a board-certified internist and has been in medical director leadership positions since 2006. The health management business unit of Minnetonka-based Medica has promoted Jim Jim Guyn, MD Guyn, MD, to vice president and senior medical officer. Guyn, who joined Medica in 2006 as medical director, provider relations, will focus on provider relations and continue to lead efforts to improve health care quality, efficiency, and patient satisfaction. All Medica medical directors will report to him. He is a graduate of the UCLA School of Medicine, and did his residency in family practice at Ventura County General Hospital in Ventura, Calif. The American Academy of Orthopaedic Surgeons has presented its 2012 Diversity Award to Franklin H. Sim, MD, of the Mayo Clinic, Rochester. The Diversity Award recognizes members of the academy who have distinguished themselves through their outstanding commitment to making orthopedics more representative of, and accessible to, diverse patient populations. The award citation noted that since the 1970s, Sim has mentored nearly 500 young physicians, including many women who have achieved prominent positions within orthopedics. In addition, he has hosted visiting international orthopedic surgeons, residents, and fellows over the past four decades, through Mayo Clinic’s Visiting Clinicians Program, from countries where orthopedic surgery continues to evolve.

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Do you have patients with trouble using their telephone due to hearing loss, speech or physical disability? If so…the TED Program provides assistive telephone equipment at NO COST to those who qualify. Please contact us, or have your patients call directly, for more information.

1-800-657-3663 www.tedprogram.org Duluth • Mankato • Metro Moorhead • St. Cloud The Telephone Equipment Distribution Program is funded through the Department of Commerce Telecommunications Access Minnesota (TAM) and administered by the Minnesota Department of Human Services

AUGUST 2012

MINNESOTA PHYSICIAN

INTERVIEW

On the field of leadership ■ How would you define leadership?

You know, I’ve asked that question a number of times, and quite frankly I don’t know that I have a good answer. I think leadership involves really intangible qualities in people that inspire others to act, however that may be and in whatever context that may be. ■ In your career you’ve seen people in leadership

■ Tell us a little about the Page Education

capacities in different areas. Could you share some examples of individual leadership that you’ve found inspiring? Alan Page, JD Minnesota Supreme Court Alan Page, JD, has been an associate justice of the Minnesota Supreme Court since 1993 and has found success in a wide range of endeavors, including playing for the Minnesota Vikings from 1967 to 1978. After his football career, which led to his induction into the NFL Hall of Fame in 1988, Page began a legal career that included being named Minnesota Assistant Attorney General in 1987. In addition, Page has worked as a broadcaster for National Public Radio and the Turner Broadcasting System, and was National Football League Player’s Association representative during the 1970s. Page is the founder of the Page Education Foundation, which has awarded grants to thousands of students of color in return for a commitment to serving the community.

I think much beyond that, (a) I don’t know, and (b) I probably shouldn’t say. But you know, we live in a political society, and thank goodness I’m in the branch of government that doesn’t have to be involved in that part of the political process. We get to make decisions, exercising our judgment in terms of sorting out what the law is, not what we would like it to be. Foundation and the role education should play in developing leadership.

I think education is obviously critical to any sucThe one that comes immediately to mind is cess that anybody’s going to have. It’s the school Nelson Mandela. If he is not a leader, nobody is. that prepares people for doing whatever it is they His actions were geared toward bringing equality to all the people of South Africa. He has been com- may choose to do. The Page Education Foundation is a tool, particularly for the disadvantaged and mitted to his principles and acts on that commitpeople of color, that puts them in the position of ment in ways that certainly have inspired me over overcoming whatever the disadvantage may be, the years, and in a way that is, at least from my and I think that’s critical to achieving whatever vantage point, for the benefit of others, not necesone’s hopes and dreams are. sarily for his own personal And because I believe that benefit, and that is certainly Ultimately we’re everybody has the right to the inspirational. to achieve their influenced by those we opportunity hopes and dreams, I think the ■ There are some parallels with our own civil rights can literally reach out more we can do to ensure that everybody has the opportunity movement. and touch far more than to learn, the better. It’s critical. Yes, clearly. Martin Luther King Jr. was another visible we are by example of someone who is a set up on leader, but I think back on my football playing days and I think of Jim Marshall and Joe Kapp, who both by their words and by their actions, inspired others to perform probably at a level higher than what they might otherwise have done.

the people we the pedestals.

■ Is there a common thread through those differ-

ent kinds of leadership? Oh, I think so. I think leadership is unselfish. I think it’s inspirational, and I think the qualities generally apply no matter what you’re doing, whether you’re a doctor or a lawyer or a football player or a CEO in a corporation or the owner of a small mom and pop grocery store. ■ The road taken for the Affordable Care Act to

reach the Supreme Court exemplifies the animosity of partisan politics. Especially considering how the ruling will be used in the presidential election process, how would you have approached this case? Well, hard for me to say because I know nothing more than what I’ve read in the newspapers, and I suspect in the grand scheme of things, that’s not very much. The reality is that it’s been a political issue from the beginning and it will remain a political issue, and sadly, oftentimes, the politics don’t necessarily look to what is best for the community, for the people.

MINNESOTA PHYSICIAN AUGUST 2012

■ How does the foundation

pursue that?

We do two things. One, we provide financial assistance to young men and women of color to encourage and assist and motivate them to pursue their education beyond high school. We provide financial grants ranging in amount from $1,000 to $2,500, renewable on an annual basis, to Minnesota students of color going to Minnesota schools, and they are outright grants. The second thing we do, and I think it’s the most important thing, is that we require our grant recipients—we call them Page Scholars—to go back into the community where they come from, back into the community where they went to school, to work with young children, kindergarten through eighth grade, specifically in the area of education. This is so those young children can see somebody who looks like them, somebody who comes from where they come from, somebody who may have some shared experience, using education as a tool and, by both word and deed, helping those younger children understand the importance of education.

■ It sounds like a great example of leadership, as

we were talking about earlier. Well, it certainly puts our Page Scholars in positions of leadership. Interesting, I haven’t necessarily thought about it in the context of leadership, but as a society, we spend a lot of time talking about who our heroes are and who our role models

are. Ultimately we’re influenced by those we can literally reach out and touch far more than we are by the people we set up on the pedestals, whether it be athletes or entertainers, or whoever it might be. Our Page Scholars are true heroes and true role models. In fact, a few years ago we adopted the motto, “Creating heroes through education and service,” but as I sit here and think about it—those scholars are really acting as leaders and are working in a leadership capacity, inspiring, motivating, and assisting the young children they work with. The work that they do certainly inspires me. ■ Childhood obesity and many related fit-

ness issues are becoming significant concerns for the health care profession. How does your work with children relate to these topics? I haven’t done anything directly related to those kinds of topics other than I do spend a lot of time in schools, talking with young children about the importance of education. But as part of that, I discuss my history and my background, and invariably the subject of my running comes up, and having a conversation about why that’s important, physically, mentally, and emotionally. [Page was the first active NFL player to complete a marathon.] So I suppose in an indirect way I do talk with young people about being phys-

ically active, which ultimately I think works to reduce the likelihood of obesity. Being physically active, first of all, just makes you feel better, makes you feel good, and it’s something that we can all benefit from, unless we have been afflicted with some disability that prevents us from being active. As I say, for me it’s been important physically, emotionally, and mentally. You get a chance to get out and clear your mind. No matter what it is, whether you’re out walking, whether you’re running or biking or playing soccer or football, you learn a lot about yourself, you learn a lot about how you can deal with challenges, you learn how you relate to other people. I’ve found it invaluable over the years ■ I’m sure that some kids look at exercise as

a chore, or something you do to get to a certain point, but it’s great that they hear the message that this is rewarding. Well, my experience is that when I started playing football, the conditioning, the running was a chore, was something that I didn’t like, didn’t want to do, and wouldn’t do unless I had to, but I’ve been fortunate to be able to talk with young people about, “How did that change and why did that change?” Why would somebody who at one point in life thought running laps on a football field was something that was to be

avoided as much as possible, why would somebody like that end up running 100 kilometers? And the answer is because you learn about yourself. In having that conversation with these young people, I think they get it. Now maybe they don’t go out and run a 100K the next day, but I think they actually begin to understand that there’s something to it beyond just hard work. ■ What thoughts can you share about

the cases of former players suing the NFL over failing to adequately protect them from brain injury? Probably nothing, because … first of all, they are pending cases, and it wouldn’t be out of the realm of possibility that some of that could show up in our courts; and so, again, I probably should not go there. I can tell you I think whatever the problems with brain injuries as a result of playing football are, we have to be aware that we have 8-, 9-, 10-, 11-year-old children playing football, and it seems to me that in the grand scheme of things, we ought to be concerned about those young children. These children are at a stage where they are not fully developed, and to have brain injuries at that age, I just think it’s a big concern.

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When changes in the local health care landscape promised a major inﬂux of new UCare members coming through metro-area clinics and hospitals, we made sure those providers were prepared. In a span of just two weeks, May Ly was among the UCare staff that personally visited 449 unique health care locations to offer a heads-up and explain the impacts. Because being responsive to our partners’ needs isn’t just talk—it’s what we mean by health care that starts with you.

| provider assistance: 1-888-531-1493 | ucare.org/providers |

AUGUST 2012

MINNESOTA PHYSICIAN

Inequities from cover has ranked Minnesota best among all states in terms of cardiovascular-related deaths. Health rankings in national publications typically place Minnesota at or near the top. Nevertheless, inside the state, residents of different races experience large differences in mortality due to heart disease, diabetes, and cancer, for example. Economic conditions that influence health vary widely. For example, while 9 percent of Minnesota residents overall live in poverty, fewer white residents live in poverty compared to residents of color (6 percent, compared to 24 percent, respectively). In a recent study commissioned by the Blue Cross and Blue Shield of Minnesota Foundation, we delved into health inequities in the sevencounty Twin Cities metro area and found startling differences in health outcomes, based on place, race, and income. Although Twin Citians tend to live about three years longer than the typical American,

average life expectancy in different neighborhoods varies widely, from 68 to 92 years. Those differences in life expectancy consistently relate to the neighborhoods’ social characteristics. So, residents of areas with the lowest household incomes (median less than $35,000) live on average seven years fewer than residents of neighborhoods with the highest incomes (median $75,000 or higher). We learned that both the racial and income characteristics of neighborhoods influence mortality rates—and that racial differences diminish, but do not disappear, in higher income areas. For example, mortality rates for American Indian and African American residents improve in higher income neighborhoods; nonetheless, they exceed those of other groups (Fig. 1). Our study demonstrates that, in our region, strong relationships exist among place, race, income, and health; it confirms the existence of regional health inequities. It also prompts deeper thinking about

MINNESOTA PHYSICIAN AUGUST 2012

the influence of underlying economic and social conditions on health inequities in the future. Economic/demographic changes

How will recent economic/demographic changes influence future health outcomes? Since 2000, Minnesota has experienced dramatic economic changes: • Residents earn less. Median household income stood at $56,000 in 2010, a decrease of $5,000 since 2000. • More residents live in poverty—up from 8 percent in 2000 to 12 percent in 2010. • More residents are housing cost–burdened. Today, onethird of households spend 30 percent or more of their income on housing—up from 22 percent in 2000. These economic changes can influence state residents’ health in multiple ways. Residents who lose jobs may find themselves uninsured or with poorer health insurance coverage; they may reduce expenses by purchasing cheaper, less nutritious foods, by delaying health care, or by rationing medications (taking them less frequently, or in smaller doses than recommended). With residents earning less, a smaller tax base can decrease government funding for preventive efforts to improve neighborhood conditions that facilitate healthy behaviors and that influence life expectancy. The Affordable Care Act will mitigate some of these negative effects by improving access to insurance, especially for young adults, the group most likely uninsured, and by covering individuals with existing conditions. Demographic shifts in the state also have implications for health. • Cultural diversity is increasing. Between 2000 and 2010, the state’s population of color grew by 55 percent. Racial diversification will continue, particularly in the Twin Cities region. The Metropolitan Council projects that, by 2040, over 40 percent of Twin Cities residents will be persons of color.

• Our senior citizen population is growing. By 2030, the number of Minnesotans over age 65 will double; older adults will account for about onefifth of our population. Simultaneously, fewer available workers will support the health care and other needs of our aging population. Demographic shifts present both challenges and opportunities for reducing health in-equities. For example, many new immigrant and refugee families reach the U.S. with healthy diet and lifestyle behaviors that eventually tend to erode. Our region should identify opportunities to help new immigrants maintain healthy lifestyle choices. While we cannot predict exactly how regional economic and demographic changes will influence health outcomes, data clearly demonstrate that many residents in our region have less financial resources than before. Our growing senior citizen population places increased stress on our economy, as we develop ways to provide necessary services for a larger and larger number of residents. In addition, persons of color in our state tend to have poorer outcomes across a variety of measures, including health, education, and employment. Anticipated cultural diversity in our state only heightens the sense of urgency we have to eliminate racial inequities. The role of physicians in reducing health inequities

Physicians treat illness, prevent disease, and advise healthy behaviors for the patients they serve. However, many factors that influence health cannot be solved in the doctor’s office. Instead, we need to look “upstream” to address other factors. In addition to promoting social justice, eliminating health inequities is a cost-saving measure. The Joint Center for Political and Economic Studies estimated in 2009 that eliminating health disparities in the U.S. could produce $56 billion per year of savings in direct medical costs alone. In our view, physicians can work towards reducing health INEQUITIES to page 38

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PROFESSIONAL

Heading to the OR to reduce the risk of stroke By Andrew Grande, MD, Ramachandra Tummala, MD, and Bharathidasan Jagadeesan, MD

which patients with stenotic vessels should undergo medical management and which will benefit from revascularization. Major contemporary studies

have evaluated surgical endarterectomy and endovascular stenting to determine how best to reduce the risk of a

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stroke from carotid stenosis. Some patients with carotid disease can tolerate a progressively stenotic carotid artery without having any symptoms.

Endovascular approaches became a widely available option in 2004, when the Food and Drug Administration approved stents for carotid artery disease.

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NEUROLOGY

Carotid artery disease

ver the last few decades, public awareness has steadily increased about the health risks of obesity, hypertension, and hyperlipidemia. Many people are now well informed about how atherosclerotic plaque in coronary arteries can heighten the likelihood of heart attacks. Less attention, however, has focused on how the same risk factors can also contribute to progressive occlusion of the carotid artery and blood vessels in the brain. But the numbers speak volumes: Of the 700,000 strokes a year in the U.S., an estimated 50,000 are caused by carotid artery disease. The effects of stroke are devastating to individuals and their families, and weigh heavily on society in costs for rehabilitation and long-term care and lost productivity. Fortunately, awareness is growing about carotid artery disease and about the steps that can be taken in prevention, management, and treatment. Studies spanning the last two decades have helped determine

U P D AT E :

MINNESOTA PHYSICIAN AUGUST 2012

In fact, some learn they have a partially occluded vessel during diagnostic tests for other conditions, like evaluation of headache or an injury following a car accident. Studies have shown that for patients who have no symptoms, medical management with statin inhibitors, daily aspirin, and blood pressure reduction can be sufficient to address a narrowing vessel. When patients become symptomatic, they may experience a transient ischemic attack (TIA), involving periods of blindness or paralysis that resolve within 24 hours, or a completed stroke in which the same symptoms persist beyond 24 hours. When TIA symptoms appear, the risk of the patient having a large stroke can be as high as 6 percent within the next two days, up to 19 percent within the next 90 days, and up to 30 percent within the next five years. The North American Symptomatic Carotid Endarterectomy Trial (1991) and European Carotid Surgery Trial (2003) showed that patients symptomatic from carotid artery narrowing greater than 50 percent of the diameter of the artery can benefit significantly from undergoing carotid endarterectomy

(CEA). Other trials, such as the Asymptomatic Carotid Artery Study (1995) and the Asymptomatic Carotid Surgery Trial (2004), have shown that CEA can be beneficial in asymptomatic patients when their internal carotid arteries are narrowed by more than 60 percent. Surgical and endovascular treatments reduce the plaqueinduced stenosis and widen the vessel. Over the years, however, controversy has arisen over which treatment, CEA or carotid artery stenting (CAS), is superior. Recent studies have helped clarify the risks-to-benefit ratio of each procedure and provide an opportunity to evaluate the options for each patient. Carotid endarterectomy (CEA)

Three studies over the last decade, conducted in North America, Europe, and within the U.S. Veterans Affairs system, have investigated the effectiveness of CEA and found that it is highly effective in symptomatic patients who have more than 70 percent stenosis and incomplete occlusion. During CEA, neurosurgeons approach the artery from an anterior approach of the neck, exposing the internal carotid artery, and clamp the vessel both proximally and distally. The procedure can be done in patients who are awake or are under general anesthesia, usually depending on the preference of the surgeon and the anatomy of the patient. Awake patients can provide immediate feedback of potential neurological problems. For patients who cannot tolerate being awake for the procedure, general anesthesia can be used, but electrophysiological monitoring is required to provide assurance that collateral blood supply is adequate to the brain (If the patient has evidence of poor collaterals manifested in diminished amplitude of EEG waves, a temporary shunt can be put in to reroute blood past the stenosis during the procedure.) After opening the vessel, neurosurgeons then dissect out the plaque and suture the open edges of the artery. CEA has been found to be

most beneficial when performed within two weeks of TIA (in patients with only 50 percent to 69 percent stenosis, the studies showed modest benefit for surgery in women, and no benefit in men when the procedure was done beyond two weeks of TIA). For optimal results, patients need to be fit for surgery, and surgeons performing CEA must have low complication rates (less than 7 percent in symptomatic patients and less than 3 percent in asymptomatic patients). In addition, the benefits have been found to be most significant in male patients, particularly those over the age of 75. When the degree of stenosis is between 50 percent and 69 percent, the surgery is of only modest benefit. Contraindications to surgery include recent myocardial infarction; coexistent active cardiac and carotid disease; contralateral carotid occlusion; and multiple, tandem stenoses. In addition, patients with neck irradiation and previous carotid endarterectomy are not good candidates for CEA. Carotid artery stenting (CAS)

Endovascular approaches became a widely available option in 2004 when the Food and Drug Administration approved stents for carotid artery disease. During CAS, interventionalists begin with a diagnostic angiogram to view the stenosis, and then install a distal embolic protection device (a tiny umbrella-like filter) in the vessel to catch plaque particles. They navigate the stent through the stenosis, which can be difficult in patients with tortuous vascular anatomy. Contemporary stents are selfexpanding and exert an outward radial force to widen the diameter of the vessel; occasionally a balloon is positioned into the stent, or into the vessel before the stent is placed, to widen the stenosis. Early studies were promising: In patients with 80 percent stenosis, the stents opened narrow arteries 92 percent of the time, and complication rates were low, with only about 10 percent of patients who received the carotid stent experiencing a

Carotid endarterectomy has been found to be most beneficial when performed within two weeks of transient ischemic attack. stroke, heart attack, or death within 30 days of the procedure. However, much controversy ensued about whether stenting is safer or more effective than surgery. The relative contraindications for CAS include renal disease, because the contrast can be nephrotoxic, and highly tortuous carotid vessels, which make placing a stent difficult. A circumferentially, heavily calcified stenosis can also prohibit safe placement of a stent. Patients are maintained on dual antiplatelet therapy with aspirin and clopidogrel for one month after stent placement and then on daily aspirin thereafter. CEA/CAS comparison

An article in the New England Journal of Medicine in 2010 reported the results of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) and answered many long-debated questions. The multicenter randomized investigation included 2,500 symptomatic and asymptomatic patients. The study found that CAS and CEA were equally effective and that complications with either procedure were low, with periprocedural stroke or death less than 6 percent for symptomatic patients and less than 3 percent for asymptomatic patients. It also showed that patients who underwent surgery were at a higher risk for myocardial infarction after the procedure (2.3 percent with CEA and 1.1 percent with CAS) but at significantly lower risk for perioperative stroke (2.3 percent for CEA and 4.1 percent for CAS). Because rehabilitation from a heart attack is typically faster than from stroke, the results can be interpreted to mean that surgery may be preferable. The study also showed that contrary to prior assumptions, patients older than 70 years

derived more benefit from CEA than from CAS, perhaps due to the tortuous nature of their carotid arteries and aortic arch, which can make CAS difficult. Regarding long-term benefits conferred by CEA or CAS, large studies have shown that the risk of having a stroke in the first year following these procedures is 1 percent to 2 percent for symptomatic patients and 0.5 percent to 0.8 percent for asymptomatic patients. The long-term durability of these benefits (beyond five years) is not yet clearly known. Sometimes the arteries can also narrow again after CEA (about 5 percent in the first year) and CAS (about 10 percent in the first year). However, such narrowing does not always need

to be re-treated with another procedure. Currently, both CEA and CAS are endorsed by the American Heart Association and the American Stroke Association for treatment of symptomatic patients with â&#x2030;Ľ50 percent narrowing of their carotid arteries and for asymptomatic patients with â&#x2030;Ľ70 percent narrowing of their carotid arteries. When the procedure is feasible, CEA has emerged as the procedure of choice, its standing having been further reinforced by the findings from the CREST trial. CAS still has a prominent role, particularly in patients determined to be highrisk candidates for CEA. Andrew Grande, MD, Ramachandra Tummala, MD, and Bharathidasan Jagadeesan, MD, are assistant professors in the Departments of Neurosurgery, Neurology, and Radiology at the University of Minnesota, Minneapolis. Grande and Jagadeesan are co-directors of the Earl Grande Stroke and Stem Cell Laboratory in the Stem Cell Institute at the University of Minnesota, Minneapolis.

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AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Sue Abderholden, MPH NAMI Minnesota Title: Executive Director Interesting projects: NAMI has been working to transform how the various systems view and interact with children and adults with mental illnesses. We have been building a greater understanding of mental illnesses, confronting common myths, reducing stigma, and creating a more empathetic response in order to eliminate barriers to treatment. Mental Health First Aid has been part of this strategy. Additionally, we have been trying to help professionals understand the importance of natural supports—family and friends—in recovery. If we want to have positive outcomes and reduce health care costs, we must eliminate all barriers to accessing treatment early and must assist and engage families and friends to provide the ongoing support that is needed. Biggest challenges: Trying to integrate mental health and health care and to develop intensive supports for children with a serious mental illness who are at risk of residential treatment and who are failing in school.

Jim Abeler, DC Minnesota House of Representatives Title: State Representative Interesting projects: The 2010– 11 health and human services budget was quite a project. Working with stakeholders, providers, the governor, and the departments, we crafted a consensus budget and created many positive reform initiatives, including an attempt to redesign our Medicaid program for greater budget certainty and service delivery flexibility. In 2011 we worked with colleagues and the White Earth tribe to transfer health and human service responsibilities from Mahnomen County to the White Earth Band of Ojibwe. This redirects funds from the county to the tribe and allows for more culturally appropriate care to members of the White Earth Nation.

n preparing this feature, we asked each of the nominated health care leaders to answer two questions: • What are the most interesting projects you have worked on in the past four years? • What are the biggest changes facing your organization? We invite you to read their responses.

Biggest challenges: The rising cost of health care continues to be a daunting challenge, as do chronic health conditions and poor health across our state and nation. Reducing costs, improving access, and bettering the health of the population are all part of the challenge in creating a sustainable, effective health care system.

David Abelson, MD Park Nicollet Health Services Title: CEO Interesting projects: Being very intentional about changing and improving our internal culture of Head + Heart, Together (treating the emotional needs of our patients as well as their clinical needs). We have worked hard to hire the right people and instill a strong sense of purpose and pride in working at Park Nicollet. It’s the right thing to do for our team members, and without it we can’t accomplish one of our most important goals: Improve the patient experience. Biggest challenges: In a time of historic and transformational change in health care, our biggest challenge is to navigate the transition from volume to value. The fee-for-service business model is breaking apart and will soon be gone. All entities in health care must have the same incentives to meet the goals of the Triple Aim: healthy communities with great experiences and outcomes for individuals provided at a sustainable cost.

Macaran Baird, MD, MS University of Minnesota Medical School Title: Professor and Head, Department of Family Medicine and Community Health Interesting projects: Over the past four years our U of M family medicine medical practices have used tools from the

MINNESOTA PHYSICIAN AUGUST 2012

Lean model for improving our practice effectiveness and efficiency, followed by leadership training and skill-building to change our four residency and teaching practices into certified health care homes. In the process, we have become a more cohesive group of clinicians, educators, and staff. Our patients and future patients of our graduates will benefit from these improvements. Biggest challenges: How to simultaneously serve our mostly underresourced patients while also training the next generation of bright, dedicated, skilled physicians, therapists, pharmacists, nurses, and others to work and learn collaboratively. Our goal is the same as that for our whole health care system: improving outcomes, improving the patient experience, and lowering overall costs. This challenge is complicated by the enormous cost pressures on all of higher education.

Eric T. Becken, MD Midwest Ear, Nose, & Throat Specialists, St. Paul Title: Staff Physician Interesting projects: My current focus is to ensure patient and payer access to patientcentered care from independent, high-value physicians through the development of the Collaborative Care Cooperative. Our organizational structure enables us to drive quality measures across practices. We also improve patient care though a communications vehicle that allows real-time collaboration between independent specialty and primary care physicians. Biggest challenges: My principal challenge is to provide exemplary, cost-effective care to every patient. Secondarily, the consolidation of large health care organizations limits patient access to independent, high-value physicians. Extraordinary effort is required to maintain patient access to and awareness of our practice.

Lee Beecher, MD Minnesota PhysicianPatient Alliance Title: President; Psychiatrist, private practice Interesting projects: Of greatest interest to me is the privilege of participating in patient care at my independent psychiatric office practice. Patients are the essential collaborators in their medical care, and we physicians need our patients’ alliance in order to practice our profession. I monitor the Minnesota PhysicianPatient Alliance email listserv featuring discussions and interchanges. I enjoy writing professional articles about the challenges and rewards to patients and physicians in their pursuit of quality, patient-centered care. Biggest challenges: Regarding MPPA, bringing the voices of patients and their families to policymakers, organized medicine, and the public. My medical practice is an ongoing “project” to collaboratively deliver patientcentered, psychiatric, and addictions care. I believe that doctors recommend and patients decide, except in emergencies. Regarding U.S. medical care policy, patients and their families should, to the extent possible, be the medical care decision-makers, rather than deferring to insurance companies or the government.

Mary Sue Beran, MD, MPH Park Nicollet Clinic, St. Louis Park Title: Staff Physician; Researcher Interesting projects: A research evaluation of a primary care redesign involving the patient-centered medical home. We compared the medical home implemented in one clinic to another with respect to disease specific outcomes, staff satisfaction, patient experience, and utilization patterns to see if this model of care offers improvements. What we learn may help identify innovative ways to care for patients with complex chronic medical problems. Biggest challenges: There are simply not enough primary care

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S physicians to meet the needs of the aging and growing Medicare population. We must develop team-based care models that allow us to provide high-quality care for more patients.

Richard M. Bergenstal, MD International Diabetes Center at Park Nicollet Title: Executive Director; Past President, American Diabetes Association Interesting projects: IDC participated in an NIH study of intensive glucose control in type 2 diabetes. Working with the American Diabetes Associat-ion, we helped translate this research into practice through development of an international, patient-centered management guideline. The IDC WHO Collaborating Center, partnering with China’s Ministry of Health, is delivering a five-year diabetes training program. Biggest challenges: Effectively managing diabetes in the wake of health care reform is a perfect challenge for IDC working with Park Nicollet’s integrated health care system. IDC research shows it takes teams (including the patient) armed with effective technology to optimize quality and the patient experience at a reduced cost.

Mary K. Brainerd, MBA HealthPartners Title: President and CEO Interesting projects: The projects I care about very deeply have focused on building new approaches and models of care to improve quality. We have done that work in primary care, hospital care, and specialty care. The results speak for themselves—topnotch quality, health, and safety. That matters. Biggest challenges: The biggest challenge we face is making health care affordable, because whether employers pay for it or we pay through our taxes or out of our wallets, it is costing too much. And we need payment reform.

Matt Brandt, MD

Julie Brunner, JD

Raymond G. Christensen, MD

Multicare Associates of the Twin Cities

Minnesota Council of Health Plans

University of Minnesota Medical School–Duluth Campus

Title: CEO Interesting projects: Patients need and want care delivered to them by physicians who are looking out for them and working for them. They want physicians who are more than just gatekeepers to an insurance company and/or feeders to a hospital system. So I am seeking out, exploring, and implementing new business models that hopefully will unlock the value of primary care delivered in an independent physician group setting. Biggest challenges: There are lots of economic and political pressures that everyone in health care is dealing with, so our biggest challenge is staying focused on doing what we do best—taking care of patients—and avoiding gettting sidetracked or getting lost in the fear of the unknown.

Title: Executive Director Interesting projects: Most of our work in the past four years falls into two categories: state and federal health reform. The constant balance is providing the best coverage possible while trying to make coverage more affordable for employers and individuals. Biggest challenges: Ensuring every Minnesotan has access to health care coverage while working to slow the rising cost of care. In addition, nation-leading work has been underway to change how care is paid for in Minnesota, moving away from paying per procedure toward paying for health while slowing the rising cost of care.

Charles Bransford, MD

Affiliated Community Medical Centers–Granite Falls

Title: Assistant Dean for Rural Health, Associate Professor of Family Medicine; Family Physician, Gateway Family Health Clinic, Moose Lake Interesting projects: Development of the Rural Medical Scholars Program on the U of M Duluth campus. The program is a mandated, longitudinal rural Family Medicine experiential rotation that recurs for one-week periods during the basic science years one and two. Continuing to pursue my personal mission of assuring access for rural citizens and our visitors, to high-quality rural health care 24/7 that maximizes the “golden hour” with high-functioning, interprofessional, local community health care systems. Biggest challenges: Conceptualizing the rural medical practice of the future for appropriate selection and training of tomorrow’s physicians and health care workforce. Identifying and supporting energetic and enthusiastic rural family physician educators and practice sites in supportive rural communities and health systems. This component is essential to complete the university’s extended rural medical school campus.

Lakeview Hospital and Lakeview Hospice/Palliative Care Program Title: Medical Director Interesting projects: Bringing hospice/palliative care into the public consciousness by developing a community-based palliative care program in Stillwater. I have also been an active participant in the Tibetan Healing Initiative, with the goal of sharing the knowledge of our two healing systems for our mutual benefit. Biggest challenges: The danger of “corporatization” of medicine. How do you provide loving, humanistic, individual care to patients in a large corporate system? Our challenge becomes creating the new healers that come out of our Western system, who can use the EMR to its max to still come up with that loving suggestion that can lead a client to health. We must find a way to instill the old joy of primary care in our new physician population, and reward them for the most difficult task in medicine—greeting the terrified person at the front door and walking with them on their particular journey.

Darrell L. Carter MD, DABFP, FAAFP, FACEP Title: Family Physician; Co-founder and Program Director of CALS Program Interesting projects: I have helped develop, write, and teach Comprehensive Advanced Life Support Program (CALS) training designed to improve rural/remote emergency and critical care. The training teaches rural providers the skills, knowledge, teamwork, proper use of needed equipment, and a universal approach focused on the essential medical needs of patients who present to their facilities, especially those patients with time-sensitive life- and organ-threatening conditions. Biggest challenges: Financing and providing the training needed by rural and remote health care providers so as to deliver the same high-quality emergency care in the rural communities that the American health care system delivers to urban populations.

AUGUST 2012

Y. Ralph Chu, MD Chu Vision Institute Title: Founder and Medical Director, Chu Vision Institute; Adjunct Associate Professor of Ophthalmology, University of Minnesota Interesting projects: Chu Vision Institute has participated in over 25 FDA clinical trials, including an ongoing study in which we are evaluating a corneal inlay that corrects presbyopia. In this trial, an implantable contact lens is placed beneath a LASIK flap to help refocus light to improve reading vision without sacrificing distance vision. With over 90 million baby boomers in need of reading glasses, this type of technology will have a significant impact. Biggest challenges: In the current MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S health care environment, practices face increased administrative, regulatory, and economic challenges. It is difficult not only to understand these changes for ourselves as providers but also to communicate these changes to our patients. Creating an organization that can provide high-quality patient care as well as the education needed to make patients feel comfortable in this new environment is our biggest challenge.

Kathryn Correia HealthEast Care System Title: President and CEO Interesting projects: I was privileged to support the complete redesign of inpatient care that was initiated, developed, and implemented by nurses in collaboration with an interdisciplinary team. The model resulted in significant improvement in quality, cost, and patient satisfaction. Prior to that, I was able to build a medical group from the ground up. Now I am intent on supporting everyone at HealthEast to reach our full potential in providing the best value for our patients and in helping to create healthy, vibrant communities. Biggest challenges: Time. Time is always our scarcest commodity. Every day we improve care is a day someone in our community is able to smile brighter, go to work, sing a song, experience less pain, or spend time on something else they would rather do. In health care we have so much to improve, and so little time … it’s personal.

Sara Criger Allina Health Title: Senior Vice President, Allina Health; President, Mercy Hospital, Coon Rapids Interesting projects: At St. Joseph’s Hospital, where I served as CEO until June 2012, we made a strategic decision to not try to be everything to everyone, but to focus on the things we could be excellent at. It was very rewarding to partner with physician leaders and others to evolve programs like the National Brain

Aneurysm Center and HealthEast Stroke Care, HealthEast’s Kidney Stone Institute, Addiction Medicine, and HealthEast Heart Care. Biggest challenges: To engage physicians, nurses, and other health-care team members in needed health-care delivery transformation. They know what to do to improve care and health and how to help avoid unnecessary services. It is the job of leadership to inspire them in this work and unleash the knowledge and creativity they possess so we end up with a better health care system.

Kent Crossley, MD

and shadow-hosting dozens of premedical students of color. It has been rewarding to see many of the students now enrolled in medical school. Biggest challenges: Maintaining the privilege, value, and quality of the patient-physician relationship. I frequently hear patients express frustration at being unable to see the doctor of their choosing due to insurance changes. They are losing longstanding physician relationships, which detracts from quality care. I strongly support patients’ ability to access a physician of their choice.

Minneapolis VA Medical Center

Peter J. Daly, MD

Title: Chief of Staff Interesting projects: Expanding access for our veterans. Our VA now has a network of 11 community clinics in Minnesota and Wisconsin. We increasingly use telecare to provide services to our patients in their homes and for consultations to our clinics and other midwestern VA hospitals. Our TeleICU service works with other VAs as far away as Spokane, Wash. Biggest challenges: Working to optimize services so that we can successfully compete for patients in the future. Recruiting and hiring great physicians to provide outstanding care to our veterans. Spreading the message that VA has evolved to become a worldclass provider of care and a leader in quality.

Summit Orthopedics

Charles E. Crutchfield III, MD Crutchfield Dermatology Title: Medical Director; Clinical Professor of Dermatology, University of Minnesota Medical School Interesting projects: I co-authored a children’s book centered on sun protection and Little League Baseball to appeal to children of all backgrounds. We are proud of the result and hope it will have a lasting impact on children and their families. I also participate in the Future Doctors program at the University of Minnesota Medical School, mentoring

MINNESOTA PHYSICIAN AUGUST 2012

Title: Orthopedic surgeon Interesting projects: Leading a group of independent medical specialists in discerning how we can maintain patients’ interests (choice, access, high quality, cost control) at the center of health care reform. Establishing the Collaborative Care Cooperative, which allows care collaboration on a platform from which we can communicate and integrate with primary care without assuming a single tax ID number. The cooperative facilitates more direct provider discourse and larger scale outcome data, and it can plug into an ACO model and wrap around a health care home. Biggest challenges: Coordinating care requires enhanced communication tools and improved technological solutions, all of which demands IT capital and engaged, innovative physicians.

Bobbi Daniels, MD University of Minnesota Medical School; University of Minnesota Physicians Title: Vice Dean for Clinical Affairs, U of M Medical School; CEO, U of M Physicians Interesting projects: Certainly our upcoming Ambulatory Care Center, in partnership with Fairview, has been an interesting and promising project. This facility will give us a unique opportunity to offer new

care and research models while promoting interdisciplinary collaboration and health care education. Biggest challenges: At a time of decreasing state support for medical education and decreasing reimbursement rates, it’s important we still find ways to support not only clinical care, but research and education as well.

Gary L. Davis, PhD University of Minnesota Medical School–Duluth Campus Title: Regional Campus Dean Interesting projects: Strategic planning to better position the medical school campus in Duluth to address the changing economic environment and prepare students for the changes coming to health care delivery and organization. This included departmental reorganization, new faculty recruitment, and extensive curricular revisions. Biggest challenges: Finding new sources of revenue to compensate for continual decreases in state funding to medical education. We are also challenged by the need to recruit new faculty to replace the retirement of a substantial portion of our faculty in a short time frame. The challenge is not only to hire new faculty but also to find the resources to support the new hires.

Rhonda Degelau, JD Minnesota Association of Community Health Centers Title: Executive Director Interesting projects: Navigating the public and private sector industry reforms on behalf of the state’s urban and rural Community Health Centers (CHCs) and working to line up the resources and partnerships they need to succeed in a rapidly transforming health-care delivery system. CHCs in Minnesota have made great strides in implementing electronic health records, moving toward health-care home certification, utilizing best practices in quality improvement, and creating innovative Medicaid and Medicare payment-reform pilots.

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S Biggest challenges: Defining the role of Community Health Centers in an “ACO world”— which will differ by market (metro, small city, rural, sparsely populated rural). The Medicaid coverage expansion under the Affordable Care Act will create greater demand for CHC services. CHCs will need additional federal and state funding resources to expand capacity for providing culturally competent services to low-income populations.

Peter Dehnel, MD Blue Cross and Blue Shield of Minnesota Title: Medical Director Interesting projects: I work to bring a physician’s perspective to my role, helping adjudicate complex medical coverage cases. My focus has been in working to forge closer collaboration between the physician/clinician community and our health plan on behalf of members. Biggest challenges: I think there’s opportunity to better inform the physician community about the role of health plans, the complexities around coverage, and how insurance plans operate. Ultimately, our goal is to optimize the interface between the insurance world and provider community, and help our members get the right benefits and services within the context of their plan, in order to deliver the best possible outcomes.

Edward P. Ehlinger, MD, MSPH Minnesota Department of Health Title: Commissioner of Health Interesting projects: Providing a long-range public health framework for health reform during a time when budget deficits narrow perspectives to the next biennium and when the role of government in health care is being questioned. Working to integrate clinical care with public health and social services as a way to improve population health and decrease costs. Biggest challenges: Having people

understand that strengthening Minnesota’s public health enterprise is essential if we are to improve health and control costs. Rebalancing our investment between individual treatment and population-focused prevention efforts. The need to increase our investment in primary care and engage citizens in creating healthy communities.

Thomas E. Elliott, MD Essentia Institute of Rural Health, Duluth Title: Executive Director Interesting projects: We are building Essentia Institute of Rural Health, which is Essentia Health’s center for research and education, launched January 2010. We support health services research, translational research, clinical trials, education programs for students and practicing physicians, and credential practitioners. We have recruited great scientific talent, developed a research informatics department with a virtual data warehouse, and joined the HMO Research Network and Midwest Research Network. An excellent strategy guides our growth, and Essentia Health, our parent organization, provides great support. Biggest challenges: The greatest threat to health care research is declining federal funding for research grants, which will slow down the discovery and dissemination of knowledge, decrease jobs in health care research, and limit the growth of our institute and other research centers across the nation.

James W. Eppel Blue Cross and Blue Shield of Minnesota Title: Chief Operating Officer Interesting projects: Our ongoing work in establishing “aligned incentive” relationships with delivery system partners is resulting in highly collaborative and mutually beneficial approaches that will improve quality and decrease the cost of health care.

We’re only beginning to realize the tremendous benefits that these partnerships will generate for our members. Biggest challenges: While I’ve never witnessed such positive energy and collaboration in 30 years of working in this industry, we are facing a level of unprecedented change that will require the requisite changes in structure, process, systems, and talent. Continually evolving to meet these needs and the opportunities before us presents the most significant, and exciting, challenge.

Nancy Feldman UCare Title: President and CEO Interesting projects: Since our membership has doubled over the past four years, we’ve been working to manage our growth and help members connect to the health services they need. We’ve increased our Medicare membership every year, and we were a very successful bidder when the state introduced competitive bidding for state health program members. We’ve been exploring innovative new payment models and relationships with our healthcare system partners for both our Medicare and Medicaid products. Biggest challenges: We need to figure out our place in a world of health reform, focusing on how we can be a link for our diverse members between the health insurance exchange and state programs. We will continue to be challenged by the fiscal pressures on government-supported health programs and how we can continue to provide value to our members and purchasers.

John R. Finnegan Jr., PhD University of Minnesota School of Public Health Title: Professor and Dean; Assistant Vice President for Public Health Interesting projects: Most important? So many in public health! Definitely, health reform that finally acknowledges and is beginning to incorporate the indisAUGUST 2012

pensable role of public health in population and community health. Also. the Taconite Workers Lung Health Partnership that unites U of M scientists, union, industry, government, and community leaders in a scientific initiative to understand the occupational health of this group of workers and their spouses. Biggest challenges: Our biggest challenge is the accelerating disinvestment in higher education. It threatens the school’s capacity to produce the world-class research for which we are famous, and to keep training public health professionals, scientists, and the current public health workforce.

Thomas P. Flynn, MD Minnesota Oncology Title: President Interesting projects: In 2009 we brought nine physicians employed by a hospital into our independent practice. The synergies were clear, as were differences in culture and employment models. The common purpose of high-quality patient care brought us together. Next came the development of a partnership with a health system to enhance the delivery of community cancer care. Finally, we have been engaged in a long-term organizational culture change process to become a more patientcentered practice. Biggest challenges: Changes in reimbursement for care will require us to be better, faster, and cheaper while continuing to deliver the best care to our patients.

Al Franken U.S. Senate Title: Senator Interesting projects: It was incredibly rewarding to pass legislation that’s helping lower health care costs and increase access to coverage for people in Minnesota and across the country. I authored a provision in the health reform law requiring insurance companies to spend at least 80–85 percent of their premium dollars on actual health care. Because of that provision, 9 million Americans— MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S including 123,000 Minnesotansâ&#x20AC;&#x201D; will get $1.1 billion in refunds from their insurance companies this year. More recently, legislation I wrote to get lifesaving medical devices to patients more quickly and safely was sent to President Obama to be signed into law. Biggest challenges: Providing high-quality, low-cost care is the biggest challenge we face when it comes to health care. While Minnesota does an exceptional job of accomplishing this balance, achieving the same success nationwide will continue to be one of my top priorities.

Aaron Friedman, MD University of Minnesota Title: Vice President for Health Sciences; Dean, U of M Medical School Interesting projects: We at the University of Minnesota have made significant strides in finding interdisciplinary solutions to impact health access and care across the state of Minnesota through education, models of clinical care, and outreach programs within our health schools.

Biggest challenges: A dedication to funding for quality health-care education will help ensure a solid foundation for the future of health care not just in Minnesota, but nationwide. Improving patient care and the health of our communities, along with delivering more effective and efficient care, need to be priorities as physicians, health care providers, and educators look ahead.

Alan L. Goldbloom, MD Childrenâ&#x20AC;&#x2122;s Hospitals and Clinics of Minnesota Title: President and CEO Interesting projects: The $300 million expansion and complete renovation of our two campuses in Minneapolis and St. Paul. The result is a state-of-theart facility that features all private patient rooms and reflects our philosophy of family-centered care. Another unique aspect was integration of the arts into the healing environment. Finally, in an age of universal connectivity, we are the only hospital in the country to have a Geek Squad precinct onsite,

thanks to a gift from Best Buy. Biggest challenges: We must find ways to continually improve quality, safety, and patient experience while reducing the total cost of care. We are determined to live up to our commitment of turning no child away and providing every child with the highest quality of care. If we can successfully change the model of care delivery, develop stronger partnerships across the system, and change the payment model, I believe we can meet that commitment.

H. Theodore Grindal, JD Lockridge Grindal Nauen PLLP Title: Partner Interesting projects: Working with physicians, hospitals, and other health care providers as they evolve to compete and collaborate in the everchanging state and federal healthcare reform environment. Counseling providers on the business and public policy aspects of these changes has been exciting and fascinating. Biggest challenges: Representing clients in this era of con-

solidation remains a challenge. New business ventures are possible, however, because of the need for collaboration without ownership. Networks are going to be stronger and demand creative arrangements to compete in this evolving health care market.

Jon Hallberg, MD University of Minnesota Physicians Title: Medical Director, Mill City Clinic; Assistant Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School; Health and Medical Analyst, Minnesota Public Radio Interesting projects: Helping design the innovative and awardwinning Mill City Clinic, an interprofessional primary care, fullservice, neighborhood-based clinic in the Mill District, near the Guthrie Theater in Minneapolis. With this effort weâ&#x20AC;&#x2122;re trying to rethink what a clinic can and should be, especially focusing on ways to engage the community. One very successful project has

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10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S been Hippocrates Cafe, a live show that explores complex health care topics using professional actors and musicians. Biggest challenges: We’re expanding the clinic. The challenge is balancing growth of our primary care efforts with the desire and need to partner with a synergistic subspecialty. We have an opportunity to build space that would position us as a true leader in primary care clinic development and design, while acknowledging the medical and financial benefits of specialty collaboration.

Linda Hamilton, RN, BSN Minnesota Nurses Association Title: President; Staff Nurse, Children’s Hospitals and Clinics Interesting projects: The MNA’s Main Street Contract for the American People campaign inspires nurses to influence state and national political discussions. Our profession is demanding real answers to heal the suffering we see every day on our shifts. Biggest challenges: Inadequate staffing at the bedside, preventing

nurses from delivering quality, lifesaving care. This issue will permeate our legislative and contract negotiations. Our employers refuse to understand the immense pressure they have forced on nurses and our physician colleagues working at the point of care, and how drastically they’ve stripped us of the resources we need to properly do our important work.

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providers, Mayo Clinic faces a future with resources becoming more limited but the need for health care increasing every day. We believe our strategic plan will lead us to a viable balance between these two forces. It’s important to stay true to our nonprofit mission and the values that have sustained us by keeping the needs of the patient foremost in our actions and providing the highest-value care possible.

Mayo Clinic Care Network Title: Medical Director; Professor of Medicine, Mayo Clinic Interesting projects: I’ve had the opportunity to participate in two initiatives that reflect how health care is evolving. The first is an initiative to advance our health and wellness offerings in a nontraditional venue, the Mall of America. The second is an initiative to form the Mayo Clinic Care Network. Biggest challenges: Given our country’s economic situation, it’s more important than ever that providers be reimbursed for value, not volume. Like most

Al Heaton, PharmD, RPh UCare Title: Director, Pharmacy Management Interesting projects: We’ve focused on improving access, affordability, and appropriateness of pharmacy services for our members. We also continue to educate members about generic alternatives. With more than 85 percent of our member prescriptions being generics, members are enjoying cost savings. To achieve appropriateness of prescriptions, we’ve worked closely with members and their doctors to ensure the

right prescription is prescribed at the right time for the right person. Biggest challenges: As prescription drugs transition from chemical to biologic medications, we will be challenged to maintain access, affordability, and appropriateness. While the cost of biologics is extremely high, appropriateness is an important consideration. Pharmacists will play an increasingly critical role—as will guidelines, genetic testing, and personal medicine practice—in ensuring biologics meet the appropriateness test for patients.

Timothy D. Henry, MD Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital Title: Director of Research; Interventional Cardiologist Interesting projects: The development of regional systems for acute cardiovascular emergencies in Minnesota has improved outcomes here and across the U.S. Significant progress has been made in cardiovascular stem cell therapy for myocardial infarction,

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10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S part of medical homes and accountable care organizations. Biggest challenges: Creating and managing a national knowledge center for rural hospitals and clinics that effectively identifies and communicates relevant rural health innovation and reform models taking place around the country. We are also funded to be the go-to resource for rural technical assistance, as well as to be rural health policy advisors to the federal government.

heart failure, refractory angina, and peripheral arterial disease. The development of percutaneous valve therapy has been a major game changer. The Heart of New Ulm project is an attempt to eliminate MI using primary prevention and community intervention. Biggest challenges: As an interventional cardiologist: understanding the implications of health care reform to continue to provide state-of-the-art cardiovascular care in a cost-efficient manner. As director of research: finding cost-efficient ways to retain clinical research and innovation in the U.S.

Ronald L. Holmgren, MD Affiliated Community Medical Centers Title: President and CEO Interesting projects: Collaboration with rural community hospitals, many of which are critical access hospitals, with an organizational goal to be on the leading edge of HITECH compliance. In Willmar, we are expanding joint ventures with Rice Memorial Hospital that have included a new Regional Cancer Center affiliated with Virginia Piper Cancer Institute.

Terry J. Hill, MPA National Rural Health Resource Center, Duluth Title: CEO Interesting projects: Helping the nationâ&#x20AC;&#x2122;s 1,327 critical access hospitals prepare for and become part of the new health reform models. This includes helping them reach HIT meaningful use, develop information exchanges, partner with physicians, and form or become

Biggest challenges: Addressing health care needs of our communities with the reality of our 50+ percent government-payer mix. We also face the significant challenge of recruiting physicians to a rural multispecialty group with six unique locations. Impacting the total cost of care through coordinating care and focused medical home implementation will be our future.

involved with development of relevant and useful quality measures and cost efficiencies; and welcome the increase in insured patients as the mandates of the Affordable Care Act are realized. Biggest challenges: Our belief is that to best serve our patients, we need to remain an independent clinic. That is our goal and challenge for the years ahead.

Charles Horowitz, MD Minneapolis Clinic of Neurology

Minnesota Department of Human Services

Title: President Interesting projects: Preparing for the medical world ahead. In an environment of anticipated change in organization of health care, we have focused on providing neurological care to patients in our clinics, hospitals, and outreach communities. We are in our third year of EHR implementation, successfully achieving meaningful use, but as physicians we remain skeptical of the benefit to patient care. We are preparing to be willing partners in accountable care organizations as they develop; be

Title: Commissioner of Human Services Interesting projects: We are advancing an agenda that will improve health care quality and access for all Minnesotans while controlling costs. This includes requiring health plans to compete for state business, which has already reaped hundreds of millions of dollars in savings; and projects that encourage providers to ntegrate health care and other services to improve outcomes. Biggest challenges: How to redesign home- and community-

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10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S based services for the elderly and people with disabilities is one of the biggest policy questions facing Minnesota. We need sustainable strategies for serving these growing populations to allow people to live as independently as possible. We will submit a proposal to the federal government this summer.

Scott R. Ketover, MD, AGAF Minnesota Gastroenterology, PA Title: President and CEO Interesting projects: We completed a longterm project to fully integrate our EHR with all aspects of our practice, including clinical and practice management. Our patients benefit from more accurate medical records, improved access to our providers, and better compliance with evidence-based guidelines. We are able to measure our patient outcomes and practice-performance characteristics and use the data to challenge ourselves to continually improve. This has also helped us minimize the growth in the total cost of care to our patients and payers.

Biggest challenges: Minnesota Gastroenterology physicians are strong supporters of the Triple Aim (improve the experience of care, lower the per unit cost of care, and improve population health). During the next several years we will be challenged by some of the bureaucratic and administrative aspects of the Affordable Care Act that are in opposition to the goals of the Triple Aim.

Phillip Kibort, MD, MBA Children’s Hospitals and Clinics of Minnesota Title: Chief Medical Officer and Vice President of Medical Affairs Interesting projects: Several projects are transforming our care delivery model and how we work with other physicians. A physician alignment strategy is creating tighter relationships with pediatric clinics and pediatric subspecialties in the community while expanding our ambulatory services. A Focused Provider Performance Evaluation

observes, monitors, and documents provider performances to align with Joint Commission and CMS requirements. We have taken steps to reduce medical errors and be transparent when one does occur. For example, all of our outcomes are now available to the public on a Web-based quality outcomes site. A quality assurance report provides patients and staff with valuable information about our hospital’s quality care. Biggest challenges: Integrating our professional and medical staff with the hospital. Our goal is to work together as one team and one integrated system to provide our patients with the best possible outcomes and experiences and ensure that the children of the entire community have timely access to the best, most appropriate care. We’ve made great strides in this direction and expect to move this forward with our physician alignment project and other initiatives.

Amy Klobuchar U.S. Senate Title: Senator Interesting projects: The rise in shortages of critical drugs has impacted countless individuals in Minnesota and across the country. This year, I passed legislation to help reduce drug shortages by requiring prescription drug manufacturers to give early notification to the Food and Drug Administration (FDA) of any incident that would likely result in a drug shortage. I have worked to reduce regulatory burdens that unnecessarily delay new, life-saving medical devices from reaching the market without compromising consumer safety. In 2012, I passed legislation to streamline FDA regulation of medical devices by strengthening FDA’s current least burdensome requirements and addressing its overly restrictive conflict-of-interest requirements. Biggest challenges: I am continuing to work to promote Minnesota’s high-quality, efficient health care system as a national model for the country. By using tools

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10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S such as the value index, we can rein in costs and reward quality care.

Steven Koop, MD Gillette Children’s Specialty Healthcare Title: Medical Director and Pediatric Orthopedic Surgeon Interesting projects: Because we serve patients who have highly complex needs, designing physical spaces that enhance patient care is critical. Recent expansions of our surgery, imaging, and inpatient areas came about after careful strategy and collaboration. The new spaces support our patients and the highly specialized work we do. Biggest challenges: The only reason that Gillette exists is to serve the needs of our patients. No matter our individual goals or areas of specialty—whether they be orthopedics, physical therapy, or finance—we must continue to maintain our patient-centered culture. If we consistently get that right, everything else falls into place.

Rahul Koranne, MD, MBA, FACP HealthEast Care System Title: Medical Director, Community and PostAcute Services Interesting projects: Building a system of care delivery for the highest-complexity patients by integrating the health care services across the continuum and leveraging the community-based services that directly impact the social determinants of health. Leading the care navigation strategy across HealthEast has been a gratifying and exciting journey. Biggest challenges: Living in two worlds and waiting for reimbursement reform to catch up with the care delivery transformation heads the list. Minnesota’s environment of high trust and broad range of partnerships across stakeholder groups gives me hope that we will continue to lead the nation in health care innovation. Accountable care organizations will need to learn how to care for the spectrum of community dwellers, from the healthy to the sickest of the sick. This

will require new partnerships and new behaviors, and this journey will require difficult trade-offs.

Kelby K. Krabbenhoft Sanford Health Title: President and CEO Interesting projects: Sanford Health’s merger with Fargo, N.D.-based MeritCare in 2009 set forth tremendous change in our organization that continues today. The merger joined two historic health systems with similar missions and values to better serve our patients and support health care in rural hospitals and communities. We’ve grown to over 25,000 employees and are the largest nonprofit health care system in the nation. The challenge of delivering quality health care to all the patients across our region inspires us every day. Biggest challenges: The changing landscape of the health care industry continues to challenge our thinking. However, Sanford Health has long been structured for success in this changing environment because we are

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a fully integrated health system. We believe our system, combining physicians, hospitals, and insurance, is the best way to provide patient care and will prevail as a national model for health care delivery. Managing our continued growth also challenges us as we strive to be relevant in our scope and reach as a health system and to those we serve.

Richard F. Kyle, MD Hennepin County Medical Center Title: Chairman, Department of Orthopaedic Surgery; Professor of Orthopaedic Surgery, University of Minnesota Medical School Interesting projects: One of the most challenging and rewarding projects I have been involved with over the last several years is the organization and promotion of Excelen Center for Orthopaedic Research. This facility is dedicated to enhancing orthopaedic care through basic biomechanical and biological research into the repair and healing process of bones, cartilage, and muscle.

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S Biggest challenges: The greatest challenge of our profession and organization is to continue to provide excellence in all aspects of patient care in an environment where value demonstrated by cost effectiveness is essential. The patient must always come first. Communication and understanding among all parties involved in the health care system are necessary to achieve this goal.

Patricia Lindholm, MD, FFAFP Lake Region Healthcare Clinic Services, Fergus Falls Title: Family Physician; Immediate Past President, Minnesota Medical Association Interesting projects: For several years I have been working on the promotion of physician/healthcare professional well-being. Several years ago, I sat on the board of [medical professional liability insurer] MMIC and stimulated the company to develop a litigation support program for practitioners. Last year, as MMA president, my emphasis was on calling attention to the problems

of professional burnout and to share resources with colleagues to promote individual well-being. Biggest challenges: The greatest challenge facing my workplace is the transition from independent hospital and independent clinic to an integrated health care organization, simultaneously with implementation of an electronic health record. I believe that the greatest challenge to MMA as an organization is to redefine what it means to be a membership organization and how to provide unique value to our members.

Richard L. Lindstrom, MD Minnesota Eye Consultants Title: Founder and Attending Surgeon; Adjunct Clinical Professor Emeritus, University of Minnesota Medical School, Department of Ophthalmology; Associate Director, Minnesota Lions Eye Bank Interesting projects: Introducing LenSx Femtosecond laser for cataract surgery into our practice. Continuing research into incorporating collagen cross-

linking for the treatment of keratoconus and corneal ectasia. Advance research for the surgical correction of presbyopia with several early-stage companies. Biggest challenges: Adapting to ever-changing health care laws and new regulatory requirements. Declining or flat reimbursement rates combined with increasing overhead costs. Developing physician alignment efforts focused on clinical integration to improve outcomes and coordination of care with the Collaborative Care Cooperative. Educating patients and engaging them to make informed decisions and proper choices for their care. Being proactive with ideas for reinventing the health-care delivery system. Supporting U.S. Rep. Erik Paulsen’s efforts to reform the FDA approval process. Being proactive and involved in the political debate surrounding public policy. Continuing to work with the government relations committee of the American Society of Refractive Surgery.

Jennifer P. Lundblad, PhD, MBA Stratis Health Title: President and CEO Interesting projects: In our longstanding role as the Medicare QIO [quality improvement organization] for Minnesota and our work as the Health Information Technology Regional Extension Center, Stratis Health has a unique role in driving national goals in Minnesota, which is increasingly important in a rapidly changing federal and state health delivery and payment environment. We take pride in being good stewards of public funds, aligning national priorities with local needs and interests. Biggest challenges: Quality and patient safety issues that hold the greatest potential for improvement require coordinated community action to affect change. We’re leading groundbreaking crosssetting initiatives to tackle complex issues such as care transitions and EHR interoperability.

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Title: CEO Interesting projects: The staff at Courage Center impress me every day with their dedication to our clients and mission and their drive to keep innovating. The Governor’s Task Force on Health Reform is pushing the conversation forward in Minnesota to how we can achieve the Triple Aim for all people in the state. The recent Innovation Award from CMS for our health care home serving people with disabilities was a great point of pride and illustrates what’s possible with reform. Biggest challenges: The last few years’ “perfect storm” of federal and state cuts to payments, insurance coverage reductions, and a simultaneous drop in charitable giving. The old financial models don’t work and new ones haven’t yet arrived for the populations we serve. Bridging that gap is challenging, but essential.

Title: President and CEO Interesting projects: Working with our 145 member hospitals and 17 health systems to influence and implement state and federal laws for health care reform. In addition, working with our members to improve quality and patient safety has resulted in Minnesota being recognized as a national leader. Biggest challenges: The absolute need to transform health care payment and delivery to generate more value for patients and communities, while maintaining access to excellent care throughout our state. Hospitals and health systems are in transition, trying to maintain successful performance in the current fee-forservice world while building the infrastructure for success in a more risk-based, global payment system.

Midwest Medical Insurance Holding Company (MMIC)

Title: President and CEO Interesting projects and biggest challenges: Working on health reform has been the most interesting and challenging part of my career in the last four years, first at the Minnesota Department of Health and now at ICSI. Working on all three parts of the Triple Aim (improved population health, improved experience of care including quality, and improved affordability by decreasing per capita costs) has been gratifying. One challenge is how we bring the wisdom of clinicians together with the wisdom of patients and community stakeholders to design our future. Bold physician leadership will co-create roadmaps to a sustainable future for health care and healthy communities.

Title: President and CEO Interesting projects: Our litigation support program. When physicians are sued, their competency and integrity are challenged; it is often life-changing. Physicians don’t often seek support, so we developed a program where an experienced psychiatrist reaches out to all policyholders who are sued, to talk and offer ways to cope and prepare for the added stress of a trial. Biggest challenges: The litigation support program shows that support combats stress. However, stress is not limited to litigation. This year we hired our first chief medical officer, Laurie DrillMellum, MD. She will create physician wellness programs to reduce and manage the multiple stressors physicians face.

Healthcare Planning and Design American Diabetes Association EXPO Healthcare Professional Breakfast Saturday, October 13, 2012 7:00 am Minneapolis Convention Center *Exhibitors feature the latest products, services and medications FREE Educational Credits!

*Ask the Expert: Questions answered by medical professionals Innovations in Diabetes Care and e-Healthcare by Brandon Nathan, MD *Exciting speakers on diabetes topics

Brandon Nathan, MD, is a Pediatric Endocrinologist at University *Healthy Eating cooking and Active Living fitness demo’sof Minnesota Amplatz Children's Hospital, Fairview in Minneapolis, Minnesota. *FREE health screenings Dr. Brandon Nathan has spent the last four years supporting an online *FREE Admission pediatric diabetes learning community at the U of M. He has demonstrated *For with moreusing information call1-888-DIABETES success the Pediatric Diabetes Learning Community and is or visit www.diabetes.org/minneapolisEXPO currently working on a project targeting high risk adolescents with type 1 diabetes and the use of on-line education/video tools to educate patients and families and improve care through utilizing e-Healthcare communication. Ophthalmology - Essentia Health

Objectives: Describe two challenges of implementing the Pediatric Diabetes Learning Community and how these challenges were overcome. Describe two benefits associated with the online educational tools and e-Healthcare communication for the healthcare provider and the patient. 7:00 am - 8:15am Breakfast, Presentation and Discussion Event is free of charge and open to all healthcare professionals.

612.338.2029 | 218.727.8446

RSVP on-line at https://diabetesmn.wufoo.com/forms/hcp-breakfast/ Space is limited. Please RSVP by Friday, September 28, 2012 1.0 Credits Hours Available through Minneapolis St. Paul Diabetes Educators (MSDE) for RN, RD, CDE, PharmD

MINNESOTA PHYSICIAN AUGUST 2012

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Robert Meiches, MD MBA Minnesota Medical Association Title: CEO Interesting projects: The multiple journeys and faces of health care reform have been very interesting. They have created a new universe of ideas and opportunities. Similarly, the changing face of physicians and physician practice in Minnesota has created new contours in our local health care environmentâ&#x20AC;&#x201D; physicians are doing new things in new ways. Biggest challenges: Although the focus on a common set of â&#x20AC;&#x153;patient-focusedâ&#x20AC;? goals unites all physicians, the way to achieve these goals has become increasingly complex. This complexity is reflected in the diversity of physician ideas, preferences, and beliefs. How can our evolving health systems address not only the diversity of our citizens, but also the diversity of our physicians and their opportunities to practice the art and science of medicine?

Marcus Merz, MBA, MHCA

Victor M. Montori, MD, MSc

PreferredOne

Mayo Clinic

Title: President and CEO Interesting projects: Planning a chance-in-a-lifetime golf trip to Ireland. Watching our daughter earn her MFA and transition into adulthood. Helping our son get married and start his career, and preparing for our first grandchild. Andâ&#x20AC;&#x201D;continuing to grow and thrive as a small, innovative health plan in a community dominated by three large competitors. Biggest challenges: Trying to guess the Supreme Courtâ&#x20AC;&#x2122;s ruling on President Obamaâ&#x20AC;&#x2122;s health reform law, and knowing what to do regardless of the decision. Helping our customers navigate the maze of conflicting laws and regulations. Assisting providers who are developing medical homes and accountable care organizations to respond to payment reforms in Medicare and Medicaid.

Title: Lead Investigator, Knowledge and Evaluation Research Unit; Professor of Medicine Interesting projects: Developing the notion of evidence-based clinical practice for patients with chronic conditions as a combination of contextually sensitive practice guidelines, shared decision-making tools, and minimally disruptive medicine. Working with different clinical practices and colleagues to implement these ideas has been at times funny, frustrating, exhilarating, and inspiring. Mostly the latter. Biggest challenges: Overcoming the pervasive force of corruption in health careâ&#x20AC;&#x201D;a force that moves health care away from the patient and from the privilege and responsibility to care for and about them; that focuses efforts toward market share and profits, brand value, and operational performance; that extracts the humanity of meaningful conversations out of the daily workflow; that fails to

honor suffering as a spur to improve our moral obligation toward those living in the â&#x20AC;&#x153;shadows of society.â&#x20AC;? That is the biggest challenge of our time.

Robert C. Moravec, MD St. Josephâ&#x20AC;&#x2122;s Hospital, St. Paul Title: Medical Director Interesting projects: As co-chair of the Minnesota Alliance for Patient Safety conference, I have had the opportunity to learn about the best practices throughout the state and interact with most of the patient safety experts from Minnesota and around the country. I have been privileged to advance some of the best of the best to the rest of the state. Biggest challenges: Two fronts facing HealthEast: (1) Implementation of an effective EHR to replace the current system within the next two years. (2) Developing an accountable care organization and redesigning the care delivery model to be the â&#x20AC;&#x153;Best Value for Healthcare by 2015.â&#x20AC;? Value-Based Health Care is an exciting and forward-thinking

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Keynote: Reed V. Tuckson, MD, FACP Executive Vice President and Chief of Medical Affairs, UnitedHealth Group

AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S initiative but will be challenging in a health care system still based on a per-use or per-procedure reimbursement model.

Steven Mulder, MD Hutchinson Area Health Care Title: President and CEO Interesting projects: For nearly two years, we have been working to integrate Hutchinson Area Health Care, a 66-bed hospital, and Hutchinson Medical Center, a private, physician-owned multispecialty clinic with 30 providers. We expect to go live with the newly integrated organization on Oct. 1, 2012. The two organizations have a history of collaboration rather than competition, a history that has served us well as we come together. The integrated organization will be well suited to serve our community in the evolving era of health care reform. Biggest challenges: We must demonstrate that continued local independence adds value for our community, patients, providers, payers, and tertiary partners.

Anne Murray, MD, MS Hennepin County Medical Center, Title: Investigator, Chronic Disease Research Group and Berman Center; Geriatrician Interesting projects: It was an honor to work as chair of the West Metro Medical Society (now Twin Cities Medical Society) with a group of outstanding colleagues. I also worked with the Minnesota Alzheimerâ&#x20AC;&#x2122;s Association and Alzheimerâ&#x20AC;&#x2122;s Disease Working Group to develop legislation to improve awareness and management of dementia in Minnesota. Recently I received a large NIH grant to conduct a longitudinal study of cognitive impairment in patients with moderate kidney disease over the next five years. Iâ&#x20AC;&#x2122;m also the lead U.S. geriatrician for a large, low-dose aspirin trial in 19,000 people 65 years and older. Biggest challenges: The merger of Hennepin Faculty Associates with HCMC has in some ways been challenging but in many ways, positive. The new Hennepin Health Systems is

very supportive of continuing clinical research at HCMC and recruiting new investigators. Funding for research has become extremely tight and will always be a challenge.

Brock Nelson, MHA Regions Hospital Title: President and CEO Interesting projects: The Best Care Best Experience patient satisfaction initiative is clearly working. Scores were at the 29th percentile in 2003 when we started; now we are consistently in the top quartile and approaching the top decile. Regionsâ&#x20AC;&#x2122; 2009 expansion added 11 floors, a new emergency department, and nearly 200 new private rooms. Patients with mental illnesses will be better served when our new, eight-story mental health building opens this year with a new model of care. Biggest challenges: Nearly half our patients are enrolled in government programs or have no insurance. The staggering funding cuts to public

programs is the biggest challenge to our achieving our mission as a safety net hospital to serve all patients in our community.

Jon Nielsen, MD Oakdale Obstetrics & Gynecology Title: Senior Partner; Staff Physician Interesting projects: My health care career has been especially interesting because it has involved multiple levels of activity. Administrative challenges have included longterm service on North Memorialâ&#x20AC;&#x2122;s board of trustees. The addition of Maple Grove Hospital to the community has been fulfilling. Assisting with the development of the divisional merger of six independent ob-gyn groups into the entity Premier Ob-Gyn of Minnesota, which I serve as president, has been a rewarding experience. Clinically, advancing the concept of patient-centered, minimally invasive gynecologic surgery has involved much national lecturing and peer education in innovative surgical techniques.

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MINNESOTA PHYSICIAN AUGUST 2012

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S Biggest challenges: Maintaining a personalized, patient-centered approach in the environment of heath care consolidation will be our biggest challenge in the years ahead.

Val Overton, CNP, RN Fairview Clinics Title: Vice President of Quality and Innovation Interesting projects: I was part of an innovation pilot project through which four Fairview primary care clinics developed a team-based model of care that uses each team member to his or her highest potential and puts patients at the center. Spreading the model to 40 Fairview clinics all at once was a fascinating process. In our teambased model of care, we have begun to tap behavioral tools such as motivational interviewing, patient activation, and shared decision-making. Biggest challenges: Pacing healthcare delivery changes with evolving private payer contracts and government reimbursement programs is a key challenge. We are

changing how we deliver care and working with payers as they create new models of payment. As the financial model moves from fee-for-service contracts to shared savings contracts and other payment approaches, our care model needs to be aligned with, and not too far ahead of, that work.

Carolyn Pare Buyers Health Care Action Group Title: President and CEO Interesting projects: Because we represent the people who pay for health care, payment reform is our highest priority. I am proud of the work we have done to improve health outcomes in the areas of diabetes, vascular disease, and depression through our Bridges to Excellence pay-for-performance program. I am pleased with the public/private sector purchasing partnership we have been able to achieve. Biggest challenges: The health of our membersâ&#x20AC;&#x2122; employees is critical to the vitality and economic viability of the communities where we do business. As a

coalition of Minnesota-based employers, we are continually challenged to support our workforce in their collective and individual quest for wellness and, in the event of illness, high quality, affordable health care.

developed a program on physician well-being that included a play, performed at the Guthrie Theater, to raise awareness of resilience and begin a larger dialogue about the future health professional workforce.

Carl Patow, MD, MPH

Erik Paulsen

HealthPartners Research & Education

U.S. House of Representatives

Title: Executive Director, Health Professional Education Interesting projects: We are using innovative teaching methods for health professionals to improve health outcomes. Recently we organized a large-scale initiative on health disparities. We partnered with community members to improve health for ethnic populations in Minnesota. The effort was successful, with better patient outcomes and experience of care. Biggest challenges: As our population ages, more health professionals will be needed to care for aging baby boomers, at a time when many physicians are considering retirement. We

Title: Representative Interesting projects: Ensuring that Minnesota continues to be the leader in medical technology innovation is one of my top priorities. In June, my legislation to repeal a dangerous new tax on all medical devices passed bipartisanly in the House. Stopping this tax on innovation is critical to protecting American jobs from moving overseas and ensuring that advances in medical technology continue to take place within our borders. Ultimately, this makes patient care more affordable and accessible and creates American jobs. Biggest challenges: One of the biggest challenges we face is ensuring Americans have access

Fairview Health Services Leading the way in innovation Fairview is seeking compassionate and adventurous caregiversâ&#x20AC;&#x201D;four full-time physicians and eight full-time nurse practitioners/physician assistantsâ&#x20AC;&#x201D;to join us in developing a unique new outpatient care model. Highlights of this opportunity include: â&#x20AC;˘ Care for adult patients with complex medical and behavioral needsâ&#x20AC;&#x201D; those not well-served in the traditional outpatient clinicâ&#x20AC;&#x201D;through development of a primarily home-based practice

THE STRENGTH TO HEAL

and stand by those who stand up for me. Learn the latest treatments and play an important role in the care of Soldiers and their Families. As a physician on the U.S. Army Reserve Health Care Team, youâ&#x20AC;&#x2122;ll continue to practice in your community and serve when needed. Youâ&#x20AC;&#x2122;ll work with the most advanced technology and distinguish yourself while working with dedicated professionals. Youâ&#x20AC;&#x2122;ll make a difference.

â&#x20AC;˘ Partner with a Fairview Medical Group team who has demonstrated the capacity to provide compassionate, high-quality and eďŹ&#x192;cient care for a similarly complex patient population â&#x20AC;˘ Provide outpatient care only; inpatient care provided by our team of hospitalists and our community and academic medical centers Candidates must have 7+ years experience as a practicing clinician. Emphasis in hospital-based medicine, cardiac, pulmonary or end-of-life care preferred. Visit fairview.org/physicians to explore this and other opportunities and apply online, call 612-672-2277 or email recruit1@fairview.org. Sorry, no J1 opportunities.

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AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S to the highest quality health care at affordable prices. I’ve been working on common sense, bipartisan initiatives like the device tax repeal and reforms to the FDA approval process to make it both rigorous and relevant, in order to tackle this important challenge.

for the foreseeable future. Our community is in need of excellent patient care that is provided at much lower costs. We will pursue this goal through a physician-led model of care with our integrated medical network leading the way.

Kenneth H. Paulus, MHCA

Essentia Health

Allina Health Title: President and CEO Interesting projects: Allina’s selection and participation as one of the nation’s 32 Pioneer Accountable Care Organizations has proven to be a significant organizational motivator. We are testing new ideas on how to best improve the health of our constituents while also lowering overall cost. The shift of Allina Hospitals & Clinics to Allina Health has also been impactful. While the name change is interesting, it is the focus on relationships with patients and helping them on the path to better health that is especially rewarding. Biggest challenges: The need to reduce costs will be a challenge

Peter E. Person, MD, MBA Title: CEO Interesting projects: Bringing together regional hospitals and health systems to form Essentia Health, which includes 65 clinics and 14 hospitals in Minnesota, North Dakota, Wisconsin, and Idaho. Our 12,000 employees, including 750 physicians and 750 advanced practitioners, are connected by a robust electronic health record, ensuring rural residents receive high-quality care close to home. Biggest challenges: Changing the current payment model to support wellness and preventive care. As an integrated health system, we are well positioned to become an accountable care organization. Our hospitals and clinics collaborate. We focus on

chronic disease management and prevention. Our EHR allows us to closely monitor population health. We are beginning to see payers align their payment structures to support these activities.

value. The greatest challenge is improving quality and reducing cost, but our patients and community deserve nothing less.

Rahshana Price-Isuk, MD Neighborhood Healthsource Clinics

Terence Pladson, MD, MBA, FACPE CentraCare Health System Title: President and CEO Interesting projects: We completed a 360,000-squarefoot, $223 million addition to St. Cloud Hospital, adding private rooms, operating rooms, and new women’s center and ICU. Lakeview Clinic in Sauk Centre became part of CentraCare in 2011; St. Michael’s Hospital will join us in October. The Coborn Cancer Center joined Mayo Clinic Cancer Care Network this year to enhance clinical services while remaining a CentraCare cancer center. Biggest challenges: We are working to achieve our vision to be the leader in Minnesota for quality, safety, service, and

Title: Medical Director Interesting projects: Assisting in development and implementation of our new Heritage Park Seniors Clinic in north Minneapolis. NHS is one partner in the new senior campus that includes medical, therapy, assisted living, and adult day care services. The project was funded by the Minneapolis Housing Authority through ARRA funds. The facility, opened early in 2012, is the first of its kind in the nation. Biggest challenges: Maintaining high-quality care and striving for excellent customer service while maintaining a pace of production that keeps the doors open. Our mission entails reducing health care disparities through the care and education we provide our patients. Due to lack of insurance,

continuing medical education 30th Annual Strategies in Primary Care Medicine

September 20-21, 2012

• New this year: “Customized Learning” featuring over 35 breakout sessions • Post-Conference Activities – Basic Life Support for Health Care Providers – Recertiﬁcation – ABIM Maintenance of Certiﬁcation Learning Session

Midwestern Region Burn Conference

October 11-12, 2012

• Pre-Conference Workshops – Burn Rehabilitation: The Bridge to Recovery – The Pathway to Improving Outcomes for Pediatric Burn Injuries (includes simulation-based learning) • Post-Conference ABLS Provider Course

Optimizing Mechanical Ventilation 13th Annual Women’s Health Conference Pediatric Fundamental Critical Care Support Emergency Medicine and Trauma Update: Beyond the Golden Hour Geriatric Orthopaedic Fracture Conference 34th Annual Cardiovascular Conference

education that measurably improves patient care 28

MINNESOTA PHYSICIAN AUGUST 2012

October 10, 2012

October 13, 2012

October 26-28, 2012 November 2, 2012 November 8-9, 2012 November 15, 2012 November 29-30, 2012 December 13-14, 2012

HealthPartnersInstitute.org

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S financial resources, health literacy, differing cultural concepts of disease vs. health, and other barriers, many of our patients forgo or fail to show up for appointments, or present to the clinic in a health crisis. The key will be high-functioning care management teams.

Brian Rank, MD HealthPartners Medical Group Title: Medical Director Interesting projects: Working with our clinicians, staff, and patients to reliably create care that supports a healing relationship between providers and patients, linking visits, sites, and specialties, over time. And providing evidence-based care that is customized to the patient’s values, preferences, needs, and unique characteristics. Biggest challenges: Making care affordable. Right now, health care is unaffordable for patients anywhere in the nation. Our responsibility as a care system, in partnership with our patients, is to provide the best care possible

with a great experience at an affordable cost. And we still need to better engage our patients in order to create new and innovative ways to care.

Dave Renner Minnesota Medical Association Title: Director of State and Federal Legislation Interesting projects: Health system reform, from the MMA’s “Physician Plan for a Healthy Minnesota” in 2005, to passage of Minnesota’s health reforms in 2008, and Congress’s passage of the Affordable Care Act in 2010. In order to achieve meaningful health reform, it must be multifaceted to address insurance, delivery, patient, and public health reforms. Biggest challenges: Transitioning to payment systems that promote health outcomes, engage patients in new ways, and maintain the high-quality care we expect. In making these changes, we must acknowledge the many different delivery styles in the state and that a “one-size-fits-all” approach will not work.

Tim Rice Lakewood Health System Title: President and CEO Interesting projects: (1) Increasing employee engagement to be one of the top in the country (“best in class”) according to HR Solutions. (2) Supporting the development of medical home and palliative care by the physicians. These are key initiatives to care coordination and improving value, allowing us to initiate discussions about shared savings with payers. (3) Pursuing initiatives to prepare financially for health reform: establishing and achieving new financial goals, implementing a new hospital electronic medical record, and developing cost and financial projection systems—which will position us well for whatever reform brings. Biggest challenges: (1) Meeting financial goals. (2) Pursuing a new management model to better fit a changing organization and to increase employee engagement. (3) Developing a greater sense of urgency for

innovation and implementation of those innovations.

Casey Ryan, MD Altru Health System Title: President Interesting projects: In 2009, we began a dialogue with Mayo Clinic to develop a non-ownership relationship. In May 2011, we became the first Mayo Clinic Care Network member. Though the process took time, it was very beneficial for Altru Health System. Mayo Clinic has helped us improve our quality and service. Biggest challenges: The biggest challenge for Altru Health System, and all providers, will be state and federal reimbursement. Patient expectations are increasing and reimbursement will be decreasing. We’ll continue to keep patients our focus and ensure they receive the high level of care they deserve.

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AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Charles E. Sawyer, DC Northwestern Health Sciences University Title: Senior Vice President Interesting projects: We are a small, independent institution that functions largely outside of mainstream health care. I have worked to develop relationships with other health care organizations so they might be better informed about the university and the value of our clinical disciplines. In 2010, we formed the Center for Healthcare Innovation and Policy to inform and influence public policy in the areas of natural and integrative health care, service delivery, and public health. Biggest challenges: Our biggest challenge is the opportunity to better inform thought leaders about the roles our clinical disciplines can play in the evolving health care system. Better access, lower cost, and higher quality patient-centered care are a few of the reform drivers that support the case for greater inclusion of chiropractic, acupuncture, thera-

peutic massage, clinical nutrition, and other integrative medicine services within new, collaborative care-delivery models.

Sue A. Schettle Twin Cities Medical Society Title: CEO Interesting projects: We are leading the largest grassroots advance-care planning initiative currently underway in the U.S., called Honoring Choices Minnesota. Our mission is to make advance care planning the community’s standard of care for adults and to ensure every person’s health care choices are clearly defined and honored. We are also leading an effort through our Twin Cities Obesity Prevention Coalition to mobilize a community-based coalition of organizations, physicians, and individuals who are committed to improving public health by advocating for healthy eating/active living strategies in metro area communities. Biggest challenges: Implications and ramifications of health care reform.

CHART TALK

Jeff Schiff, MD, MBA

Mark Schoenbaum, MSW

Minnesota Department of Human Services

Minnesota Department of Health

Title: Medical Director for Minnesota Health Care Programs Interesting projects: Our Health Care Home program has been our most significant project. Our health care community stepped up to this transformational challenge in a very productive way. Other key projects have been the national Medicaid quality agenda, evidence-based benefit design, our state accountable care organization model, and birth outcomes improvement. Biggest challenges: Providing health care within the limits of state resources will always be our biggest challenge. After this, the coordinated and thoughtful implementation of multiple state and federal reform efforts is an ongoing challenge. Last, efforts to create person-centered integration of health care with community resources are gaining momentum.

Title: Director, Office of Rural Health and Primary Care Interesting projects: Staffing a work group of the Governor’s Health Reform Task Force, which has made a clear connection between reform goals and workforce needs. We’re also working on models that hit the Triple Aim while taking into account the financial, workforce, and technology challenges characteristic of rural and safety net providers. Biggest challenges: Minnesota’s underserved population continues to grow and evolve, becoming older and more diverse everywhere. Add rapid change in a transforming system, and we in government must continuously refine how we use our limited resources to best help the health care safety net navigate this transition while serving those in need.

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MINNESOTA PHYSICIAN AUGUST 2012

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Susan F. Sencer, MD Children’s Hospitals and Clinics of Minnesota Title: Medical Director, Hematology/ Oncology Interesting projects: One of the projects I am most proud of is our cultural fluency work that is tied to interpreter services. We’ve made great strides with our Spanish-speaking patients: A study done in 2007 showed great patient satisfaction and fewer medication errors. Over the next year we plan to bring a similar approach to our Hmong and Somali families. Biggest challenges: A big challenge confronting pediatric health care in general is the need for improved nutrition. One of my goals for Children’s is to bring a new outlook on nutrition, specifically for children who have lifethreatening diseases such as cancer. Increasingly, obese patients with cancer have more complications because they face issues such as diabetes or joint and bone issues, which makes planning treatment more difficult. Better

nutrition will mean better treatment and better outcomes for our kids.

Ann Settgast, MD, DTM&H

Dawn Simonson, MPA

Minnesota Chapter of Physicians for a National Health Program

Metropolitan Area Agency on Aging, Inc.

Stephen R. Setterberg, MD

Title: Co-chair Interesting projects: Our chapter formed from the belief that the best way to provide highquality health care to all Minnesotans while controlling costs is via singlepayer reform. The unnecessary suffering of uninsured and underinsured patients is astonishing. Educating and organizing physicians around single-payer is the most important work I do for patients. Biggest challenges: There is a common misperception that U.S. health care is so costly because we provide too much unnecessary care. However, when compared to other wealthy democracies (all with universal care), the massive difference in spending is seen mainly in the administrative realm, due to our uniquely complex, multipayer, profit-driven system.

Title: Executive Director Interesting projects: The Area Agency on Aging is partnering with community organizations to deliver evidence-based falls prevention and chronic disease management services for older adults in the metro region. Demand for these classes is strong and we are testing exciting new approaches that meet the needs of minority elders. Biggest challenges: Frail seniors often need nonmedical services and supports to help them recover from illness and live at home as independently as possible. We’re working diligently to bring our knowledge and connections to the table as health care providers seek to engage community organizations in delivery of comprehensive care approaches. While the task is overwhelming at times, the opportunities to embrace the complexities of health and aging have never been as forthcoming.

PrairieCare Child & Adolescent Psychiatric Hospital, Maple Grove Title: President and Founder Interesting projects: PrairieCare plans to complete an expansion from 20 to 50 inpatient beds by early 2014. Along with expanding our own outpatient resources, we are joining Mayo, Sanford, and Essentia in a statesponsored program to increase access to psychiatric consultation in primary care. Biggest challenges: There is still insufficient grasp of the suffering caused by psychiatric conditions. Underfunding prevention and early intervention efforts leads to higher costs in the long run. At the same time, a lack of outpatient resources is sometimes used to rationalize denying needed acute inpatient care.

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AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Cheryl M. Stephens, MBA, PhD

M. Thomas Stillman, MD, FACP

Community Health Information Collaborative (CHIC)

Hennepin County Medical Center Title: Director, Undergraduate Medical Education, Department of Medicine; Professor of Medicine, University of Minnesota Medical School Interesting projects and biggest challenges: The practice of medicine has always appropriately focused on the doctor-patient relationship and the importance of providing care that is respectful of individual preferences, needs, and values. A challenge we face is honoring this sacred relationship in the face of advancing technology. One example is the use of computers in daily practice. To be sure, there is no doubt about the benefits that electronic health records provide with respect to efficiency and data management. But if we’re not careful, we can pay an unintentional price of depersonalization in an otherwise successful doctorpatient relationship during a face-to-face visit. Our patients need our undivided

Title: President and CEO Interesting projects: The development of HIEBridge, CHIC’s health information exchange, began in 2008 with a federal grant to assist in building policies, governance structure, and piloting standards for the Nationwide Health Information Network. Through this work, CHIC obtained contracts with the Social Security Administration and the Veterans Administration to provide exchange of patient information with federal agencies and HIE services to the full continuum of health care providers in Minnesota. Biggest challenges: Development and sustainability of new programs is more difficult as our economy recovers; health care providers are facing reductions or changes in their payment structure, impacting decisions to implement new technologies.

Urgent Care We have part-time and on-call positions available at a variety of Twin Cities’ metro area HealthPartners Clinics. Evening and weekend shifts are currently available. We are seeking BC/ BE full-range family medicine and internal medicine pediatric (Med-Peds) physicians. We offer a competitive salary and paid malpractice. For consideration, apply online at healthpartners.jobs and follow the Search Physician Careers link to view our Urgent Care opportunities. For more information, please contact diane.m.collins@ healthpartners.com or call Diane at: 952-883-5453; toll-free: 1-800-472-4695 x3. EOE

healthpartners.com

MINNESOTA PHYSICIAN AUGUST 2012

attention and must feel we are listening and absorbing their story. Step back from your computer. Talk with and listen to your patients in order to be moved to action on their behalf. Being successful in maintaining the doctorpatient relationship requires adaptation to technology, not submission to it.

Lyle Swenson, MD, FACC Minnesota Medical Association Title: President; Cardiologist, East Metro Cardiology Interesting projects: In 2010, I submitted a resolution at the MMA annual meeting calling for the development of a task force to identify and evaluate unique challenges to the independent practice of medicine in Minnesota. This effort led to the formation of the Independent Practice of Medicine Task Force, which has worked over the past year to identify and prioritize the most important issues for independent physicians. The task force recently presented its findings and recommendations to the MMA

board of directors, and now an action plan is being developed. Biggest challenges: The MMA is challenged primarily by trends that divide us as physicians: the increasing pressures to accept employment by large hospital systems vs. staying independent; the political polarization of physicians; and trends toward increasing specialization of physicians and reliance on specialty organizations vs. broad-based physician organizations.

Loren “Larry” Taylor, MBA North Memorial Health Care Title: CEO Interesting projects: Opening the new Maple Grove Hospital and watching it flourish and expand, ahead of schedule. Biggest challenges: Given the state of the economy, our main challenge is getting reimbursed for our services. We have witnessed growth in both charity and uncompensated care. North Memorial desires to continue our discussion with legislators regarding meaningful payment and

Internal Medicine?

Yup.

Family Medicine?

NEW clinic in Mahtomedi, MN?

Internal and Family Medicine Opportunities Stillwater Medical Group is an 90+ provider multi-specialty group practice afﬁliated with Lakeview Hospital. For more than 50 years we have been providing comprehensive healthcare services in the St. Croix Valley, just east of the Twin Cities metro area. Internal and Family Medicine Physician Opportunities: Stillwater Medical Group has exciting new Internal and Family Medicine Physician opportunities at our NEW Mahtomedi, MN clinic opening Fall 2012! Additional opportunities also available in Stillwater, MN. Mahtomedi, MN? (Ma-toe-me-dye) So what if you can’t pronounce it? We can help with that. Mahtomedi is located in Washington County, on the east shore of White Bear Lake. Residents appreciate the community’s small town charm, lakeside ﬂavor, and close proximity to the Twin Cities Metropolitan Area. In addition, the Mahtomedi School District and other area colleges offer excellence in education. For further information please contact: Patti Lewis, Director Human Resources 1500 Curve Crest Blvd, Stillwater MN (651) 275-3304, plewis@lakeview.org stillwatermedicalgroup.com

We’ll make it all better.

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S delivery reform. We envision a care model that holds both providers and patients responsible for the cost of care. As we learned in the Coordinated Care Delivery project, when we had assigned patients and tracked our data, we could identify frequent users and coordinate individualized care.

Paul Thissen, JD Minnesota House of Representatives Title: State Representative and Minority Leader Interesting projects: Health care reform. Implementing smart models of care in a world of increasingly limited resources has been fascinating and inspiring. In my law practice (as a partner at Lindquist & Vennum), we help health care clients across the country. We are lucky to live in a state that’s far ahead of the curve on quality and innovation. Biggest challenges: The biggest challenge facing Minnesota is taking on folks protecting turf, so we can transform the delivery system toward a total cost of care

model. In my law practice, I see clients struggling to reinvent their organizations to thrive in an increasingly collaborative, integrated and more commoditized health care world.

David Thorson, MD Minnesota Medical Association Title: Board chair; Staff Physician, Entira Family Clinics Interesting projects: (1) With Entira Family Clinics (formerly Family HealthServices Minnesota), transitioning to an electronic health record and becoming a certified Health Care Home. (2) Involvement with an project led by the Institute for Clinical Systems Improvement, attempting to transform how low back pain is treated through new pathways that will improve outcomes, decrease chronicity, and decrease imaging and surgeries. (3) Over the past two years, the MMA has developed a new strategic plan; as board chair, I have helped to lead that change. Biggest challenges: As a physician-led and -owned

group, we continually face the challenge of transforming care at the practice level with limited financial resources. We need to provide high-quality, patient-centric, high-value care by using the “sweat equity” of our providers to balance out our limited financial resources. The greatest frustration is knowing that care transformation is so close, but that the funding of that care is still a ways off.

David Tilford

products increasingly are adapting to individual preferences. Medica’s individual products appeal to people at all stages of their lives, while our group offerings include a private health exchange that allows beneficiaries to make the plan choice that best meets their needs. We have a ways to go to ensure the entire experience meets the disparate needs of the populations served by the health care industry.

Medica

Jeffrey L. Tucker, EFPM

Title: President and CEO Interesting projects: Developing partnerships with providers where we share in patient and financial outcomes. Medica was a leader in this area through our Total Cost of Care approach, which is based on the notion that performance-based provider contracts drive improvement in quality, cost, and access. Providers are measured and rewarded on their results in these critical areas. Biggest challenges: Personalizing the health care experience. Services and

Integrity Health Network, LLC Title: CEO and President Interesting projects: The merger of three organizations into what is now Integrity Health. As a result of talks over the past 25 years, in 2010 we formally merged Northstar Physicians Network, Northland Medical Associates, and Carenorth into the new organization. The development of our e-health strategies has been very interesting, as has, most recently, the development of our data warehousing and reporting initiative.

VA Health Care System In South Dakota & North Dakota Working with and for America’s Veterans is a privilege and we pride ourselves on the quality of care we provide. In return for your commitment to quality health care for our nation’s Veterans, the VA offers an incomparable benefits package. The VAHCS is currently recruiting for the following healthcare positions in the following locations. Sioux Falls VA HCS, SD

Black Hills VA HCS, SD

Fargo VA HCS, ND

Urologist Psychiatrist ENT Hospitalist Endocrinology

Psychiatrist Neuropsychologist General Surgeon Physician (Primary Care) Hospitalist (Internal Medicine) Urologist

Psychiatrist Hospitalist Family Practice Internal Medicine

Orthopedic Surgeon Radiologist Cardiologist Pulmonologist Physiatrist

Sioux Falls VA HCS (605) 333-6858 www.siouxfalls.va.gov

Black Hills VA HCS (605) 720-7487 www.blackhills.va.gov

Fargo VA HCS (701) 239-3700 x2353 www.fargo.va.gov

Applicants can apply online at www.USAJOBS.gov

AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S Biggest challenges: The rise of corporate mega-health care systems; stifling government regulations; health plan and government reimbursements that favor the consolidation and elimination of independent providers. Funding new initiatives is a challenge as the need for data management and reporting becomes crucial to providing key decision support at the administrative and, more importantly, the clinical and levels of operations.

Jen Van Liew, PhD, RN Minnesota Visiting Nurse Agency and Hospice of the Twin Cities Title: President and CEO Interesting projects: Since February 2011, I have had the opportunity to partner with community leaders to understand and address the health and human service issues that families experience. Founded in 1902, MVNA and HOTC continue to provide critical community services that support pregnancy through endof-life care. My most interesting project has been to look creatively

at our current health care model, and determine mission impact through cost-effective home-visiting practice. Biggest challenges: With health care needs continuing to increase, our opportunities to affect change are in the following areas: reducing rehospitalizations; meeting client palliative care needs in the home setting; providing wellness initiatives to address obesity; and providing nurse-driven services to reduce infant mortality and morbidity.

Dale Wahlstrom LifeScience Alley and the BioBusiness Alliance of Minnesota Title: President and CEO Interesting projects: In 2009 we published “Destination 2025,” a 20-year strategic life sciences plan for Minnesota. As we implement those recommendations, we are already seeing positive results, including 3,471 jobs created in three years. We are also establishing a public-private partnership among the FDA, Minnesota’s medical device industry, and

our academic sector, focused on improving the science used in creating and evaluating lifeenhancing products for patients. Biggest challenges: Medical device, pharmaceutical, and biotechnology companies face the same paradigm shift confronting physicians, health care providers, and payers: a complex and costly health care system in the midst of significant public and private restructuring. All parties involved in health and patient care need to build partnerships that can bring holistic solutions to improving public health. For our organization, this means ensuring that our constituents are able to innovate cost-effective therapies that meet current and future patient and provider needs.

Penny Wheeler, MD

(2) Collaborating with Children’s Hospital on the Mother-Baby Hospital and shared programs to improve care and outcomes. (3) Collaborating with HealthPartners on our accountable care-like work through the Northwest Alliance. (4) Being one of 32 national health care organizations named as Pioneer Accountable Care Organizations. Biggest challenges: Living in the world of fee-for-service, still our predominant mode of payment, which rewards us for volume of services, while evolving to more mission-oriented rewards for demonstrating better care at the lowest appropriate cost. At present, working to improve care (like lowering re-admissions or complications) often results in lower payments under our current model.

Allina Health Title: Chief Clinical Officer Interesting projects: (1) Working with patients, doctors, and care teams to advance the quality, experience, and affordability of care for those we serve.

Emergency Medicine Look for the friendly doctor in a MN based physician staffing service ...

Physicians: • Let us do your scheduling & credentialing • Paid Malpractice • Physician Friendly • Choose where and when you want to work • Competitve Rates • Courteous Staff

Clients: • Prevent loss of revenue • BC/BE physicians • Competitive rates • Quality coverage • Malpractice coverage paid by us

P-763-682-5906/F-763-684-0243 michelle@whitesellmedstaff.com www.whitesellmedstaff.com

MINNESOTA PHYSICIAN AUGUST 2012

Emergency Practice Associates has immediate full-time, part-time and locums opportunities at our sites in:

Hibbing Little Falls Park Rapids Alexandria Austin For more information contact Tina Dalton or Mike Coulter at 800-458-5003, email:

recruiting@epamidwest.com or visit our website at

www.epamidwest.com

Your Emergency Practice Partner

Innovative parknicollet.com/careers “At Park Nicollet, I’m part of a

A Journey of Opportunity After Hours (Walk In Care) Family Medicine, Med/Peds or Pediatrics Physicians

team that’s breaking the mold.” – Andrea, Pediatrician

Watch a team member video and learn about our culture of Head+Heart, Together at parknicollet.com/careers

Park Nicollet is expanding! We’re looking for dedicated, passionate

If work / life balance is important enjoy these Part-time and Casual positions currently available at four of our established clinics: Maplewood Clinic, Woodbury Clinic, Grand Avenue Clinic and Stillwater Clinic. Weeknight and weekend hours, 4 or 8-hour shifts. Beneﬁt eligibility at .5 FTE. HealthEast® Care System, the largest non-proﬁt health care organization in the Twin Cities’ East Metro area, is dedicated to offering physicians the professional journey that works best for them.

Family Medicine, Internal Medicine, Med-Peds, Pediatricians and Urgent Care physicians to join the team at our newest community clinic, opening January 2013 in Champlin. We’re also seeking Primary Care physicians to join our growing family of clinics in the northwest suburbs.

Your career journey starts here! For more information visit our website or contact Michael Grifﬁn, Manager of Physician/Provider Recruitment at 651-232-2227 or 702-595-3716 (Cell), or email mjgrifﬁn@healtheast.org. EOE

To learn more about available opportunities, contact Missy Fisher at 952-993-6025 or melissa.ﬁsher@parknicollet.com.

www.healtheast.org/careers www .healtheast.orrg/careers

Psychiatrist 40 Hour Work Week The Federal Medical Center, Rochester, MN, is an accredited Joint Commission medical and behavioral health referral center for the Federal Bureau of Prisons. Psychiatrists work closely with a multi-disciplinary team consisting of health care, mental health care, social work, rehabilitation services, and correctional professionals to provide diagnostic and treatment services to federal inmates. The Federal Bureau of Prisons, Health Services Division, is committed to providing evidence-based medical and psychiatric treatment and has a national impact through the development of comprehensive medical and psychiatric clinical guidelines. The Federal Bureau of Prisons offers a competitive salary and benefits package. The Federal Bureau of Prisons is an Equal Opportunity Employer.

Contact: Lynn Platte, Assistant Human Resource Manager AIRFORCE.COM/HEALTHCARE

lplatte@bop.gov or call (507) 424-7521

AUGUST 2012

MINNESOTA PHYSICIAN

10 0 I N F L U E N T I A L H E A LT H C A R E L E A D E R S

Cody Wiberg, PharmD, MS, RPh

Barbara Yawn, MD, MSc, FAAFP

Minnesota Board of Pharmacy

Olmsted Medical Center, Rochester

Title: Executive Director Interesting projects: Efforts to reduce drug abuse in Minnesota. The Minnesota Prescription Monitoring Program is a tool that prescribers and pharmacists can use to identify “doctor shoppers” who obtain controlled substance prescriptions from multiple prescribers and have them filled at multiple pharmacies. I also drafted legislation that makes the sale and possession of new designer drugs illegal. Biggest challenges: The introduction of new technologies, such as electronic prescribing and automated drug distribution systems, is having a significant impact on the profession of pharmacy. The board has worked on changes to rules and statutes that allow these technologies to be used in a manner that does not adversely affect patient safety

Title: Director of Research Interesting projects: For many years I did translational research —research on real-world problems in real-world practices. Interest was limited until the NIH RoadMap for Medical Research, which was supposed to move studies out of the academic specialist setting, was introduced in 2004. RoadMap progress in moving studies to community practices and to include complex patients in studies has been slow. But now we have “pragmatic clinical trials,” which are intended to address realworld complex patients in realpractice settings—and renewed interest. NIH has even made a special request for pragmatic studies and set aside funds for them. Biggest challenges: The most complex problem in future medical practice will be to solve who is going to do what the dwindling supply of primary care physicians is currently doing.

Practice Well. Live Well. Lake Region Healthcare is located in a magnificent, rural, and family-friendly setting in Minnesota lakes country where we aim to be the state’s preeminent regional health care partner. Our award winning patient care and uncommon medical specialties set us apart from other regional health care groups. Lake Region’s physicians and their families also enjoy an unmatched quality of professional and personal life. Current opportunities including competitive salary and benefit packages available for BE/BC physicians are: • Dermatologist • Family Medicine • Emergency Medicine • Internal Medicine

• Orthopedic Surgeon • Pediatrics • Psychiatrist • Psychiatric NP or PA

For more information contact Barb Miller, Physician Recruiter bjmiller@lrhc.org • (218) 736-8227

Douglas Yee, MD

Therese Zink, MD, MPH

Masonic Cancer Center, University of Minnesota

University of Minnesota Medical School

Title: Director; Professor of Medicine and Pharmacology, University of Minnesota Medical School Interesting projects: We’ve seen our laboratory findings (studying the insulin-like growth factor receptor) translate into new cancer therapies. New drugs have been made based on our results, along with others, showing this pathway’s relevance. I am working on a national clinical trial to test new ways to bring these drugs and targets into the treatment of breast cancer. Biggest challenges: While great progress has been made in cancer research, federal funding is not expanding at the pace of discovery. We are on the verge of “precision therapy,” but need better ways to bring these therapies to the clinic. We must develop partnerships with patients, health care providers, funding sources, and industry to advance the field.

Title: Professor, Department of Family Medicine and Community Health Interesting projects: Writing and editing three books: “The Country Doctor Revisited: A 21st Century Reader” (2010); “Becoming a Doctor” (2011); and “Confessions of a Sin Eater” (2012). Recently I chaired the workforce committee for Gov. Dayton’s Health Care Reform Task Force and worked with others to envision the steps needed to create a workforce that can meet the demands of our increasingly diverse and aging population. Biggest challenges: Training health care professionals who are willing to move beyond the status quo and make the tough choices needed to address the health care needs of the future (rural and metro). This means working in teams, judiciously using technology, and helping patients make decisions about their health and treatment options, while managing the escalating costs.

Minneapolis VA Health Care System Great place to work, great place to live. You are invited to be part of the Department of Veterans Affairs that has been leading change in the health care sector.The Minneapolis VA is a 341-bed tertiary care medical center affiliated with the University of Minnesota. Our patient population and case mix is challenging and exciting, providing care to veterans and active-duty personnel.The Twin Cities area offers excellent living and cultural opportunities. Opportunities for full-time and part-time physicians are available in the following positions: • Chief of Surgery/Director of Specialty Care Service Line • Compensation & Pension (Occupational Medicine) • Gastroenterologist • General Internal Medicine • Internal Medicine/Family Practice – Rice Lake, Chippewa Falls and Superior, WI • Psychiatrist – Ramsey, MN and Superior, WI • Spinal Cord Injury

712 Cascade St. S., Fergus Falls, MN 736-8000 • (800) 439-6424

Physician applicants should be BC/BE. Possible recruitment bonus.

Lake Region Healthcare is an Equal Opportunity Employer. EOE

Interested applicants should email CV to: Brittany Sierakowski, HRMS • brittany.sierakowski@va.gov Fax 612-725-2287 • Telephone 612-629-7873

www.lrhc.org 36

MINNESOTA PHYSICIAN AUGUST 2012

EEO Employer

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Crookston, MN and Roseau, MN

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• Country Lifestyle.... Urban Technology • Dedicated Team Approach • Competitive Salary & Benefits

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Idylic Practice Opportunities located in family friendly communities. Leave the hassle and bustle of the city behind.

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Tri-County Tri Coun Tr unty ty Health Care

Contact: Kerri Hjelmstad, Physician Recruiter Altru Health System PO Box 6003 Grand Forks, ND 58201-6003

ϰϭϱ EŽƌƚŚ :ĞīĞƌƐŽŶ ^ƚƌĞĞƚ ϰϭϱ EŽƌƚŚ :ĞīĞƌƐŽŶ ^ƚƌĞĞƚ Wadena, MN 56482 ǁǁǁ͘ƚƌŝĐŽƵŶƚǇŚŽƐƉŝƚĂů͘ŽƌŐ

1-800-437-5373 Fax: 701-780-6641 khjelmstad@altru.org

EOE

www.altru.org

An equal opportunity employer and provider

Orthopaedic Surgery Opportunity Live in Beautiful Minnesota Resort Community

An immediate opportunity is available for a BC/BE orthopedic surgeon in Bemidji, MN. Join three board certified orthopedic surgeons in this beautiful lakes community. Enjoy practicing in a new Orthopedic & Sport Medicine Center, opening spring 2013 and serving a region of 100,000. Live and work in a community that offers exceptional schools, a state university with NCAA Division I hockey and community symphony and orchestra. With over 500 miles of trails and 400 surrounding lakes, this active community was ranked a “Top Town” by Outdoor Life Magazine. Enjoy a fulfilling lifestyle and rewarding career. To learn more about this excellent practice opportunity contact: Celia Beck, Physician Recruiter Phone: (218) 333-5056 Fax: (218) 333-5360 Email: Celia.Beck@sanfordhealth.org

Growth and Opportunity

For

Every Stage of Your Career

Over 700 physicians in more than 40 specialties. An award-winning hospital and network of primary/urgent and specialty clinics.

North Memorial is seeking driven providers to be part of our 2012-2013 growth initiatives. Opportunities exist in Family Medicine Internal Medicine Obstetrics Gynecology

and in multiple surgical or medical specialties

Optimize your education and leadership potential.

AA/EOE - Not subject to H1B Caps To learn more, contact Mark A. Peterson, Physician Recruiter 763-520-1336 mark.peterson@northmemorial.com northmemorial.com

AUGUST 2012

MINNESOTA PHYSICIAN

FIGURE 1. Mortality rates* by race and ethnicity within median household income groups of census tracts

Inequities from page 10 inequities in their individual consultation with patients, and by leveraging their knowledge and influence in the policy arena. Suggestions for working with patients

Reflect social and cultural opportunities and barriers in conversations with patients. Studies summarized in the May 2008 volume of the Journal of General Internal Medicine show that even brief conversations between health care providers and patients about health issues can lead to positive changes in patient behavior. To maximize the effectiveness of such conversations, recommendations must fit within both cultural norms and social constraints that influence eating behavior and food choices. For example, Hmong patients with diabetes cannot simply cut rice out of their diets. Patients who experience poverty or who live in neighborhoods with few opportunities for physical activity may need extra support in

* Deaths per 100,000 for those age 25-64. Sources: Minnesota Department of Health (mortality data 2005-2009), American Community Survey (2005-2009 population and median household income by census tract).

identifying and addressing perceived barriers to exercise. Use team-based approaches to support behavior change. The Institute for Clinical Systems Improvement guideline for healthy lifestyles encourages health care providers to use collaborative decision-making and motivational interviewing practices to develop realistic goals with patients about their behavior choices and to follow-up with patients on their goals. While physicians alone usually cannot incorporate all the steps

Practice Well. Live Well. Lake Region Medical Group is seeking a full-time Certified Physician Assistant to join our Lake Region Healthcare team of 2 orthopedic surgeons; providing care in a multi-specialty clinic with 50+ providers. We are looking for a hardworking, conscientious individual committed to providing quality care to our patients as we develop our Orthopedic Center of Excellence. Duties will include new and follow-up patient visits, assisting with surgery, post-op visits and hospital rounds in our 108 –bed community based hospital. The ideal candidate will have 2-5 years experience in orthopedics. We offer a competitive salary with a healthy benefit package. For more information contact Barb Miller, Physician Recruiter bjmiller@lrhc.org • (218) 736-8227

712 Cascade St. S., Fergus Falls, MN 736-8000 • (800) 439-6424 Lake Region Healthcare is an Equal Opportunity Employer. EOE

www.lrhc.org

MINNESOTA PHYSICIAN AUGUST 2012

to assess need, develop goals, offer referrals, and follow-up on goals, multidisciplinary teams can frequently do so in their work. Make connections to nonmedical community resources. The Minnesota Department of Health has encouraged health care providers to use active referral strategies through their Statewide Health Improvement Program initiative (www.health .state.mn.us/divs/oshii/ship/index .html) to help patients recognize and use community resources that support healthy eating and physical activity. An enhanced referral system can help patients not only access specialty medical services and structured interventions, but also take greater advantage of all community resources, such as recreation centers, walking groups, food markets, and healthy cooking classes. Suggestions for working “upstream”

Elect officials who understand social determinants of health and educate those who do not. Elected policymakers need to better understand that education, law enforcement, economic development, and housing policies all influence health. Physicians can clarify those connections in their professional work and can advocate to elect officials who understand those connections. Leverage clinic and hospital resources to improve community conditions. Clinics and hospitals often provide a variety of health education and promotion services. However, many health care facilities can

broaden their role to provide resources to residents. For example, a clinic can house an affordable, community-supported agriculture program, helping residents to access fresh produce, or house a computer lab for residents seeking jobs or online classes. Amplify the voice of community residents. A challenge in addressing health inequities is ensuring that the approaches used to address economic instability or neighborhood conditions reflect the needs, interests, and priorities of community residents. Because patients often share a trusting relationship with their provider, health care professionals are well positioned to convene discussion groups with community residents or share their knowledge of community needs and interests with others. Physicians and other health care providers already play crucial roles in improving the health of Minnesota’s residents. Yet, unless all of us find ways to address the underlying socioeconomic conditions that influence health, inequities will persist in our region, in our state, and across the nation. We can’t afford to ignore this challenge. Melanie Ferris, MPH, is a research scientist at Wilder Research, one of the largest nonprofit research organizations in the nation and home of Minnesota Compass (www.mncompass.org). Her work focuses in the areas of health and mental health. Paul W. Mattessich, PhD, is the executive director of Wilder Research. For more information about this study and other current reports, visit www.wilderresearch.org.

NEW POSITIONS:

Family Practice Urgent Care Dynamic, independent 3 location, single-specialty practice in northwest Minneapolis suburbs is seeking additional associates for its Rogers site and has Full Time/ Part Time shifts in the Crystal and Rogers Urgent Care. • • • • •

Partnership opportunity after 2 years Competitive salary with incentives Excellent benefits, 401k/employer paid pension Practice at one site/one hospital Physician-owned

Please contact or fax CV to: Joel Sagedahl, M.D. 5700 Bottineau Blvd., Crystal, MN 55429 763-504-6600 • Fax 763-504-6622

St. Cloud VA Health Care System is accepting applications for the following full or part-time positions: • Associate Chief, Primary & Specialty Medicine (Internist-St. Cloud) • Dermatologist (St. Cloud) • Director, Primary and Specialty Medicine (Internal Medicine) (St. Cloud) • ENT (St. Cloud)

• Internal Medicine/ Family Practice (Alexandria, Brainerd, St. Cloud, Montevideo) • Medical DirectorExtended Care & Rehab (IM or Geriatrics) (St. Cloud) • Psychiatrist (Brainerd, St. Cloud) • Radiologist (St. Cloud)

• Geriatrician (Nursing Home-St. Cloud)

• Urgent Care Provider (MD: IM/FP/ER) (St. Cloud)

Visit our website at www.NWFPC.com

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Join a truly mission-driven organization! Independent, nonproﬁt UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 285,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.

Associate Medical Director The Associate Medical Director will oversee the health care needs of the membership in products and assist with the administration of medical services for all members. Provide professional leadership and direction for the development, implementation and maintenance of assigned quality improvement, credentialing, operational, utilization review, and case management activities of the health plan. Work collaboratively with other plan functions that interface with medical management such as Health Care Economics, Provider Relations and Contracting, Health Promotion, Compliance and the Pharmacy Department. Provide support to staff in activities requiring physician oversight. This position has some flexibility for our selected candidate to choose a full-time or part-time work schedule. Qualified candidates will be license in Minnesota as a Doctor of Medicine (MD or DO), possess Board Certification in a specialty recognized by the American Board of Medical Specialties (ABMS) and 3 years of medical practice experience with knowledge and advocacy of primary care. Experience with managed care, practice guidelines and outcome data analysis, and pediatric experience to meet the needs of our membership are preferred. -

To learn more about UCare and to apply, visit www.ucare.org fax: 612-884-2204; or contact Lisa Habisch at 612-676-3512 with questions. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA

J-1 candidates are now being accepted for the Hematology/Oncology positions. Physician applicants should be BC/BE. Applicant(s) selected for a position may be eligible for an award up to the maximum limitation under the provision of the Education Debt Reduction Program. Possible relocation bonus. EEO Employer.

Excellent benefit package including: Favorable lifestyle

13 days sick leave

26 days vacation

Liability insurance

CME days Competitive salary

Interested applicants can mail or email your CV to VAHCS

St.Health Cloud VA Care System Brainerd | Montevideo | Alexandria

Sharon Schmitz (Sharon.schmitz@va.gov) 4801 Veterans Drive, St. Cloud, MN 56303 Or fax: 320-654-7650 or Telephone: 320-252-1670, extension 6618

AUGUST 2012

MINNESOTA PHYSICIAN

H E A LT H

AND

THE

LAW

The Minnesota False Claims Act

he Minnesota False Claims Act (Minn. Stat. Ch. 15C) went into effect on July 10, 2010. As we approach the two-year anniversary of its effective date, this article looks back on reported enforcement activity under the Act, and then looks forward to amendments state legislators would have to adopt to add even more teeth to the Act, bring it in line with its federal counterpart, and maximize the state’s ability to recover damages in Medicaid fraud actions.

CARE

A look back and a look forward By Brian Dillon, JD lation, plus three times the damages suffered by the state or local government as a result of the violation, plus attorneys’ fees and costs. By January 15 of each year, the Minnesota Attorney General

through December 2011. [These reports are available at www .leg.state.mn.us/edocs/edocs.aspx ?oclcnumber=699781529.] The reports indicate that in the 18month period during which the Act has been in effect, state

Looking back

The Minnesota False Claims Act (Minnesota Act) authorizes state, county, and local prosecutors, as well as private citizen “whistleblowers” (referred to as qui tam relators) acting on behalf of state and local government entities, to bring lawsuits and recover funds that were falsely or fraudulently obtained from state or local government programs. Any person found to have violated the Act is subject to significant financial penalties—including as much as $11,000 per vio-

It is likely just a matter of time before prosecutors in Minnesota follow suit and ramp up their enforcement activities under the Minnesota False Claims Act. must file a report with the Legislature describing activity under the Act over the prior 12month period. Two such reports have been filed to date, covering the period from July 2010

Family Medicine St. Cloud/Sartell, MN We are actively recruiting exceptional part-time or full-time BC/ BE family medicine physicians to join our primary care team in Sartell, MN. This is an out-patient only opportunity and does not include labor and delivery or hospital call and rounding. Our current primary care team includes family medicine, adult medicine, OB/ GYN and pediatrics. Previous electronic medical record experience is preferred, but not required. We use the Epic electronic medical record system at all of our clinics and admitting hospitals. Our HealthPartners Central Minnesota Clinics – Sartell moved into a new primary care clinic in the summer 2010. We offer a competitive salary, an excellent beneﬁt package, a rewarding practice and a commitment to providing exceptional patientcentered care. St. Cloud/Sartell, MN is located just one hour north of the Twin Cities and offers a dynamic lifestyle in a growing community with a traditional appeal. Apply on-line at healthpartners.jobs or contact diane.m.collins@ healthpartners.com or call Diane at 800-472-4695 x3. EOE

healthpartners.com

MINNESOTA PHYSICIAN AUGUST 2012

prosecutors have relied on the Minnesota Act to intervene in just four cases. Further research indicates that three of these cases involve allegations of Medicaid fraud, and the other involves false claims submitted in connection with state-funded student aid programs. This relatively small number of interventions under the Minnesota Act is not terribly surprising, given that violations of the Act have been accruing for a relatively short period of time, and there is almost always some lag time before the violations of a new law are discovered and prosecuted. At the same time, the Attorney General’s reports indicate that state prosecutors are paying careful attention to fraud schemes that impact state and local governments and have annually participated in at least 70 cases involving allegations of government program fraud since the Minnesota Act went into effect. During that time, attorneys within the Attorney General’s Office spent an average of 103 hours per month on these cases. As federal government officials continue to expand their enforcement efforts under the federal False Claims Act and tout the return on their investment in these efforts, it is likely just a matter of time before

prosecutors in Minnesota follow suit and ramp up their enforcement activities under the Minnesota Act. And, as is the case under the federal Act, the health care industry will likely serve as the prime target of actions brought under the Minnesota Act. During the last three fiscal years, for example, federal prosecutors claim to have returned $7 to federal health care programs for each $1 invested on enforcement. [See A.G. Eric Holder Speaks at the Health Care Fraud Takedown Press Conference (May 2, 2012), available at www.justice .gov/iso/opa/ag/speeches/2012 /ag-speech-1205021.html.] And, in the 12-month period ending September 2011, a staggering $3.03 billion was recovered under the federal Act, with $2.4 billion of that amount (79 percent) recovered in health care fraud cases. [See Justice Dept. Recovers $3 Billion in False Claims Act Cases in Fiscal Year 2011, available at www.justice .gov/opa/pr/2011/December /11-civ-1665.html.] Looking forward: bolstering the Minnesota False Claims Act

Because Medicaid is funded with state and federal dollars, state and federal governments (and qui tam relators in cases initiated by private whistleblowers) generally share any recoveries obtained in Medicaid fraud cases. In the Deficit Reduction Act of 2005 (DRA), Congress enacted a financial incentive for states to adopt state laws that are at least as robust as the federal False Claims Act and include the same or stronger protections for private whistleblowers. Specifically, as a result of the DRA, states are entitled to receive a 10 percent greater recovery in Medicaid fraud cases if a claim is asserted under the state’s false claims act, provided the state law: (1) contains liability and penalty provisions that are at least as broad as the federal Act; and (2) rewards and facilitates private whistleblower actions at least as effectively as the federal Act (42 U.S.C. § 1396h). By letter received on Aug. FALSE CLAIMS to page 42

Spine Surgeons, join our team and set the standards for patient care. Orthopaedic Associates of Duluth is seeking a highly motivated passionate and experienced SPINE SURGEON to provide outstanding orthopaedic care to its patients. The successful candidate will be part of our expanding and growing, well-respected team that serves patients from Duluth to northern Minnesota. Orthopaedic Associates of Duluth is a group of nine orthopaedic surgeons that provide comprehensive orthopaedic services ranging from specialty specific exams and diagnosis to state-of-the-art inoffice MRI and imaging and surgery at their physician-owned surgery center.

Email CV to jwaller@slhduluth.com or call 800-461-8843 (Sue) or 218-625-2731 (June)

The perfect match of career and lifestyle. Affiliated Community Medical Centers is a physician owned multispecialty group with 11 affiliate sites located in western and southwestern Minnesota. ACMC is the perfect match for healthcare providers who are looking for an exceptional practice opportunity and a high quality of life. Current opportunities available for BE/BC physicians in the following specialties: â&#x20AC;˘ ENT â&#x20AC;˘ Internal Medicine â&#x20AC;˘ Psychology â&#x20AC;˘ Family Medicine â&#x20AC;˘ Med/Peds Hospitalist â&#x20AC;˘ Pediatrics â&#x20AC;˘ General Surgery â&#x20AC;˘ OB/GYN â&#x20AC;˘ Pulmonary/ Critical Care â&#x20AC;˘ Geriatrician/Outpatient â&#x20AC;˘ Oncology Internal Medicine â&#x20AC;˘ Radiation Oncology â&#x20AC;˘ Orthopedic Surgery â&#x20AC;˘ Hospitalist â&#x20AC;˘ Rheumatology â&#x20AC;˘ Psychiatry â&#x20AC;˘ Infectious Disease For additional information, please contact:

Kari Bredberg, Physician Recruitment karib@acmc.com, (320) 231-6366

Julayne Mayer, Physician Recruitment mayerj@acmc.com, (320) 231-5052

www.acmc.com

Opportunities available in the following specialties:

Olmsted Medical Center, a 150-clinician multi-specialty clinic with 9 outlying branch clinics and a 61 bed hospital, continues to experience significant growth. Olmsted Medical Center provides an excellent opportunity to practice quality medicine in a family oriented atmosphere. The Rochester community provides numerous cultural, educational, and recreational opportunities. Olmsted Medical Center offers a competitive salary and comprehensive benefit package.

Family Medicine Rochester Northwest Clinic Wanamingo Clinic Chatfield Clinic

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Dermatology Southeast Clinic Child Psychiatry Southeast Clinic Hospitalist OMC Rochester Hospital Emergency Medicine OMC Rochester Hospital Send CV to: Olmsted Medical Center Administration/Clinician Recruitment 1650 4th Street SE Rochester, MN 55904 email: egarcia@olmmed.org Phone: 507.529.6610 Fax: 507.529.6622

EOE

)FÂŹYOU REÂŹSEEKINGÂŹÂŹ AÂŹNEWÂŹCAREERÂŹDIRECTION ÂŹÂŹ CALLÂŹUS ÂŹ7E REÂŹOFFERINGÂŹ THEÂŹRIGHTÂŹPHYSICIANÂŹAN OPPORTUNITYÂŹTOÂŹMAKEÂŹAÂŹ DIFFERENCEÂŹINÂŹRURALÂŹHEALTHÂŹ CAREÂŹASÂŹAÂŹMEDICALÂŹ LEADERÂŹFORÂŹOURÂŹSMALL ÂŹYETÂŹ INNOVATIVEÂŹHEALTHÂŹPLAN

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www.olmstedmedicalcenter.org AUGUST 2012

MINNESOTA PHYSICIAN

Preventing False Claims Act Violations False claims from page 40 31, 2011, federal officials informed the Minnesota Attorney General’s Office that the Minnesota Act does not meet the requirements for the 10 percent incentive. In sum, the letter concludes that the Minnesota Act does not establish liability for the same breadth of conduct as the federal Act and is not as effective in rewarding and facilitating whistleblower actions. [the letter is available at http:// archive.leg.state.mn.us/docs /2012/mandated/120282.pdf, p. 3–7.] The letter acknowledges that many states no longer meet the eligibility requirements because of recent expansions to the federal Act, which were adopted as part of the Fraud Enforcement and Recovery Act of 2009 (FERA), the Patient Protection and Affordable Care Act of 2010 (ACA), and the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010 (Dodd-Frank). Simply put, the federal Act has expanded in recent years, and many states have yet to amend their state laws to keep

False Claims Act violations can be very costly to health care providers —both in terms of financial costs and damage to reputation. To prevent False Claims Act violations, all health care providers should: • Implement a robust ethics and regulatory compliance program. • Effectively communicate a strong commitment to ethics and regulatory compliance to all levels of employees. • Implement a training program and internal control system that is designed to achieve and maintain compliance with applicable laws and regulations, including systems for monitoring, auditing, and reporting suspected wrongdoing. • Regularly review and confirm compliance with conditions to eligibility for payments or reimbursements under government programs.

pace. Unlike Minnesota—which has never been deemed eligible for the 10 percent incentive— these states will forgo their eligibility for the incentive on March 31, 2013, assuming they fail to amend their laws by that date in order to bring them into compliance with the more robust federal Act. If Minnesota legislators are interested in obtaining eligibility for the federal incentive in Medicaid fraud cases, federal officials have concluded that the Minnesota Act would have to be amended in at least the following ways: • Expand general liability provisions. The liability provisions of the Minnesota Act

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would have to be expanded to include not only false or fraudulent claims presented to the government, but also false or fraudulent claims presented to government intermediaries (e.g., prime contractors) that dispense state or local government funds to promote a government program or interest. The Minnesota Act also would have to eliminate negligence or mistake as a defense in false claims cases. • Expand employer liability provisions. The Minnesota Act would have to be amended to render employers liable for the acts of their nonmanagerial employees, even if they had no knowledge of the employee’s act, did not ratify the act, and were not reckless in hiring or supervising the employee. • Eliminate right to cure violations through repayment. A safe harbor in the Minnesota Act immunizes any violator from further liability if he or she did not act with intent to defraud the government and repays any damages caused by a violation of the Act within 45 days of being informed of the amount. In order to obtain eligibility for the federal incentive, this safe harbor would have to be eliminated. • Enhance anti-retaliation provisions. The Minnesota Act would have to be amended to provide greater relief to employees, contractors, and others who are retaliated against because of lawful actions taken to report or stop violations of the Act. • Reduce the scope of the public disclosure bar. The scope of the public disclosure bar in the Minnesota Act, which precludes private whistleblowers from asserting claims under the Act if the substance of

their claim was publicly disclosed before the claim was asserted, would have to be narrowed. • Expand the definition of “original source.” The Minnesota Act would have to be amended to expand the definition of “original source.” Under the federal Act, a whistleblower is an original source and can escape the limitations of the public disclosure bar if he or she has knowledge that is independent of, and materially adds to, the publicly disclosed allegations or transactions underlying a violation. The definition of original source under the Minnesota Act is not as broad as the federal Act and creates a higher hurdle for whistleblowers in Minnesota. • Mandate the recovery of attorneys’ fees. Currently, courts have discretion under the Minnesota Act to award attorneys’ fees and costs to a prevailing plaintiff, but the recovery of attorneys’ fees is not required. In order to obtain eligibility for the federal incentive, recovery of attorneys’ fees and costs would have to be mandatory. • Expand the recovery of qui tam relators. The Minnesota Act would have to be amended to provide whistleblowers with a greater share of the recovery in any qui tam action in which the government elects to intervene. Whether Minnesota legislators decide to amend the Minnesota Act to keep pace with its federal counterpart remains to be seen. However, recent expansions of the federal False Claims Act, coupled with persistent state budget deficits and record-breaking recoveries under the federal Act, could provide state legislators with the motivation they need to do just that. Brian Dillon, JD, is an attorney with the law firm of Gray Plant Mooty in Minneapolis, where he provides counsel to clients in their efforts to prevent or respond to federal, state, and local government investigations and enforcement matters. Previously, Dillon served as an assistant attorney general in the Minnesota Attorney General’s Office in the health, antitrust, and complex litigation groups.

You wouldnâ&#x20AC;&#x2122;t give a 2-year-old a drink, so why would you give one to an unborn child? As a physician, itâ&#x20AC;&#x2122;s your responsibility to let her know: the U.S. Surgeon General Advisory says no amount of alcohol is safe during pregnancy. Share 049: Zero Alcohol For Nine Months.

www.mofas.org

We protect your peace of mind. And we do it in lots of ways for physicians, facilities and hospitals. Whatever your situation, we’ve been there, and will be there. We’ve gotten good at it. Excellent, actually, with a proven success rate. It’s a peace of mind movement. And we’d love to have you along. Join the Peace of Mind Movement at PeaceofMindMovement.com,or contact your independent agent or broker.