Dr. Steve Albrecht, a family physician in Olympia and 2010-2011 president of the Washington Academy of Family Physicians, talks about the changes health reform might bring to our region–and what it will take to make these changes happen.
Q: What are your impressions about where we’re at with reform?
A: We’re finally starting to get it. We realize that the right care at the right time in the right place will eventually equal the right cost–and that more health care does not inevitably equal better health. It’s exciting to me to hear thoughtful, smart people who aren’t clinicians talking about the importance of primary care and talking about how we need a system that focuses on outcomes.
I think we have the opportunity to do this around the country, and it will look different in Georgia than it does it Maryland than it does in Maine and Minnesota and Washington. There are smart and dedicated and creative people who will make this happen, and we have to. The greatest logic that drove the need for healthcare reform was that we can’t keep doing what we’re doing.
Q: How might reform look here in Olympia, or Washington State?
A: I think that we’re going to continue to see a huge variety of different models. I think we’re going to continue to see the small one-person offices in primary care who serve a unique niche. We’re also going to see bigger consolidation. My practice moved from a small independent practice to a hospital employed practice and doubled in size in the past two years. I think we’re going to see more of that, because the right partner can equal the right outcome.
Q: Does the consolidation that some people believe will result from health reform have any upside for patients?
A: Sure. I think if I’m working more closely with the ERs where my patients are seen and … when there’s time and an incentive for the hospitalist to sit down and call me when they’re discharging a patient to make sure I have information on that patient, and I’m seeing that patient in the next day or two, that patients will have fewer errors, better information, stronger allies that will help them take care of themselves.
Q: What will it take to make these changes, and what is being done now to make them?
A: Change is hard and a lot of us learned how to succeed in the current set of rules, and we want to change the rules–for good reason, but it’s hard to change the rules, to get everybody to buy into playing by new rules and to determine what are these best rules going to be.
For providers, it’s hard, and in the patient-centered medical home collaborative that’s coming out of the Puget Sound Health Alliance, they’re talking about very small additional incentive payments for patient case management–$2 per member per month. Boeing, to do their intensive ambulatory care unit and really drive costs down, were spending in excess of $20 per member per month. Group Health spent 0 per member per month to save 4. If we don’t want to put resources into supporting this change, we won’t get the change we want.