Family Medicine in an Institution Where NIH is

Family Medicine in an Institution Where NIH is King Jeannette E. South-Paul, MD Andrew W. Mathieson UPMC Professor and Chair STFM Annual Meeting – Baltimore April 30, 2008

City Of Pittsburgh • De – industrialized community

Nativity of Foreign Born Population – 2000, Pittsburgh vs. United States U. S. Census Bureau

Percent of People With Disabilities, Age 5 and Older, 2000 Place Disabled Men Disabled Women United States 19. 6 19. 1 Pennsylvania 18. 5 18. 7 Southwestern Pennsylvania Pittsburgh 18. 4 18. 8 20. 2 22. 2

Socio-economic Characteristics from 2000 Census U. S. Census Bureau

Diversity Compared Percentage of the metropolitan area’s population that is non-white* 1. Atlanta 37 9. Denver 19. 4 2. San Diego 33. 4 10. Kansas City 19. 1 3. Miami 29. 9 11. Tampa – St. Pete 17 4. Phoenix 23 12. Portland 15. 7 5. Milwaukee 22. 2 13. Cincinnati 14. 6 6. St. Louis 21. 7 14. Minneapolis St. - Paul 13. 8 7. Cleveland 20. 9 8. Seattle 20. 6 15. Pittsburgh 10. 4 Includes people of two or more races, one of which could be white Source: Post Gazette Benchmarking Series

University of Pittsburgh Schools of the Health Sciences • • • School of Dental Medicine School of Health and Rehab Sciences School of Nursing School of Medicine School of Pharmacy School of Public Health • Arthur Levine, MD – Senior Vice Chancellor for the Health Sciences and Dean, School of Medicine

University of Pittsburgh Health Sciences Buildings

A TRADITION OF EXCELLENCE Of the many achievements for which the School of Medicine is known, two are always mentioned: The development of the polio vaccine by Dr. Jonas Salk and colleagues in the 1950 s The pioneering work in organ transplantation and immunology led by Dr. Thomas Starzl and still going on today.

The Shot Heard ‘Round the World

The Thomas E. Starzl Biomedical Science Tower (Sidney Davis/Tribune-Review)

A Transforming Approach: NIH Institutional Clinical and Translational Science Awards (CTSA) § Implementing biomedical discoveries in the last made 10 years demands an evolution of clinical science § New prevention strategies treatments must and be developed, tested, and brought into medical practice more rapidly § CTSA awards will lower barriers between disciplines, and encourage creative, innovative approaches to solve complex medical problems § These clinical and translational science awards will catalyze change -- breaking silos, breaking barrie and breaking conventions From www. nih. gov

RACIAL AND ETHNIC HEALTH DISPARITIES RESEARCH • Graduate School of Public Health the site of Research Center of Excellence in Minority Health Disparities, a five-year, $4. 8 million grant from the National Center on Minority Health and Health Disparities, a part of the National Institutes of Health Stephen B. Thomas, Ph. D. • Will embed scientific research within the Healthy Black Family Project, a health promotion and disease prevention program that has enrolled more than 6, 000 participants in the Pittsburgh area in a lifestyle behavior-change intervention designed to increase physical activity, improve nutrition, reduce stress, and provide access to a medical home • Improve the translation of scientific findings into interventions that contribute to the elimination of racial and ethnic health disparities

PETER M. WINTER INSTITUTE FOR SIMULATION, EDUCATION, AND RESEARCH (WISER) • More than 6, 700 trainees and more than 6, 500 simulations per year

University of Pittsburgh Medical Center • • • 20 hospitals More than 47, 000 employees More than 4300 physicians with privileges at UPMC hospitals including approximately 2400 employed docs • Greater than 2 million outpatient visits per year • Greater than 180, 000 admissions per year • Serving 29 counties in Western Pennsylvania

UPMC Overview: More than 400 points of access UPMC Horizon Greenville UPMC Northwest UPMC Horizon Shenango UPMC St. Margaret UPMC Passavant Cranberry UPMC Passavant UPMC Presbyterian UPMC Shadyside UPMC Montefiore Magee Womens Hosp Children’s Hosp Western Psych Eye and Ear UPMC Braddock UPMC South Side UPMC Mc. Keesport UPMC Bedford Stars represent locations of UPMC Cancer Centers, Surgery Centers, Doctors Offices, Imaging Centers, Senior Living Facilities, and other care sites (Total 400) UPMC serves Southwestern Pennsylvania 7, 044 square miles 2. 6 million population

UPMC Overview Rank 268 269 270 271 272 273 Company Lyondell Chemical NCR Pitney Bowes UPMC William Wrigley Fi. Serv Coca-Cola Profits $531 $529 $526 $523 $517 $516 $514 Company Starbucks Owens Corning Revenue $6, 369 $6, 323 353 Google $6, 138 357 358 359 UPMC equivalent: #360 in Revenue #271 in Profit Rank 338 341 NCR OGE Energy Mc. Graw Hill UPMC Starwood Hotels Group 1 Auto. Saks $6, 028 $6, 017 $6, 003 $6, 000 $5, 977 $5, 969 $5, 953 360 361 362

Best-In-Class Business Discipline to Non-Profit Arena 1. Voluntary SOX Certification 2. National leader in ethics, transparency, governance practices – System-wide dissemination of ethics guidelines; Chief Ethics Officer to provide leadership – Board and public web initiatives – Public disclosure of quarterly and annual financials 3. Disciplined approach to each aspect of the business to add value – Daily dashboarding of key indicators – Appointments within 72 hours in 85% of services – Technology (e. g. , Combine. Med; E-Benefits)

Physician Services Division Functions: • Insurance billing and contracting • Human resources management • Financial management • Coding and compliance oversight • Risk management • Purchasing • Medical management • Marketing and public relations

Department of Family Medicine • Founded 1994 • Previous Family Medicine presence concentrated in 3 community residencies • Third chair in 2001 • Third year clerkship subsumed during generalist initiative in 1998 • No clinical sites • 1200 sf of poor space on campus

Chair Goals for the Department 2001 • • • Establish departmental offices on campus Re-establish MSIII Family Medicine clerkship Assemble a group of faculty who identify with the School of Medicine • Create a clinical presence – ambulatory and inpatient - on campus • Identify a Director of Research

Chair Goals for the Department 2004 • • • Identify an Executive Vice Chair Stabilize administrative/financial leadership of the Department Increase the numbers of students selecting careers in Family Medicine Unify the maternity education and clinical service for the residencies Unify inpatient medical services Build collaborative research program

Departmental Goals for 2007 • Identify an integrated Residency Program Director • Redefine, enhance and expand the departmental research program • Identify and market the Department as a scholarly home for student mentored research program

Potential Rewards for Residency Integration • Advocate for resources for our learners • Implement “best practices” for education and operations rapidly and in a noncompetitive environment • Access resources more easily through greater collaboration with the UPMC GME department and other residencies

Potential Rewards for Residency Integration • Align Family Medicine more closely with the strategic initiatives of UPMC when this makes sense for us • Increase the opportunities for scholarly activities by faculty and residents • Assemble a foundation that will be large enough to implement innovation in education with less risk

UPMC Mega –trends that have implications for Family Medicine • UPMC/UPSOM values and rewards excellence especially if it is externally validated • UPMC/UPSOM values research dollars especially NIH grants • UPMC considers its market to be global • UPMC’s community role is evolving • UPMC wants to grow its health plan. • UPMC wants to grow and export high quality, high tech care

Integration of Family Medicine Residencies • Accepted by UPMC leadership and tolerated by FPs involved • First steps: – Combined FM/OB service – Creation of the Family Medicine Integration Board – Integration, Clinical Ops, Education Committees – FM/Psych training – Standardization of resident stipends

How will we get all this done?

Integrator?

Integrator?

Our Current Structure

How we get stuff

Doing Things in the Matrix

A beautiful friendship

Department of Family Medicine Organizational Chart -2004 DFM Board Administrator Radakovich Vice Chair for Education – Middleton Dean - UPSOM UPMC – CEO Levine Romoff DFM Chair South-Paul Director of Operations – Lea Clinical Education Vice Chair for Operations – TBA Research Director of Research – Janosky STM Schaffer SHY MCK Sports Med Fac Medical Students Rao Dev. Blandino Markle Stone Jenkins Montellese. Merenstein Boyd Bardella Penkower CAM Glick Greco CCM Clin. Res & Process Improvement Clinical Sites Glick Zimmerman Nowalk Raymund Tabbarah East Liberty Squirrel Hill Fam. Health Ctr Practice Zimmerman 7 Matilda Hazelwood Theiss Ctr Clinic Conti Lincoln South-Paul Bardella Primack Abrams Srinivasan

Department of Family Medicine Organizational Chart - 2008 DFM Board Administrator T. Jones UPMC – CEO Dean - UPSOM Romoff Levine DFM Chair South-Paul Integrated Residency Program Director – Dewar UPMC Pandemic Flu Program Executive Vice Chair Mackett Education Research Mercy 12 residents Schaffer 39 residents UPMC Disaster Management Program Depression Screening Johnjulio STM President UPP Webster Clinical CTSI Yonas Breast CA Disparities SHY MCK Kolb Markle Sports Med Boyd 27 residents 18 residents Geriatrics Balestrino Medical Students Minority Womens’ Heart Initiative South-Paul Matambanadzo Faculty Xia Development Middleton Teen Pregnancy Intervention Merenstein Wilson South-Paul, Rosen, Klein Bloomfield-Garfield FHC East Liberty FHC New Kensington FHC Latterman FHC Lawrenceville FHC Shadyside FHC 7 Lin, Nowalk, Yonas Immunization Barriers Clinical Sites 64, 000 Visits Zimmerman Nowalk Tabbarah Raymund Squirrel Hill Practice Abrams Moyer Xia Lincoln Magee Pre. Op Matilda Clinic Theiss Ctr Woodyear South-Paul Unified Maternity Service Mackett 18 Fac & 81 Residents Dewar Maier

Family Medicine Funding by Sponsor

Family Medicine Research Funding

Current Funders • • CDC AHRQ HRSA NIH – CTSA Pennsylvania Department of Health Federal Office of Minority Health Private Foundations – Robert Wood Johnson Foundation, Heinz Endowments, Grable Foundation • Industry

Family Medicine Funding Trends FY 2004 32 $2, 125, 578 FY 2005 24 $2, 113, 626 FY 2006 25 $1, 750, 000 FY 2007 25 $2, 471, 027 FY 2008 18 + 3 $1, 708, 364 +

Collaborators • GSPH – Behavioral and Community Health Sciences • Clinical Translational Science Institute • Late Life Mood Disorder Center – Research Network Development Core • Obesity Nutrition Research Center • Center for Minority Health