[Bob:] I’d like to welcome Peter Weir, the executive medical director of population health. Let’s start with how you got into medicine.
[Peter:] I graduated from college as a business economics major, and I had an existential crisis about what I was going to do with the rest of my life. I wanted to be able to say that I had helped people. I began to look at different career possibilities. I was always interested in medicine as a kid. That led me to go back and get the post-baccalaureate education and go on to medical school.
[Bob:] You’ve had a non-traditional career path. Reflecting on your career now, how has it been different than you imagined?
[Peter:] At 22 years old, I followed a rural family medicine physician in Bishop, California. I saw an old-fashioned practice during the 3 days I was there. That became my ideal - work in a small town and be a significant part of the community. I’ve had a circuitous route to get here. Its been a matter of finding opportunities that resonate and pursuing them. I’m really pleased with what I’ve done and where I am now.
[Bob:] You’ve really challenged my thinking in terms of employer-based clinics. Your intrinsic motivation to create a family-type feeling at ARUP, an employer-based clinic. Describe the emotional, patient-connected part of the employer clinic.
[Peter:] It dawned on me that the ARUP clinic fulfilled my original idea of what it was to be a physician. ARUP is a community in and of itself. It's 6,500 lives. I felt like the family medicine doc of the community. I loved it. I would walk through the halls, see patients, have conversations; it was really ideal.
Getting the whole thing started happened in a very indirect manner. I went to a talk from Thomas Bodenheimer from UCSF. He spoke about the patient-centered medical home model and chronic disease registries, and I said to myself ‘I could do this at ARUP.’ That drove a ton of energy and vision for what we did there.
[Bob:] There are two big buzzwords in healthcare–one is value-based care, and the other is population health. How do you define population health?
"The goal of population health is to improve or maintain the health of a defined population and reduce the health disparities within that population."
[Peter:] That question makes it hard to sleep at night. Taking some of these ideals and vision from our efforts at ARUP and applying it to a far more complex environment - its daunting. To answer your question more directly – the goal of population health is to improve or maintain the health of a defined population and reduce the health disparities within that population. People are always asking me, ‘what is population health?’ It’s so broad, it can be anything to anybody.
[Bob:] There is this military acronym called VUCA, which is an environment that is volatile, uncertain, complex, and ambiguous. Because population health can be all to everyone, VUCA sounds like the world you’re living in. What are some of the biggest challenges you’ve faced this last year?
[Peter:] I was worried initially that people might be threatened by the concept. For the most part, I haven’t seen that. Most of the people I’m working with are very interested in pursuing the population health concept and vision. While that’s not everyone, it’s a great majority. I also received high-level support that has helped me as well. Complex, uncertain, rapidly changing–it is a tough environment to work within.
One of the strategies I’ve tried is to focus on early wins. As Dr. Clark would say, I’m not starting a revolution, but an evolution within the health system. We want to have some early wins and show some successes. I’m focused on discrete projects that move us in the right direction.
[Bob:] I’m curious about team-based care. The population health effort you’re leading is true team-based care; team-based care on steroids. You’ve started an intensive care clinic. What are some of the challenges and the opportunities in designing a truly authentic team?
"What separated us was trust."
[Peter:] We had a strong interdisciplinary team at ARUP. I leaned heavily on pharmacists for chronic disease management. I found pharmacists to be incredibly helpful. When you’ve got diseases where management is a medicine related algorithm (changing doses, ensuring proper testing, etc.) there is a ton of opportunity for pharmacist involvement. What separated us was trust. I hired an absolutely fabulous pharmacist, Holly Gurgle. I had a lot of trust in her. She acted autonomously, and after working together for several years we learned our weaknesses and strengths. Going forward for this intensive outpatient clinic, we just hired a new staff, and the idea is to work together in a way that promotes trust. Each person has expertise that they bring to the team. The idea is to use that expertise to get more effective care.
[Bob:] One of my favorite books that I’ve read in the last year was Stanley McChrystal’s book Team of Teams. The premise is moving from a very hierarchical power oriented team to a flattened hierarchy where everyone brings value and is respected for the value they bring. What you just described mirrors that. As doctors, we’re trained to be these autonomous captains of the ship. You describe a need to change that dynamic and be much more collaborative. What advice would you give to our fellow physicians or our residents, students in training, so that they come out equipped to lead authentic teams?
[Peter:] I totally agree. Physicians are trained to take total responsibility. That’s probably why we’re not much fun to be with in a clinical environment. It doesn’t have to be that way. I believe the future for physicians is to get away from that model; to learn to manage and lead teams. That takes trust. Whether it’s APC, NP or PAs, or pharmacist or care manager, even medical assistants, as physicians we need to learn the skills to manage and lead teams. Leading and managing aren’t intuitive. None of these skills are taught in our medical education. That’s a real gap. I would love to see a movement to help physicians attain those skills. Right now, when you graduate, you’re off into the wilderness.
[Bob:] There is a movement towards inter-professional education but the components of authentic team leadership is something we can work on.
[Peter:] I stumbled with the management so much at ARUP. If you talk to the people I worked with, they would have a lot of humorous stories. I learned skills the hard way. I had good mentors at ARUP with incredible talent. I wish other physicians could be exposed to a corporate setting; there are a lot of lessons we could learn in that environment. Learning about things that physicians don’t normally think about, like HR issues, are critical.
[Bob:] The last question I have – looking into the future, what excites you about the opportunity of population health over the next 5-10 years?
"In the end, I’m after a better patient experience."
[Peter:] What gets me out of bed is that I’m contributing to improving health care for patients. That’s why I’m here. I love making systems work. In the end, I’m after a better patient experience. I think anyone can agree that parts of the health care system are broken. I’m here to work on solutions to fix that. Reimbursement reform is driving a lot of this change. It’s hard and creates a lot of uncertainty and even chaos. We have to adjust our health care delivery to new models and make it better for patients - improving access, improving health, and to improving patient experience.
[Bob:] We’re in good hands with you leading the way.