As reported by the Hartford Business Journal, October 17, 2010.

St. Francis, UConn in Collaboration on Innovative Primary Care Institute

By Greg Bordonaro

To help reverse a primary care physician shortage in the state, a major Connecticut hospital and medical school are teaming up to open a new primary care institute that will provide research and training to doctors.

This month, St. Francis Hospital and the University of Connecticut School Medicine will open the Connecticut Institute for Primary Care Innovation, which will focus on the education and training of doctors, research that can lead to better care at reduced cost, and, most importantly, help find ways to increase the ranks of primary care physicians in the state.

The opening of the institute comes at crucial time for the industry and the delivery of health care services in Connecticut.

The Connecticut State Medical Society has already warned of a major shortage of primary care physicians in the state that, if not addressed soon, will lead to longer waiting periods for patients or a lack of access to doctors for the newly insured.

The addition of thousands of newly insured patients as a result of health care reform will make the problem worse, especially in rural areas, if structural issues are not addressed, industry officials agree.

"A lot of medical students say they are interested in primary care, but not many of them who are interested, actually end up going into it," said Gregory Makoul, St. Francisís chief academic officer and senior vice president for innovation and quality integration. ďWe are trying to change that."

Makoul said the institute, which will be housed on St. Francisís Hartford campus, will have four major focus points: research, education, outreach and an information provider.

The idea is to create opportunities for innovative models of training as well as a laboratory for improving coordination and transitions of care, both of which are hallmarks of the health care reform law.

Makoul said the institute is meant to be a resource for the region and the state, and can become a national model for training and retaining primary care physicians.

Fewer medical students are going into the field because primary care doctors are paid less than specialists. The huge debt load medical students carry after they graduate adds pressure to go into the highest paying practice areas.

According to a survey by the medical society, which polled 498 Connecticut doctors, about 25 percent of family physicians and 22 percent of internists in the state were contemplating a career change because of the practice environment in Connecticut, including high malpractice insurance costs.

One of the things the institute will study is the possibility of adopting a loan forgiveness program, an idea that is being kicked around in the state legislature, said Dr. Bruce Gould, associate dean for primary care at the UConn School of Medicine and a governing board member of the primary care institute.

Gould said he has been working for years to encourage students to go into primary care, but it has been a challenge. He said there is now renewed support in making the primary care physician the center of the health care delivery system, an opportunity the industry canít afford to pass up.

"The pendulum has swung back," Gould said. "Now there is societal pressure and institutional support to produce more primary care doctors. But unless we are proactive and deliberate in how we react, these opportunities will pass. The institute for primary care is potentially an enormous asset in ensuring that this is a defining moment."

St. Francis and UConn are also working together to develop a primary care track within UConnís medical school, Makoul said.

Another key component of the institute will be to study ways to provide more efficient care. In particular, the institute will focus on identifying the most effective aspects of the patient-centered medical home concept, a model that is being touted by both the state and federal government as a way to provide more cost effective care.

The idea behind medical homes is to use primary care physicians as central figures in coordinating patientís care among specialists, hospitals and other health care providers.

That reduces costs in the long term by eliminating duplicative care and encouraging preventative services that help to root out serious diseases or health problems before they develop.

But Makoul said there is some confusion, especially among patients, about what exactly a medical home is. There are also questions about the best ways to utilize the model in Connecticut to create more efficient care.

"We need to make sure there is a tight connection between primary care physicians and the hospitals," Makoul said.

The institute is also meant to provide support for practicing primary care physicians in Connecticut by helping to keep them abreast of the changing industry. Makoul said there are many small primary care practitioners in the state so they often donít have the resources to help them understand where the industry is headed.

That makes capitalizing on quality improvement initiatives and adopting electronic medical records, for instance, a difficult task. Keeping up with changes associated with health care reform makes the task even more daunting.

The institute, which was one of the UConn Health Network initiatives signed into law in June, is made up of a governing board of St. Francis and UConn officials. The institute is searching for a director, who will be a senior researcher who will help attract grants.

St. Francis is fronting start up money for the institute. But the hospital will also be looking for state money, which will be contingent upon UConn receiving a $100 million federal grant, or other funds.