From The Field F E B R U A R Y 1 7 , 2 0 1 4 Changing the Community Conversation on Health Care in Orange County, California GERALD SOLOMON Executive Director, Samueli Foundation I n 2000 a group of Orange County funders met to discuss medical and nursing students at the University of California, the health care needs of the community. Orange County is Irvine (UCI), which would then transform the way care is particularly challenged in a number of ways. First, it lacks delivered to the medically underserved of the county. a public hospital. Private medical systems act as the safety net. The Samueli Foundation convened community leaders from And second, Orange County is a “tale of two communities,” UCI Hospital, UCI Medical School, the Santa Ana with huge disparities between wealthy and poor. Given these Community Clinic (where all medical students do internships fundamentals, the conversation centered on the role of private and rotations), and the Susan Samueli Center for Integrative funders and health care systems to address these systemic Medicine (SSCIM) to develop this plan. At its core, it changes challenges. The conversation resulted in the formation of the how medicine is taught, incorporating principles of integrative Health Funders Partnership of Orange County (HFPOC), medicine (IM) with the goal of creating an environment of which for the next 10 years served as the safety net for tens of health, wellness, and well-being through a curriculum redesign thousands of people. that adopts the philosophy of IM. That would then translate In 2011 the HFPOC embarked upon a year-long strategic into providing an IM care model for Santa Ana Community planning process to envision its role in the decade ahead. The Clinic’s patients. group quickly realized that much had changed. Health care This program, with more than $1 million of committed costs were skyrocketing, and community indicators were philanthropic multiyear funding, has just completed its first showing that infant mortality, life expectancy, and obesity year. The strategies and outcomes are laying a foundational were headed in the wrong direction. Quality of life was framework that is forever changing the way health care is deteriorating. being delivered to one of the largest counties in this country. Data demonstrated that two-thirds of chronic illness is The following outline highlights the accomplishments to date. caused by lifestyle and behavioral factors influenced by mental, social, and physical environments. Addressing the health care STRATEGY 1: Reduce disparities of access to IM treat- system at the tail end, from a disease management perspective, was a failing approach. Something had to change. That change ments for the underserved patient community. began by looking at how the community defined “health.” ® Develop IM consult clinic at the Family Health Center Health had to be viewed through a much broader lens, such (FHC) in Santa Ana. as the World Health Organization’s definition of health as “a state of complete physical, mental, and social well-being and • The clinic offers in-depth evaluation and treatment not merely the absence of disease.” True health really occurs recommendations for lifestyle, nutrition, sleep, stress and outside the doctor’s office. Once this was understood, and mind-body approaches, and herbal/supplement options. consensus reached to adopt this new definition encompassing • IM-track family medicine residents and third-year the social determinants of health, the conversation moved to medical students rotate through the clinic and become the question: How can this group of funders and health care familiar with IM diagnostic and treatment approaches. systems change an entire health care ecosystem? It began with setting forth a new mission for community ® Collaborate with multidisciplinary IM allied care health. HFPOC adopted a new mission statement: “the role of providers. HFPOC is to improve the health and wellness of the Orange • IM modalities and providers interested in and appropri- County community by enhancing the impact and efficiency of ate for FHC practice have been identified (including health philanthropy.” The next step was to design, develop, acupuncture, naturopathy, and yoga). and implement strategies to translate this into reality. It was at this stage that the Samueli Foundation brought forward an • A patient survey measures the knowledge and interest in innovative concept: to transform the way medicine is taught to accessing IM modalities at the FHC. ® Offer group visits for integrative modalities and patient ® Tier 2: Advanced IM training track for all family educational sessions. medicine residents • The first monthly diabetes group visit started in Fall • The track started in late 2012, and more than 20 percent 2013, incorporating a wide range of IM topics. of all UCI family medicine residents participate. On com- pletion, they will receive a Special Certificate in Integrative • The FHC board approved the first yoga classes at the Medicine from ACIM. In addition to completing approxi- FHC to be offered twice monthly for patients and staff. mately 170 hours of the Web-based interactive curriculum • Content for healthy cooking education has been from ACIM, residents participate in training, including: designed. • rotation through the FHC IM clinic, ® Teach patient-centered communication and • interactive teaching sessions and case-based reviews, decisionmaking. • requirement to do a yearly IM journal club article review, • All family medicine residents now learn motivational • requirement to give a yearly didactic talk on an interviewing and receive one:one reinforcement of these integrative clinical topic, and skills during faculty presenting. • a third-year month-long rotation at SSCIM. ® Expose faculty, residents, and staff to self-care skills and tools for personal wellness. STRATEGY 3: Develop UCI primary care faculty • Monthly lunch and learn series on health and wellness knowledge, skills, and interest in IM. are offered, including mindfulness practice and stress ® Expand the base of UCI primary care teaching faculty relaxation. Future topics include Tai Chi and healthy expertise in IM. cooking. • There is a program in place for increasing IM continuing ® Develop a teaching program that provides a basic level medical education (CME) activities by FHC faculty. of exposure to IM for all medical students, family medicine residents, and faculty at the FHC. STRATEGY 4: Create the Susan Samueli Integrative • An IM lecture series and a journal club are in place, Medicine Center of Excellence with bimonthly presentations on integrative topics. ® Increase community awareness of the health benefits • An IM residency Web site has been developed with of IM. links to IM care resources. • Launch annual Women’s Wellness Day focused on IM • Faculty have access to Arizona Center for Integrative throughout the county. Medicine (ACIM) Web-based teaching modules. • Give a Dean’s Advisory Council, comprised of community leaders, presentation on Health Catalyst STRATEGY 2: Ensure that all UCI medical students, and Samueli-FHC IM Program. nurse practitioner students, family medicine residents, • Offer various community outreach events and activities. and faculty have a basic level of knowledge of IM. Create of a multitiered educational IM program for all Year two will see an expansion of both clinical and teaching medical students. programs. The focus will be on fostering educational and clinical collaboration between UCI and allopathic and allied ® Tier 1: Basic foundational knowledge and skills in IM health schools and the community; stimulating interdisciplinary • An IM lecture series and a journal club are in place, research projects, and holding IM CME events. Additional with bimonthly presentations. components will be introduced with a focus on healthy living and lifestyle change. • An IM residency Web site is developed with links to IM Although initially met with skepticism, especially in the med- care resources. ical school and care delivery system, it turns out that the first • There are monthly experiential teaching sessions for all adopters were the medical provider community. Seeing is believ- residents. ing, and doing is even better. The health care system of Orange County is being equipped with a larger, more effective “medicine • All third-year medical students are required to attend bag.” Time will tell how systemic the adoption of this integrated lectures on IM. approach will be, but from all evidence to date, the community is • The Health Catalyst Program is a year-long course accepting and engaging at levels far greater than expected. designed to give medical students practical information about a healthy lifestyle and build skills in patient- centered motivational interviewing. Students are invited to provide health coaching to employees at a local Views from the Field is offered by GIH as a forum company during a Healthy Living Summer Program. for health grantmakers to share insights and experiences. If you are interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.