We came from the future to see the future : USF Health at The Villages, and CAMLS

When you come up I would also like you to see our Villages initiative—our community based, primary care driven, patient centric ACO (email to me from Stephen Klasko, MD, MBA, CEO USF Health, Dean, Morsani College of Medicine)

My prior interactions with Stephen Klasko (@sklasko) –

( see: Do Medical School Deans see social media in the future of medicine? I asked Dean Stephen Klasko of USFhealth if he does. | Ted Eytan, MD  )

– suggest that an idea from him is worth following up on.

So I went, along with several colleagues from Kaiser Permanente, including my Executive Director partner of the Center for Total Health Keith Montgomery, and our Chief Communication Officer Diane Gage-Lofgren (@dianelofgren) to see not just this initiative but also the brand new Center for Advanced Medical Learning and Simulation ( CAMLS – @CAMLSTAMPA ), located in downtown Tampa, Florida.

The title of the post is the tongue and cheek mantra of an innovator, who sometimes finds her/himself sharing a vision that’s far ahead of their audience. The mantra is calming in these situations.

Then there’s the situation where innovator meets innovator, and no calming is necessary…

What if EPCOT were actually built, and with a sustainable health system?

We’ll never know the answer to that question because EPCOT , the experimental prototype community of tomorrow, ended up becoming an amusement park.

Meanwhile, The Villages (not on Twitter yet, but with a YouTube channel) with 100,000 residents clustered around 3 towns among 40 acres square miles, is thriving and has what looks like a Main Street USA feel to me. See my photographs below. Click to enlarge.

We were led through just a portion of The Villages Health System, which not only includes care centers for outpatient care, but recreation centers for health. This health system is being created right now, so what we got was a sneak peek offered by Elliott Sussman, MD and Jeff Lowenkron, MD our gracious hosts.

Telling the story of what primary care is exceptionally well

The Villages Care Center brochure does among the best jobs I have ever seen describing what primary care “is” and the contribution of the primary care specialties to it (Family Medicine, Internal Medicine, and Pediatrics) in the most clear terms.

Most health systems shy away this and refer to “primary care providers” in the generic. That approach isn’t as respectful of the physicians who train in these different specialties. The Villages Health method, on the other hand, respects the residents’ ability to understand the differences. In the ideal world, our specialties work together, because we are not the same, to produce health with patients and the community.

The brochure itself isn’t online but tucked away on the About Us page is a nicely written white paper about what The Villages Health System is working to become, with references. Check it out.

The care center

The attention to care experience are apparent here – a few that I’ll note:

  • The “waiting room” looks more like a living room, actually the whole place looks more like home than hospital
  • Note the “visit room” rather than an “exam room” – not every room needs an exam table, because not every visit in primary care is about being examined. Listening is the most important innovation in health care.
  • Learning is emphasized everywhere. There’s a “Knowledge Pharmacy” labeled as such
  • Collaboration – same thing. Physicians and nurses are collocated during practice sessions. A nice touch, a sofa and comfortable chairs in an open space right next to physician offices. There is room to breathe here.
  • A sizable kitchen and dining room which can support teaching in nutrition and general gathering of the community around health topics

For more detail, you’ll just have to visit yourself, if Stephen or Elliot invite you 🙂

That’s just the design of the space. Know that Elliott and Jeff are champions of and for primary care. They proudly discuss plans to recruit in the primary care specialities including family medicine, to support a team-based patient centered medical home model (just like Steve Klasko described – it’s real).

The part about the future

As Elliott explained to us, this is a planned health system that is set to slowly grow and learn and evolve. The partnership with University of South Florida (@USFHealth) supports medical education via video links, as well as specialty care and future on site teaching and rotations. If you understand that the specialty of family medicine is primarily taught in the outpatient setting with a depth of focus on a person and their environment, imagine learning it here, in an entire community designed to support health.

It’s in the tagline : “America’s Healthiest Hometown”

The Villages may discover how to integrate medical care, environmental support, and involvement in the social determinants of health to provide what people really want – to have better lives.

CAMLS : Clinical Grade Simulation and Medical Learning

This was day 2 in Tampa –  we were given a tour by John Ekarius, the COO of USF Health and Morsani College of Medicine. CAMLS just celebrated its first birthday.

When John says “clinical grade,” what he means is that the hospital wards, outpatient wards, and operating rooms are high fidelity, and learners are brought in with the expectation that this environment demands the respect and professionalism that a learner would bring to the care of an actual patient. There is modeling and simulation on site as well (and they have the second 3D printer I have seen in as many months…it’s the thing to have in the future).

It’s possible for professionals at all stages in their career – undergraduate learners, graduate learners, remedial learners to come here to adopt a skill, relearn a skill, remediate a skill not just in procedural techniques but in communication. As we literally crossed a threshold to go from outpatient to inpatient setting we saw the setup for standardized patients to conduct mock visits with learners that can be recorded on video and debriefed in rooms setup for this purpose. John told us that the debriefs themselves are also recorded so that instructors can be learners, too.

In my medical school training, I examined “standardized patients” from the community. The patients would begin each visit as the patient and then step into the role of teacher and show us how to improve our examination skills. It was ahead of its time then, and we didn’t have anything near the setup that CAMLS has.

No photography was allowed past the lobby, however the CAMLS web site has detailed photographs of the interior of the learning spaces.

The part about the future

Here there is a strong focus on learning and education, the workforce side of the health system equation. As John and later Debbie Sutherland, MD explained to us, this is a stage/a set, for the most up to date content to be given to learners in their professional careers.

You can see a future where perhaps this stage might be a place where people learn whether they should embark on a career in medicine in the first place.

You could also see a future, in the era of the ACO, where health systems in the community would have a resource to send professionals to learn to lead better through excellence in diagnosis, treatment, and communication. This could very well fill a gap that some people discuss with regard to ACO’s.

We came from the Center for Total Health because we are studying the ways that health systems tell the story of health and engage their stakeholders in producing health for societies. We found a good example here.

Thanks to Stephen Klasko, MD MBA,  Elliott Sussman, MD MBA, Jeff Lowenkron, MD, MPP, John Ekarius, Debbie Sutherland, MD, and the VillagesHealth leadership team who also took time out of their schedules to dialogue with us.

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