Ronald Deprez: Will Travel for Health Reform

Ronald Deprez, Ph.D., M.P.H., is Executive Director of The Center for Health Policy, Planning & Research (CHPPR) at the University of New England. Dr. Deprez conducts research and consults on health policy and health systems innovations designed to improve health care access, chronic disease management, and population health status. Ron is an expert in chronic disease delivery systems. His SHARE project examines affordability, sustainability and access in Vermont’s health reform initiatives.

We talked to Ron about health reform in Vermont, providing incentives to primary care physicians, and his love of Africa.

Your SHARE study examines the effectiveness of Vermont’s Health Care Affordability Act, which passed in May 2006. What makes Vermont’s reform unique?

Vermont’s reform initiative goes beyond improving access (through insurance) only; instead it focuses on comprehensive reform and targets improvement in chronic disease management and prevention as a long term strategy to program sustainability. This effort began in 2003 with the implementation of Blueprint for Health, a statewide disease management initiative to address the care of patients with chronic health condition. This has been a focus of mine for years. Chronic disease links strongly with access; without improved care management (and prevention) of chronic conditions, programs that expand coverage are almost impossible to sustain.

To achieve such ambitious goals, Vermont must have built strong partnerships to get this initiative passed.

Vermont developed a strong public-private partnership for these reforms. All stakeholders came together with the goal of covering people with a sustainable set of programs. The cooperation from the private sector has been amazing – from private health insurers to the business community to physician groups. States that do not want to use the MassachusettsVermont’s development of a strong public-private partnership. model of pay or play can learn from

You plan to use a variety of data sources in your evaluation including five surveys and emergency room utilization and expenditure data.

That is typical of our evaluation research. My staff are experts at combining disparate data sources, both primary and administrative, to answer planning and policy questions. We conduct a lot of community assessments throughout the US. That work that involves obtaining all relevant publicly available datasets from states (such as tumor registry, mortality, birthing, hospital and ED data) combined with population survey data conducted specifically for each assessment. From these we build comprehensive profiles of health status, utilization, delivery system and best practice care indicators for a population.

Is it challenging to manage all these data sources?

From the beginning we identify different data sources for each of our research questions. Then we create a data map to connect our questions with the measures we need and those that are available. It is a very methodical way of utilizing varied data sets for evaluation research.

Similar to the rest of the country, Vermont is struggling with a shortage of primary care physicians – how will this affect the reform efforts?

The shortage of primary care physicians has a tremendous impact on emergency room and hospital inpatient use, especially for Medicaid and the uninsured– both areas for potential cost reductions. By investing resources into the Federally Qualified Health Centers (FQHC) and FQHC look-alikes, officials in Vermont are hoping to drive down costs incurred by those who end up in the emergency room or the hospital.

Why are more physicians not going into primary care?

This is a major policy problem in this country. Newly educated physician tend to go into specialty care, even osteopathic physician graduates, a group traditionally routed to primary care. Incomes and working conditions are much better. This has adverse local consequences especially in rural communities. Innovative primary care systems, those that attract and keep high quality providers, need strong and dedicated leadership to create and maintain a culture of excellence. I have observed this in our studies across the US. This results in better health status, and lower hospital and ED utilization for patients with chronic diseases. Building this culture needs to be part of in health reform.

Do you see any solutions for this problem?

One way to address the lack of primary care physicians is to devise policies that promote the change we want to see. Instead, we often build barriers. Loan forgiveness programs can address, in part, the alleged barrier of loan burden to entering primary care. Medical schools can also play a role. I work at an osteopathic medical school where the primary mission is to produce primary care physicians. Incentivizing medical schools to select candidates interested in primary care is sound policy; directing government funding to medical schools that train primary care and public health physicians is needed as well. In Europe and the Middle East, for example, they have medical school programs with departments of public health. The U.S. can learn from these approaches.

Your interest in underserved populations has taken you all over the globe.

Yes. I have worked in Africa and the Middle East – The Gambia, Tanzania, Zanzibar, Saudi Arabia, and Egypt. My heart is in Africa – I love the people I meet there. Currently, I am working on an evaluation design of a rural chronic care disease program in China. In the 1980s China switched to the market economy and dismantled its rural (barefoot) doctor program. They are now trying to address access issues that arose from this, which adversely effects chronic disease care.

Did you tune in to the Olympics in Beijing?

I watched the track & field and swimming events. Ian Crocker is from Portland, Maine and he went to my high school. He used to beat Michael Phelps in the butterfly, but it looks like this time Michael beat him.