Episode Two: Transforming the Patient Experience

Doug Newbold, MD, a family practice doctor at the Taylorsville Clinic, is one of Intermountain’s highest rated doctors in patient satisfaction. Listen to Dr. Newbold discuss some of the small but impactful changes he has made in his practice to improve the patient experience.

Transcript

Mark Briesacher, MD: I'm Mark Briesacher. I'm the President of the Intermountain Medical Group, and I'm here with Doug Newbold, MD, who is a family doc out of Taylorsville. He's also the chair of the medical group board's Population Health Committee. And, Doug, thanks for coming in today.

Doug Newbold, MD: Thanks for having me Dr. Briesacher. I mean it's been ... It's been a lot of fun these last many years, working with Intermountain, so ...

Mark Briesacher, MD: Yeah. Yeah. Pretty formal there, Dr. Briesacher.

Doug Newbold, MD: Ah, you know.

Mark Briesacher, MD: We've known each other too long for ...

Doug Newbold, MD: I know, I'll just call you Mark. I ... That's probably a little bit better, so ...

Mark Briesacher, MD: Yeah. So, you know, I was thinking about ... I was trying to remember the year that we first met. It was in the early 2000, because I was managing kids care. I was a medical director for kids care at that time, and what year was that?

Doug Newbold, MD: So, it was about 2002. I was down at the Utah Valley Residency Program from '99 to 2002 and joined Taylorsville in the summer of 2002.

Mark Briesacher, MD: That's right.

Doug Newbold, MD: And, yeah we kind of met when I was just trying to figure out ways to build my practice. You know, you start out and you only see nine or ten on a schedule, and I thought, "How am I going to get people to know me?" And, I realized really quick that we had an insta-care and a kids care. Well, back then it was all insta-care, but we did a lot of the pediatric stuff at night. And I just realized that that's the fastest way to build a practice, to get the nurses to know you.

Mark Briesacher, MD: Right.

Doug Newbold, MD: And, it worked really well, actually. So, I spent a couple of years doing that. So I contacted you to see if I could get on the schedule for Taylorsville's insta-care there.

Mark Briesacher, MD: I recall it took me about two nanoseconds to say yes. You can imagine how challenging it might be to get people to agree to work from 5 to 10 on weeknights and noon to 10 on weekends. So, I was thrilled to have you call. And of course, I think ... I agree with you, and I think it is, providing and being available is absolutely a great way to build a practice.

So then, after that, I shortly thereafter became medical director of the Central Salt Lake Region, and my recollection is I began leaning on you to consider leadership positions in the medical group, probably two, three years, four years later maybe. 2007, 2008 and of course, you were pretty busy. But here you are today.

So, again I'm thrilled that you've taken some time to talk about family medicine, and the fundamentals of care, and how you apply them in your practice. So I guess, you know, there was a reason I wanted you to consider a leadership position. Because as I looked at how the region was doing, you know, I noted that you consistently had great clinical outcomes. You know.

Your number of patients in a challenging population of people that have diabetes, the number of clinical outcomes you were achieving with respect to the diabetes bundle. I knew that your patient experience scores, you know if I was looking at every family medicine doc in the medical group, you were always in the top five.

I also knew that sometimes when I texted you at 7:00 at night, you'd reply, "I'm still seeing patients, can I call you later?" So, tell us a little bit about how you ... How does this all happen, right? How do you do this?

Doug Newbold, MD: Well, first of all I look back when we were discussing, when you were medical director. You know, there were some things that I saw that Intermountain was doing that I'm not sure I agreed with in some ways, and other things I agreed with a lot. And, I thought I have some ideas on what I think might be helpful to our patients for physician satisfaction, and other things that were going on at the time.

And so, my thought was initially, I was very resistant to doing any kind of leadership anything. In fact, you know I remember talking to Tim...

Mark Briesacher, MD: Tim Johnson.

Doug Newbold, MD:...Tim Johnson, yeah. One time, and he suggested that maybe I consider running for a board position that was opened up. And that application kind of came and left, and I didn't do anything with it.

He grabbed me after a meeting and he says, "Why didn't you do this?" He says, "You're frequently sending an email with some ideas on how to change things, so why didn't you do this?" And I said, "Well, I just felt like I was in high school running for class office. I just didn't want the thought of not making it." You know? And he said, "Well remember you lose 100% of the time of things that you don't apply for."

So, that really kind of stuck with me that, yeah, I mean there's no way to make that difference just by sitting back and doing nothing. But I also learned, really, that there was a lot of individuals responsive to some of the ideas that I had had. And I decided that was one of the best ways to try to do that, was just to get out there.

I wasn't trying to do any type of leadership positions in any way, for any purpose other than to hopefully make things better for our patients, our clinic, but also for myself. Just my own satisfaction as a physician. Because you know, with all the changes that were going on nationally and otherwise, I figured that you can either jump on the train and you can help try to steer it a little bit, or you get left behind.

And so, that's the way that it worked for me. So, you know, after I had done kids care for a couple of years, I guess I realized that late Wednesday night which is when I usually did it, was pretty helpful to, in me just catching up on some paperwork and some other things. And, in time, I thought well, now that my practice is kind of flowing and doing really well, why not have an extended hours version on a Wednesday night that, instead of doing kids care now for my own patients.

And I quickly realized that that became a very popular time for some patients. And also, for me since I had Thursdays off, I figured I could stay late on a Wednesday. And then, I had Thursdays off. And then, it could truly be off instead of me trying to do charting and stuff on my day off.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: And I'd realized that that's a lot of the reason why that really came about, was to allow physicians a day of just administrative time. But for me, I wanted to have that day just to spend with my wife and family. And so, that's kind of how it evolved. And then, over time, I started talking with a lot of patients.

I had some diabetics that I really couldn't get in because they said, "Doc, I work... I have to be at work at 8:00 and I have an employer that is unforgiving." You know? Especially some of my heavy equipment operators.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: Some of those where they have a skill that's so unique, the boss just isn't willing to let them go. Big crane operators, and things like that, so I sat and I thought, well you know on Fridays I want to get out of here a little earlier. And so, I started a 7:00 a.m. clinic on Friday, and then I would end at 3:00.

And, a lot of it at first was for selfish reasons, too. I thought getting out of here early on a Friday sounds really good to me. You know? I'll start my weekend early, but then again, I realized that suddenly my 7:00am appointments, from 7 to 8:00 a.m. were booked out months in advance. Where some of the other ones were a couple of weeks.

And that's kind of what helped me realize that that was probably the better way to go, at least for my patients. Not necessarily every day, but to have that option available to them. And they still remain some of my most popular appointments.

Mark Briesacher, MD: You know, there's this funny thing. People who have health insurance generally also have jobs.

Doug Newbold, MD: Yeah.

Mark Briesacher, MD: You know, there's an interesting fact that I heard awhile back. And, that is of all of our SelectHealth members that have a high deductible health plan, only 8% of them actually meet their deductible every year.

Doug Newbold, MD: Wow.

Mark Briesacher, MD: And so, what that means ... what that tells me is that our SelectHealth members are spending their money, right. They have to pay full price for everything we do. So, they are absolutely a consumer. And so, they're going to be looking for the lowest cost providers and the most convenient, open access providers of care in the community.

And, we have competitors, right. They have a choice as to where to go. So, I think that ... Thinking about how you have done appointments at 7:00 in the morning, before work starts, you know for 10 years now. That's pretty impressive. So, thank you for doing that.

Doug Newbold, MD: Thanks. And I ... Like I said, the intent in the beginning wasn't in terms of access, at least as I was thinking of it for patients. But one thing I did realize is that it builds a lot of loyalty.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: You know? Between you and your patients. And I think ... There are a tremendous number of clinicians within the medical group that have had patients come in and tell them that their employer is looking at different insurances. And they'll say something like, "Oh, I absolutely have to check and see if you're on the panel."

I mean, I've got great partners at Taylorsville, but I've also spoken with many great colleagues that are with Intermountain that have that experience.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: And that loyalty is built because you're providing something for them that ... help them realize how much you care about them. And I think the overall experience when they come in, whether it's the time in the morning so that you're trying to meet early so they can go to work, or whether it's responding quickly to a small crisis that they have at home through a phone message, these all play out to be some of the most important things with loyalty.

And you had mentioned, as far as patient experience before. One of the things that I have tried to emphasize within the clinic is a lot of laughter, actually. And within each of my patient rooms, I have a joke book. Of course I have to filter the jokes sometimes to make sure that they're appropriate, and clean, and pediatric worthy even.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: But, my nurse actually ... We started noticing patients would bring in some jokes, and I have some patients that won't start the visit without telling me a joke also. So, I've encouraged patients to bring in jokes that they had, and a lot of them have. And so we started compiling them.

We even put little jokes behind the door, because people often look at the mirror at themselves when they think you're not looking. We have some jokes that are above the scale. And so it's been a lot of fun to have patients. They stand on the scale, usually that's the one place that they cry. And instead, they start to laugh a little bit or they agree with what's on the wall. So, I think laughter is a very potent healer as people come in.

That's the hope. It's kind of nice to walk into a room having them looking in the joke book and smiling and laughing, instead of focusing on their area of pain or otherwise. Of course that still happens too.

Mark Briesacher, MD: Right.

Doug Newbold, MD: But, it seems to be less frequent when you have attempts at humor around.

Mark Briesacher, MD: You know, what I really like about how ... When you talked about your 7:00 a.m. to 3:00 p.m., and I hear the humility when you say this started as could I have some balance in my life. And I'm actually struck by the fact that what you've achieved is something that works for you and your family, and also works for your patients. And, as you work with your partners in the clinic, you have one night where you stay later. And you have one morning where you start early and leave early.

And, in a group practice, it sounds like it's possible for everyone to do if we coordinate who's starting early on Monday and who's staying late. And no one is working more hours. And actually, everyone not only has their day off, but they also have another day of the week that they can get home in time to pick their kids up from school that day. Or have the barbecue going by the time they get home from after school practice.

So, I appreciate your humility around that, but I actually think that's exactly what, when we have gone this year and asked people to think about how could we do extended hours, it wasn't with the message of you have to work harder and longer. It's just ... It was a message around how can we work smart together, and actually provide great access for our patients, and also take care of ourselves and our families. So I think that's really cool.

Doug Newbold, MD: Thanks. You know, and we have a joke at our clinic. If we survive iCentra, then we might be able to make the access happen.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: It's been a little longer hours lately, as we try to learn the system.

Mark Briesacher, MD: Yep.

Doug Newbold, MD: But we recognize it for the tool that it is, and the improvements that are being worked on with it. I have partners that have already mentioned that they're considering looking at a 7:00 a.m. start time, and it's ... I think it's a good way to go for those that feel like it meets their families' needs. And I know that there are some physicians that would rather come in later.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: Whether they would rather do their exercise in the morning. You know, not get up so early, or whether they would rather just stay at home with their family, get their kids ready for school and they would rather start it later. You know, I think there's some leeway that way. In that message of we're not trying to have you work longer hours, just ...

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: ... try to strategize it a little bit, and then make it work for the patients. That makes sense, too.

Mark Briesacher, MD: So, I love the jokes. I love hearing jokes. I'm not a very good joke teller. So I'm glad we didn't start today with you asking me to tell you a joke. But it really points out the importance of connecting to patients. Connecting to people. And I love the fact that you use the jokes.

I was talking to a family physician up at South Ogden, and his way of connecting was he had an iPad of family photos of their camping trips and event, their soccer games, and birthday parties. Oftentimes, his conversations would start with the patients asking, "Well, how is your daughter doing? Did she graduate from college?" And then, he would ask them about their family. [00:16:30] So, they always started with a human moment, a personal moment, as opposed to what brings you in today and getting right down to business. You know, Dr. Stephen Beeson who we're working with on the Clinician Effectiveness Project. This is the project where you can log on, any Intermountain physician can log on and hear other physicians talk about issues in healthcare and challenges with practice, etc.

I heard his video just two nights ago, and he was talking about the importance of connecting to patients as part of the patient experience. So, I mentioned before that you're always top five. You're top decile in the country in patient experience for family medicine. And that's hard to do because you have to actually ... to be top quartile, that's 93% of your patients saying they would recommend you to other patients. And you're top decile. And that's great to have that number, but what do you think that means for patients? What experiences have you had that tells you this means a lot to people? 

Doug Newbold, MD: Well, I think back to an experience I had with a diabetic patient... He started seeing me after Dr. Bullock passed away. Now, Dr. Bullock was an internal medicine physician at Taylorsville, and we lost him I think back in 2007. And it was a difficult time for his patients. There were a lot of tears shed from the patients over his loss.

Mark Briesacher, MD: Yes.

Doug Newbold, MD: And I remember, he started seeing me and he was a diabetic that was very poorly controlled. His A1Cs were usually around 9, 10, 11. And he's a UTA bus driver. And I kept thinking, boy, we've got to get these down for safety for the public, but also more importantly for him. And I remember having a conversation one time with him where he came in and his A1C was under seven. And it hadn't been in the two years I had been working with him.

And, though I didn't remember the moment from the visit before, he said to me ... Well I asked him first, "What changed this? Why is it so different?" And he said, "Last time, as we started to talk about some of the complications that can come in diabetes ... " He said, "I saw the concern in your eyes, and the worry that you had. Not because of a number, but for me, and that I'm going to start struggling with some health challenges that I currently don't have if something doesn't change."

He said, "It was that concern that really got to me." And then, that's when I first realized the power that a physician has in the lives of their patients and their health.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: And so, as we talked about different things, I see so many of my colleagues and others that do an amazing job at this. And, where patients are so loyal to them, and they change their behaviors because of that love and concern. I learned quickly that no two patients are alike, and you have to approach people differently. But, that idea of being in this together and a team, and genuinely caring about them and their lives was something that, the fullness of that, I hadn't realized when I went into medicine, to be honest with you.

And now, it's starting to make a lot more sense. And now I feel that excitement with them when they achieve different goals that they've had. When I saw one of my patients that weighed 400 pounds, through hard work, get down to 200. And, he got off three different cholesterol medicines. He got off four diabetes medicines. He got off three blood pressure medicines. And he just couldn't believe the difference in how he felt. That was him. He was driven to do that, and we had discussions on how to maybe go about that, but it was an honor to be in that with him. And I found inspiration from him myself and think I can do better.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: He did this, I can do this, you know. And so, I find that it's really helped my own life, too. So, for selfish reasons I find that my patients teach me more than I teach them. And I'm grateful for the opportunity to have that trust with them. And I really don't look at them as a number.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: I look at ... that's not to say that there aren't some that are very frustrating.

Mark Briesacher, MD: Right.

Doug Newbold, MD: And there have been some that I wanted to kick to the curb. I mean, we have those patients, right that are somewhat toxic in how they do things. But even some of them, if the right kind of patients ... If they see the care and concern in your eyes that many of them don't receive from anyone else in their life...

Mark Briesacher, MD: Right.

Doug Newbold, MD: Then, suddenly, you can see a desire to change. And for those that don't, or are abusive or difficult, well then that's a different discussion for a different day.

Mark Briesacher, MD: Right.

Doug Newbold, MD: But anyway, I love what I do and I love working with these people. I really do. 

Mark Briesacher, MD: Yeah, and it's striking how ... you know, the link between the care and concern that patients feel from a physician or an advanced practice clinician, and how that is linked to their success to improve their health and get to the clinical outcomes that of course we need to achieve as a Medical Group. It's increasingly so as our revenues are tied to how well we take care of people with diabetes.

How well we manage blood pressure, how low our rates of surgical site infections in the hospital, how our rates of catheter associated UTIs or central line associated blood infections. You know, those should be zero. There should be zero per year practically.

Doug Newbold, MD: Right.

Mark Briesacher, MD: You know, so those are all the things that whether you're a primary care physician like you and I are, or an orthopedic surgeon or general surgeon or colorectal surgeon, or an intensivist. You know these are things that patients ...they're counting on us to keep them safe when we're caring for them, and to help them get back to health. And, so I think your approach to this is something that everyone could probably take a little bit of something from. So what do you think ... So you're out in Taylorsville.

Doug Newbold, MD: Mm-hmm (affirmative).

Mark Briesacher, MD: Who are your local competitors out there? 

Doug Newbold, MD: Well, there are certainly other medical systems that...I mean, there's a lot of...There are still a fair amount of independent clinicians that are there that take lots of different insurances. They might not be able to be on the most restrictive panels.

Mark Briesacher, MD: Right.

Doug Newbold, MD: But they take some of the SelectHealth. They take some of the Blue Crosses, the Altius. So, we see some of that, you know. And it's interesting. One area that I admit I get very frustrated with as we talk about the competition, is I hate driving down the freeway and seeing the sign that says two minutes to an ER doctor.

Mark Briesacher, MD: Yep.

Doug Newbold, MD: I absolutely hate that sign because it gives the message like, come to our ER, we'll see you really fast.

Mark Briesacher, MD: Yep.

Doug Newbold, MD: And, we all know that that's the worst place to go, not because the quality of care is bad, but because it's just the most expensive.

Mark Briesacher, MD: That's right.

Doug Newbold, MD: You know? And I see ... I feel bad when I see some of my patients that might go in there for a upper respiratory infection or a bladder infection. And I think, my goodness, that's something that I need to figure out how to get these patients so I can get them in, or at least see one of my partners, or physician's assistant or whatever. Because that can save the system tremendous amounts of money, but most of the patients ... and what I've learned is a lot of the patients that are doing that, that are going an utilizing the ER that way, are some of my lower income patients that have the least amount of money to begin with.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: And also, maybe, the least amount of knowledge. And so part of my responsibility is to educate and train, and say, "Hey, come in to see me." But, the problem is again, going back to access. You know. If they see a sign that says two minutes to go in there to be seen for a URI, and me ... Well, we'll see you in two weeks.

Mark Briesacher, MD: Right. That's not going to work.

Doug Newbold, MD: That becomes a challenge. And so...but I see competitors in the area. There are a lot of different medical groups that are there, but also, I'm seeing insurance companies starting to do things like...Take Optum for example. I mean, they've really been pushing this...We call it the van down by the river, where they've got all these different things in this van, and their calling all the Medicare patients that I'm caring for. They're doing these annual wellness visits.

Now, I know why they're doing it. They're trying to get their RAF scores up, and everything else, but yet it kind of helps me see that, okay, they're getting this visit from someone that has no idea who they are. And they might even be recommending and doing some things that are not helpful. I mean, every one of these patients is getting an ultrasound when really an ultrasound is really not indicated, you know.

And it worries me a little bit because sometimes when we go looking for things we end up costing a lot of money for patients, and we can put them at risk for things that maybe they don't really need. So the competitor thing is a concern, because you feel like that control slipping, but again my hope is that patients feel the loyalty to us. And I think if we have a really good patient centered model within our clinics, where they feel like they're being taken such good care of that they don't want to even look elsewhere.

There's no need to. And that's why that whole idea, I think where medicine is evolving is into a team.

Mark Briesacher, MD: Right.

Doug Newbold, MD: And I have an amazing team in Taylorsville. I have some caregivers that are ... You know, whether it's our nurse on the nursing side, or whether it's on the ... even some of the caregivers. The care guides that are there just working with us. It's been amazing. And that, I think, can help us keep the competition out. [00:27:00] What I'd like to see happen is the clinics to have pharmacists, to be honest with you.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: We had one for about six months, and she came in and she ... at first I thought, how's this going to go? You know. I don't know that I need her help this way, but when suddenly I could grab her and say, "Hey, I've got to change this person from Lantus insulin and short-acting over to a 70/30, because I think they're going to be more compliant. You know, could you help me take some time with the dosing and figuring it out." She would call the insurance. She would figure out the brand that was necessary. She helped me with all of the things that went together.

Mark Briesacher, MD: Yeah. That's great.

Doug Newbold, MD: And the patient did better. And then she'd call him, "How are you doing on it? How are things going?"

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: And so, that's an example of the team model that I think will help Intermountain keep patients where they need to be, and get the best care possible. And stay away from, where appropriate, the ER if possible.

Mark Briesacher, MD: Well, you know you mentioned Optum Medical Group.

Doug Newbold, MD: Mm-hmm (affirmative).

Mark Briesacher, MD: And so, maybe in the last part of our discussion this morning, let's focus a little bit about ... a little bit on them, and our application to become an accountable care organization. And, you know, your new role. And so, you know it's interesting. Optum Medical Group now employs 24,000 physicians across the country. They are the largest medical group in the country now, and I think it's probably worth noting that Optum is a wholly owned subsidiary of United Healthcare.

So, this is an insurance company who has built an Optum Analytics Group, and now, the largest medical group in the country. And they're here in Utah, so the competition is already here. And in fact, as I scan ... you know, when I look from a strategic perspective, where does a medical group need to head?

When I scan the landscape of other competitors, I see Davita Healthcare Partners in every surrounding state of Utah. I see Iora Health in Arizona and in Nevada. And, what Optum and Iora and Davita Healthcare Partners all do is they just focus on Medicare Advantage and Medicare ACO lives. So they are essentially competing against us just in Medicare. So, they have the van down by the river. Nice reference to Chris Farley there, by the way.

Doug Newbold, MD: One of my favorites.

Mark Briesacher, MD: Yes.

Doug Newbold, MD: Speaking of humor.

Mark Briesacher, MD: Yes. And they're providing access, and they are executing from a business perspective and a clinical perspective to make sure they have care plans, and have documented every chronic condition for their Medicare patients, that they've gotten all the appropriate healthcare screening.

So, you mentioned the ultrasound, is that indicated or not indicated, leaving that to the side. We know, for sure, they're making sure that breast cancer screening is completed and colon cancer screening is completed.

Doug Newbold, MD: Mm-hmm (affirmative).

Mark Briesacher, MD: And that every patient who has diabetes has been screened for nephropathy and retinopathy and all the things that are the value based payment in Medicare Advantage is linked to. So, in your new role, with the ACO, the Medical Group now has somewhere between 70 and 80,000 patients that are attributed to us that we have full risk for through either Medicare Advantage or the Medicare UCO.

So I'm, first of all, very thankful that you accepted the nomination to be chair of this new Population Health Committee. And, you know I think ... I'm really looking forward to us working together to help the rest of our colleagues in internal medicine and family medicine learn about ACOs and begin to prepare for taking what we do for our Medicare Advantage patients today, and now do that for another 55,000 of our patients who have been on Medicare fee for service and are part of an ACO.

So, as you ... Just thinking about your practice, Doug, what are some of the things that you think you and your partners are going to have to do to prepare for this change that starts next year?

Doug Newbold, MD: That's a great question, and that's what we will be meeting a lot about is what are some things we can do to stay operational and strategic in the future. You know, there are a lot that don't know what an accountable care organization is and really, kind of briefly it's a group of hospitals and doctors and other clinicians that are kind of joining together to give really high quality care to their Medicare patients. Now, there are financial sums attached to that.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: And, Intermountain has made the decision to become an ACO. There are different payment models that are out there. I mean, I think a lot of primary care doctors have heard of MACRA and MIPS.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: And, you know of course, we've decided not to go the direction of MIPS, but rather to go through an alternative payment model, which is the ACO, which I think is a wise choice considering the quality that can come with that.

So, you know, how it relates to the average every day clinician and what they're doing. What we're envisioning a little bit is, first of all, the team approach.

I mean, the team factor. We're already on our way there. You know, most of the clinics have now some care coordination that can take place, in primary care anyway. And I would envision that expanding to take the pressure off of doctors to spend time ... let them operate at the top of their license. Let others kind of help support that and take care of patients in whatever way. But also, you know, with the financial implications that come with this. What I see is it's going to take, not just one change but several. You know, for example, I see the telehealth portion of becoming incredible for certain kinds of visits.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: Certainly, I can't look at an ear infection that way.

Mark Briesacher, MD: Right.

Doug Newbold, MD: But, at least not yet. Who knows? Somebody's going to probably come up with an otoscope that plugs into the phone.

Mark Briesacher, MD: You're right. We're work- Actually, they already have.

Doug Newbold, MD: It's ... okay. I haven't seen that yet, but ...

Mark Briesacher, MD: We just have to figure out how to use it.

Doug Newbold, MD: And, you know, and also there's...I've seen patients that take their phone, and they put it up against their chest, and it reads a blood pressure now and a small EKG. I don't really know how accurate that is yet, I haven't seen the science behind it, but that's where it's going.

Mark Briesacher, MD: That's right.

Doug Newbold, MD: So I see that there are opportunities, though, for certain kinds of visits that we can do through our phones, or through our computers, making it so patients don't have to leave their bedroom. You know? And, think of the cost savings for a patient there.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: Whether it's gas and time, time off work, whatever the case may be. But that, we can't have it just that kind of visit. There needs to be still face-to-face and other things. So that's ...we're going to focus on trying to figure out how the team approach can be applied to all different kinds of models that allow clinicians to take care of lives as best and as effectively as they can. And have the support with others, too, to make sure that patients have the support that they need. Whether it be a pharmacy question, or whether it be mental health integration.

Mark Briesacher, MD: Mm-hmm (affirmative).

Doug Newbold, MD: You know, I currently see that that's becoming the future model where the physician still is the lead, because these are his or her patients, but they are not the sole decision maker. You know? They use their experience and their judgment, but they rely heavily upon their teams.

And, when you have a fantastic team that all have expertise in different areas, the patient wins. So does the physician because it takes the pressure off of me. Now, of course, a lot of clinicians might be sitting, thinking about well, okay if I do a lot more phone medicine or telemedicine is this going to affect my income. Well, certainly those are things we have to address too.

Mark Briesacher, MD: Yes, we do.

Doug Newbold, MD: And that's something that will happen at the Medical Group level to ensure that no one's penalized. In fact, there's potential to actually even have greater savings as we ... You take these financial risk models, the whole idea of it is if we save the system money by giving, not ration care, but giving really appropriate and evidence based care in every aspect of a patient's life, then really we should be saving them money and us money. Less hospitalizations, less ER visits. And then, Intermountain and physicians have a share in those savings.

Mark Briesacher, MD: That's right.

Doug Newbold, MD: And so, there's a tremendous amount of potential there. I see it, anyway. That we can ... everybody wins.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: So, from a payment standpoint too, you know clinicians need not to be so worried about that as we work forward with that. A lot of people are worried that we'll just throw somebody on salary, and say, "Well, this is what it is." But, that's not quite how ... It can't work that way, you know. But there are a bunch of different things that will come, but ...

Mark Briesacher, MD: Alright, so I think you've hit on all the important, and probably the most important thing is this is a team sport. And so you guys, I know you have a great team out at Taylorsville.

Doug Newbold, MD: We do.

Mark Briesacher, MD: I know that you're thinking about how that team has to evolve to prepare for this new strategy of being an Accountable Care Organization, and I think the other important thing is we have to look at all aspects of our care model, including the compensation model. So, finding that right fit for this new way of taking care of people, and taking risk up front, providing the safest and highest quality care, with great experience, great access.

That then becomes a winning combination for everybody, and you know, I like to laugh and I like to meet people and make friends, but boy do I like to win. And so I think the way you talk about that in terms of when we win, it's our patients winning. That's exactly right. They're healthier, they're happier, and so it's an exciting time. Hey, thanks for coming in. I can tell you the ...

Doug Newbold, MD: Thank you.

Mark Briesacher, MD: One of the things I miss about practice is I don't get to see your kids and your wife any more, like I used to. So, tell them "hi" for me when you see them.

Doug Newbold, MD: Will do. And, you know it's ... The beautiful thing about working with Intermountain is there are so many amazing clinicians ...

Mark Briesacher, MD: I agree.

Doug Newbold, MD: Colleagues in all specialties. I trust the very lives of my family and myself to any one of them. I really, genuinely mean that. And, I'm grateful for the many specialists that have taken care of my family and also for even in the primary care arena too. I'm really grateful for the way Intermountain is going in that direction. And, I believe that if we can create a system where our very own families and lives, including our own, we're willing to trust with this style of practice, everybody wins.

Mark Briesacher, MD: Yeah.

Doug Newbold, MD: You know, and then we know we've got a winning model, so ... I hope to have that be in the near future.

Mark Briesacher, MD: Great. Thanks, Doug.

Doug Newbold, MD: Thanks to you. Automated: Subscribe and give us a review on iTunes.