2009 Caring Community Conference

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					2009 Caring Community Conference
Strategies for the Future: Capitalizing
on Our Assets, Opportunities and Change
September 16, 2009
                               The Center for Global Health and Medical Diplomacy appreciates
                                    the contributions and support of generous sponsors.
FOUNDING SPONSORS                          SPONSORS                       FOUNDATIONS                             INSTITUTIONS                       CORPORATIONS

Alice and T. O’Neal Douglas         Alice and T. O’Neal Douglas   Blue Cross and Blue Shield of Florida    The University of North Florida           Jacksonville Regional
                                                                                                                                                    Chamber of Commerce
  Isabelle and Robert Davis          Isabelle and Robert Davis      The Cascone Family Foundation         The Brooks College of Health, UNF
                                                                                                                                              Pfizer Medical Humanities Initiative
 University of North Florida         Blanche and Luther Coggin      The Delores Kesler Foundation                  Baptist Health
                                                                                                                                                      PSS World Medical
UNF Brooks College of Health             James H. Winston           The DuBow Family Foundation                 Brooks Health System
                                                                                                                                               WJCT Public Broadcasting Station
       Baptist Health                                                   The Schultz Foundation              Duval County Medical Society
                                                                                                                     Mayo Clinic
                                                                                                               St. Vincent’s HealthCare
                                                                                                                    UF & Shands


Caring Community Conference
     September 16, 2009

2009 Caring Community Conference
                      Mark E. Workman, Ph.D                                                     Yank Coble, MD
                                                                                                Program Chair, Director
                      Provost and VP for
                                                                                                and Distinguished Professor,
                                                                                                                                                       “If we did not
                      Academic Affairs,
                      University of North Florida                                               Center for Global Health                                already have
                                                                                                and Medical Diplomacy
                                                                                                                                                        a Center for
                                                                                                                                                       Global Health
Dr. Workman welcomed participants to the 3rd Caring Community             Dr. Coble thanked the distinguished guests for participating in the
Conference, expressing pride in the UNF Center for Global Health and      3rd annual Caring Community Conference, acknowledging that we                 and Medical
                                                                                                                                                       Diplomacy, we
Medical Diplomacy (the Center), whose leadership activities contribute    gather to discuss health because it is our most important asset, locally,
to fulfilling UNF’s mission of serving the North Florida region at a      nationally and globally. Dr. Coble reminded participants of the first
level of national quality. Dr. Workman explained the function of
a “center” as a nucleus exerting centripetal force on surrounding
                                                                          Caring Community Conference which was held at Amelia Island, Sept.
                                                                          26-28, 2007. That conference resulted in 12 Final Recommendations to
                                                                                                                                                       would need to
entities, organizing them in a meaningful relationship to their common    enhance the individual and economic health of northeast Florida, and an
                                                                          additional recommendation to form a regional Healthcare and Bioscience
                                                                                                                                                       create one as
center and to one another. The Center fills that role by providing a
nexus for critical conversations between the many healthcare agencies,    Council. That Council was formed in April 2008, and has worked to            expeditiously
institutions and organizations of northeast Florida.                      investigate and address regional issues in education, research and patient
                                                                          care. The Final Recommendations were consolidated from 12 to four (see        as possible.”
Two timely issues reinforce the need for the Center and for this          chart on page 12) as Council members found that in some areas, very
Conference: the emergence and spread of the H1N1 pandemic,                impressive efforts were already in place.
and the national debate over the provision of health insurance. The
pandemic reminds us that in the 21st century, all health is global        The Center and the Council work to raise awareness and appreciation           — M. WORKMAN
health, just as all economics are global economics. Economic concerns     for our regional assets and the economic value of investing in biomedical
are responsible for much of the debate over health insurance reform,      research, health and medical care. Dr. Coble invited conference
along with deeply contested views on social welfare, the distribution     participants to take full advantage of the opportunity presented by
of wealth, ethical responsibility and medical efficiencies. Dr. Workman   today’s conference, to address Council members about their work and
remarked that: “these noble and urgent concerns with life and the         future plans.
quality of life” are what enables the Center to exert such compelling
                                                                          Dr. Coble reminded participants that the power of collaboration had
gravitational pull on people who care about the well being of others,
                                                                          been acknowledged as our greatest regional asset during the first Caring
as evidenced by the distinguished and accomplished assembly of
                                                                          Community Conference. Only through collaboration can we achieve our
conference participants. Dr. Workman introduced Center Director, Dr.
                                                                          missions to improve health and medical care and enhance the individual
Yank Coble, describing him as “a wonderful embodiment of the values
                                                                          and economic health of our region.
which define our Center.”

                                                                                                                                                       Caring Community Conference
                                                                                                                                                            September 16, 2009
     Thomas Gorrie, Ph.D

                              Our HIddEN VaLuE
                              Medical Education and Research
                                             Increasing Medical Residencies
                                             The Honorable Susan Black
                                             Federal Judge, US Court of Appeals for the Eleventh Circuit;
                                             Member, Healthcare and Bioscience Council of Northeast Florida

                                             Judge Black welcomed conference attendees on behalf of the Healthcare and Bioscience Council of Northeast Florida and set the
                                             stage for the discussion of Academic Health Science Centers and graduate medical education. Judge Black reminded the audience
                                             that the majority of medical residents will choose to remain where they train, practicing medicine in the community where they
                                             fulfilled their residency program. Therefore, high quality medical residency programs are the key to building a vibrant medical
                                             community, able to meet the healthcare needs of the population.
                                             Judge Black and Mr. Lawrence DuBow, Council member, interviewed all organizational leaders responsible for residency training
                                             in the community. There are over 500 residents in training and organizations are committed to the growth of residency training
                                             programs. A report on how Jacksonville can expand medical residencies is under development.

                                             Understanding the Power of Health Science Centers
                                             David S. Guzick, MD
                                             SR. VP for Health Affairs, University of Florida; and President, UF&Shands Health System

                                             Dr. Guzick explained that the mission of a Health Science Center is to bring education and research together with clinical enterprise.
                                             The mission of patient care is inextricably connected with the missions of education and research. These three missions form the
                                             basis of the Health Science Center and when each prospers there is a synergy and a powerful outward expanding spiral. This
                                             intellectual, evidence-based environment, where patients are seen with an eye toward understanding underlying pathophysiology
                               “There is a   attracts the best faculty and students. Jacksonville is fortunate to have two complementary Health Science Centers – UF College of
                              synergy and    Medicine/Shands and Mayo Clinic, with relatively no overlapping patient care and research programs. Dr. Guzick stressed that in
                               a powerful    addition to their primary missions, Health Science Centers have and additional responsibility for the health of the community, often
                                outward      providing a safety net of care for the underserved.
                               expanding     The success of the three missions is interwoven. The patient care mission is the essential economic engine to support the expense
                               spiral …”     of research. While research is always a net expense to the organization deriving its support from the medical practice, extramural
                                             grants and philanthropy, it contributes strongly to the organization’s reputation and in time generates intellectual property and
            2                                royalty streams. The core mission of the Health Science Center is education which provides an intellectual vitality to all components
                                             of the enterprise. It also represents the base for the practicing provider community, as 60-65% of residents remain in the community
Caring Community Conference                  of their training. It follows then that the higher the quality of the Health Science Center, the higher the quality of medical care in the
     September 16, 2009                      community. In conclusion, Dr. Guzick was optimistic about Jacksonville’s potential to create a powerful bioscience corridor.
                      The Role of the                                                                       Healthcare Reform
                      Regional Campus                                                                       Implications for
                      Robert Nuss, MD                                                                       Medical Education
                      Associate VP for University                                                           William C. Rupp, MD                          “Dream no small
                      of Florida Health Affairs; and
                      Dean, Health Science Center
                                                                                                            CEO, Mayo Clinic Florida                      dreams for they
                      Regional Campus, Jacksonville                                                                                                       have no power
Dr. Nuss described the evolution of medical school regional campuses across          Dr. Rupp highlighted potential changes and challenges to               to move the
the nation compared with the growth of the University of Florida College of
Medicine – Jacksonville. A regional campus, by definition, is geographically
                                                                                     medical education that will stem from the current national
                                                                                     healthcare reform movement. The first challenge is to ensure         hearts of men.”
separate, does not serve as the medical school’s primary clinical site for medical   that there will be sufficient physicians to care for the Florida
student education, and is administratively responsible to the dean of the medical    population. The majority of medical residents tend to remain
school. Dr. Nuss reviewed the growth of medical schools nationally including         where they train, practicing medicine in the community where        — JOHANN WOLFgANg
the addition of four in Florida within the past decade. The current 40 regional      they fulfilled their residency program. Yet, the state of Florida       VON gOeTHe
medical campuses in the country are anticipated to grow to over 100. There is        has about 50% fewer residents per capita than the nation
also a trend to evolve to four-year regional campuses with seven in operation or     overall. Both Mayo Clinic and UF College of Medicine –
planned to open by 2010.                                                             Jacksonville have the capacity to train more residents but are
                                                                                     limited by funding.
The American Association of Medical Colleges (AAMC) has stated that regional
medical campuses will play a larger role in the expansion of undergraduate           Current funding for medical education is at risk. In past years
medical education than existing or new medical schools. Some regional campuses       Medicare has subsidized medical education, but cannot afford
are geographically far removed from the primary campus. An example is the            to continue this subsidy. Medical reimbursement is forecast to
University of South Florida’s regional campus located in Allentown, Pennsylvania.    decrease to accommodate the exploding number of Medicare
                                                                                     beneficiaries as baby boomers reach age 65 in 2011.
Dr. Nuss discussed the three Academic Health Center missions (education,
research, patient care) as they relate to the University of Florida College of       This leads to the second challenge, which is educating
Medicine – Jacksonville. Approximately 300 residents train at the regional           sufficient primary care physicians to care for the expanding,
campus in Jacksonville. That number has remained relatively flat for the past ten    aging population. Burdened by significant debt, physicians
years due primarily to funding constraints, even though there is the capacity to     feel pressured to select residencies leading to higher paying
accommodate an additional 30-50 residents. A goal of the Jacksonville regional       specialty practice rather than lower paying primary care. Dr.
campus is to offer 3rd and 4th year training for to up to 48 medical students.       Rupp encouraged participants to watch these issues closely as
Regional campuses are generally viewed as primarily clinical in focus. However,      the healthcare reform debate unfolds.
the UF College of Medicine – Jacksonville, in the last fiscal year received
$12.5 million in extramural funding for research, well more than most regional
campuses. Finally, Dr. Nuss reviewed the robust and growing medical, surgical
and trauma practices at UF and Shands in Jacksonville, which provide a rich                                                                                            3
clinical experience for medical residents and students.
                                                                                                                                                           Caring Community Conference
                                                                                                                                                                September 16, 2009
     Pamela Chally, Ph.D, RN

                               BuILdING a rEGION Of MEdICaL ExCELLENCE IN HEaLTH aNd PaTIENT CarE
                               Quality, Safety, Communication and
                               Health Information Technology
                                        Health Information Technology and Quality
                                        Robert G. Harmon, MD, MPH
                                        Director, Duval County Health Department
                                        Health Information Technology (HIT) is a major component of healthcare reform and the American Recovery and Reinvestment
                                        Act (ARRA). More than $20 billion has already been appropriated for special projects and incentives to promote electronic health
                                        records (EHRs) and health information exchange (HIE). The majority of the ARRA stimulus funding will be available to physicians
                                        and hospitals as Medicare and Medicaid incentive payments if “meaningful use” such as capturing coded data and exchanging
                                        data among providers can be demonstrated. Northeast Florida is well ahead of most communities in the implementation of
                                        HIT, with the majority of the larger systems taking the lead. Dr. Harmon described the wide deployment of EHR systems in the
                                        community, noting that many use the same vendor. However, there is limited exchange of data among institutions and only 10%
                                        of physicians use electronic prescribing. Although the JaxCare initiative to provide insurance to the uninsured is now inactive, its
                                        Jacksonville Health Information Network (JHIN) is one of the few examples in the country of an operating HIE.

                                        Quality and Safety Initiatives at the Naval Hospital Jacksonville
                                        Bruce L. Gillingham, MD, CAPT, MC, USN
                                        Commanding Officer, Naval Hospital Jacksonville
                                        Dr. Gillingham explained the Navy Hospital’s five-part Patient Safety Initiative designed to assure that quality performance
                                        is on par with military readiness and financial performance. The initiative includes: participation in the National Surgical
                                        Quality Improvement Program, the Institute for Healthcare Improvement’s “Passport Program” and “Patient Safety Leadership
                                        WalkRounds,” instituting a Patient Advisory Council, and deploying Electronic Medical Record (EMR) and Computerized Physician
                                        Order Entry (CPOE). The goal is to become a High Reliability Organization (HRO). Attributes of an HRO include a “trust but verify”
                                        mentality; and the practice of attending and responding to weak signals of flawed processes (preventing them from increasing
                                        to a point which might result in patient harm). Problems in teamwork and communication are at the heart of most failures in
                                        medicine, therefore the Navy is committed to TeamSTEPPS training to build a shared culture of teamwork and communication.
                                        Dr. Gillingham invited participants to attend the Naval Hospital’s upcoming conference, “Leading From the Front, Tools to
                                        Enhance Patient Safety,” featuring keynote presentations by VADM Adam Robinson, Jr., MD, Surgeon General, US Navy, and John
            4                           Nance, the author of Why Hospitals Should Fly!

Caring Community Conference
     September 16, 2009
Teamwork and Simulation Training
Constance Haan, MD, MS
Associate Dean, University of Florida Office of Educational Affairs; and
Associate Professor, Surgery, University of Florida-Jacksonville
The Center for Simulation Education and Safety Research (CSESaR) at the University of Florida College of Medicine–Jacksonville and Shands Jacksonville Medical Center
campus creates high value by improving patient care, quality and safety, as well as enhancing the education of physicians and nurses in training. Simulation training
is now required for the credentialing of medical personnel in the use of moderate sedation; and has shown a decrease in adverse events when moderate sedation
is used following simulation training. Similarly, a reduction in the ratio of observed and expected mortality in hospitalized patients was shown after proactive team-
training of the Rapid Response Team was initiated. Simulation is also increasingly used in improving effective communication. CSESaR provides a safe environment
to practice difficult communication skills, such as when a problem is suspected, delivering bad news, getting informed consent, and patient education, especially for
communication-challenged patients. In summary Dr. Haan states now, “We work as we train.”

How Do We Make EMR Really Work?
Paul Pitel, MD
Chair, Dept. of Pediatrics, Nemours Children’s Clinic, Jacksonville; and
Associate Chief Executive of the Practice for Nemours Florida
The Nemours Children’s Clinic has implemented and fully deployed an integrated electronic medical record (EMR) system such that today, everything is digital – all
medical records, test results, x-ray images and prescription forms. Creating an environment where the electronic medical record is “business as usual” is a necessary
but not sufficient step to achieving the potential offered by this technology. Dr. Pitel described the initiatives where Nemours is using the technology of the EMR to
assure quality, improve safety, communicate with the outside medical community and with families by means of “Read Only” features. The imbedded Decision Support
System provides best practice notifiers, drug-drug interaction advice and antibiotic cost data. The Electronic Care-Practice module provides reminders of needed care,
patient notification and safeguards against a patient “falling between the cracks.” The “MyNemours” website allows patients and families to view medical records,
communicate with their physicians and request appointments and prescription refills.

Relationship-Centered Communication
William J. Maples, MD                                                                                                    PEARLS
                                                                                      P — Partnership: “Let’s tackle this together.”
Consultant, Medical Oncology, Mayo Clinic Florida
                                                                                      E — Empathy: “This must be difficult for you.”
Mayo Clinic Florida introduced a curriculum of communication skill development       A — Acknowledgement/Apology: “I am sorry that this process is taking so long.”
for physicians which proved so effective that subsequently all 5000 employees
participated in the training. Dr. Maples quoted Dr. Gene Page, one of the course’s   R — Respect: “I appreciate your decision.”
initial internal faculty members, who said that “being correct is important, but     L — Legitimization: “Anyone would be concerned by this situation.”
even more important is being able to connect.” To illustrate relationship-centered   S — Support: “I’ll be there if you need me.”
communication, Dr. Maples showed a brief video vignette of poor communication
between a physician and a patient. He then reviewed PEARLS, the steps in
establishing relationship-centered communication, and concluded with a follow-up video                                                                  5
vignette demonstrating effective, caring communication.
                                                                                                                                           Caring Community Conference
                                                                                                                                                September 16, 2009
     Jerry Mallot,

                              HEaLTHCarE aNd BIOSCIENCE INduSTrIES
                              Economic Impact

                                      Economic Impact of Healthcare and Bioscience in Jacksonville
                                      Henry Luke
                                      President, Luke Planning, Inc., Consultant for Strategic Planning and Economic Development

                                      Mr. Luke described the booming impact of healthcare and bioscience industry on Jacksonville’s economy, referencing per
                                      capita income for Jacksonville, Tampa and Orlando. In 2007 the personal per capita income in Jacksonville as a percent of U.S.
                                      personal per capita income was 101%, while in Tampa it was 94% and in Orlando 89%. If Jacksonville’s per capita income
                                      were at Orlando’s level, it would represent $6.4 billion less income in the Jacksonville economy. Jacksonville’s higher per capita
                                      income reflects the economic impact of healthcare and bioscience industry in our community.
                                      For the past 30 years, Orlando has focused on tourism, an industry with significantly lower wages than healthcare. In an
                                      attempt to boost economic development in the region, Orlando has invested $1.5 billion to create the Lake Nona Medical
                                      Center which will include: a Nemours Children’s Hospital, the University of Central Florida Medical School, a branch of the
                                      Burnham Institute for Medical Research and a Veteran’s Affairs Hospital.
                                      While Orlando’s investment in a “medical city” is impressive, Mr. Luke reminded participants that Jacksonville has invested
                                      much more in healthcare and bioscience. Over the past 40 years Jacksonville has nurtured existing facilities and added
                                      Vistakon, Medtronic, UF Shands, Nemours, Mayo Clinic and Blue Cross/Blue Shield. This investment in healthcare and
                                      bioscience has created a critical mass; producing a direct annual economic impact of $23.6 billion and employing one out of
                                      every six employees. There is also significant investment in medical research, approaching $100 million annually.
                                      The question and challenge remains: will we take advantage
                                      of this investment and continue to grow the healthcare and                 Jacksonville Milestones by Decade
                                      bioscience industries in our region? In the current recession,
                                      the Jacksonville area has lost 50,000 jobs, which will not be           1960s     Consolidated government enacted
                                      recovered for the next three to four years. Focusing on continued       1970s     University of North Florida founded
                                      healthcare and bioscience growth over the next decade is the best       1980s     Mayo Clinic in FL established
                                      opportunity for speeding up the recovery.                               1990s     NFL Team awarded
                                                                                                              2000s     Healthcare and Bioscience Industry Growth


Caring Community Conference
     September 16, 2009
                     Medtronic:                                                        Assessing the                                                    Patents and
                     Overview and                                                      Biotechnology                                                    Licensing of
                     Growth in                                                         Assets of the                                                    the University
                     Jacksonville                                                      Region                                                           of Florida
                     Mark Fletcher                                                     Arthur C. Wotiz                                                  David Day
                     President, ENT Division,                                          Chief Executive Officer                                          Director, University
                     Medtronic Xomed                                                   and President, NovaBone                                          of Florida, Office of
                                                                                       Products, LLC                                                    Technology Licensing
Medtronic is the largest medical technology company in          NovaBone is a small, rapidly growing producer of synthetic        Mr. Day expressed concern over the “Florida brain drain,”
the world with over $16 billion in annual sales and 40,000      bone graft products, whose growth provides a hint of the          explaining that technology invented in Florida is increasingly
employees working in 120 countries. It was founded in           potential for biotech growth which could span the corridor        leaving the state to be developed by companies in other
Minneapolis, Minnesota by Mr. Earl Bakken, inventor of          between Alachua County and Jacksonville. NovaBone was             parts of the country. High paying scientific jobs are leaving
the first artificial pacemaker. Mr. Fletcher highlighted the    started from technology licensed from the University of Florida   the state as well. The University of Florida’s research budget
mission of Medtronic which includes creation of “devices        and is now growing from world-wide sales at 50-100 percent        is $562 million and is a significant economic development
that alleviate pain, restore health and extend life.” The       annually, with offices in Jacksonville, Alachua and Shanghai.     engine. While Gainesville certainly has been successful, there
company produces therapies for cardiology, urology, digestive   Mr. Wotiz believes the biotechnology and medical device           is the opportunity to double or triple technology start-up
diseases, ENT, neurology and diabetes. The ENT Division         assets in Alachua County and Jacksonville are synergistic and     companies in our region. We have a tremendous opportunity
based in Jacksonville was founded in 1970 as Xomed Surgical     complementary. Additionally, the basic research underway          to expand the presence of biotech industry but we must invest
Products. Today, as part of Medtronic, Xomed has revenues of    at UF, Mayo and Nemours fits nicely with the robust clinical      in ourselves before others will invest in us. What is needed
$1 billion, and 750 employees, 120 of whom are in research      environment in Jacksonville. An active collaboration effort       to grow start-up biotech companies is seed capital and
and development.                                                between research organizations, economic development              “bankable management” that will give financial supporters
                                                                organizations and governments could lead to an economic           the confidence to invest. North Florida possesses much of
Mr. Fletcher explained that community support and favorable     development zone stretching between Gainesville and               this management talent. We are no longer competing with
tax treatment would be essential factors in attracting          Jacksonville that someday could rival North Carolina’s            Georgia and North Carolina. Biotechnology is a global market
other biotechnology companies to relocate to Jacksonville.      Research Triangle Park.                                           and we must compete aggressively.
Additional growth of healthcare and medical research industry
would significantly enhance the attractiveness of our city.


                                                                                                                                                                   Caring Community Conference
                                                                                                                                                                        September 16, 2009
     Michael Boylan,
     Moderator                rHETOrIC Or rEaLITy?

       PaNEL                  Healthcare Reform
                                                     Overview of                                                                 Healthcare Reform
                                                     Issues Relating to                                                          – Current Activity
                                                     Healthcare Reform                                                           Ms. Randy Kammer
                                                     A. Hugh Greene, FACHE                                                       Vice President of Regulatory
                                                     President and Chief Executive Officer,                                      Affairs and Public Policy,
                                                     Baptist Health of Northeast Florida                                         BlueCross BlueShield of Florida

                              Mr. Greene described the issues relating to healthcare reform in three        Ms. Kammer explained that the healthcare debate has transitioned
                              broad categories: Coverage Reform, Finance Reform, and Delivery System        from Healthcare Reform to Health Insurance Reform. Insurance related
                              Reform. Coverage Reform relates to extending healthcare insurance             recommendations include: guaranteed issue and renewal, no pre-existing
                              to those currently uninsured. Proposed initiatives to expand coverage         condition requirements, a compression of insurance premiums as they
                              include the employer mandate, the individual mandate, “pay or play,”          relate to age or family composition, and no annual or lifetime limits.
                              guaranteed issuance, and creation of a national insurance exchange            There has been significant misinformation, passionate debate, and a
                              with the controversial concept of creating a “public option” insurance        continued assertion that a government plan is necessary to counteract
                              plan. The concern with Finance Reform is two-fold: how to pay for             perceived insurance abuses.
                              the expanded coverage, and how to address the long-term cost issue of
                              spiraling healthcare expenditures.                                            BlueCross BlueShield’s vision for healthcare reform includes: assurance
                                                                                                            that 95% of Americans have access to appropriate health services;
                              Delivery System Reform is the least discussed of the three areas              enforceable mandates for individuals and employers; reform of the
                              as it has less direct effect on the public. The concept is to change how      malpractice system; change of the delivery system from an “illness”
                              providers are paid to ultimately reduce overall costs. Rather than a          model to a “wellness” model; better management of chronic illness; and
                              system which rewards providing more services, reform proposals attempt        increased personal responsibility for a healthier lifestyle. Ms. Kammer
                              to bundle payments and provide incentives for higher quality and more         reviewed the cost estimates of reform for the various plans, as provided
                              cost effective care. In conclusion, Mr. Greene believes that the status quo   by the Congressional Budget Office, as well as proposed annual fees
                              is not sustainable and that first steps toward incremental reform of the      on various healthcare industry sectors to offset the cost of expanded
                              system will be passed.                                                        coverage.


Caring Community Conference
     September 16, 2009
                      The American Medical                                                              Aims and Elements
                      Association’s Vision for                                                          of Reform
                      Health System Reform                                                              Otmar Kloiber, MD
                      Cecil B. Wilson, MD                                                               Secretary General,
                      President-elect,                                                                  World Medical Association
                      American Medical Association

Dr. Wilson provided an overview of the American Medical Association’s views       Dr. Otmar Kloiber provided a global and external perspective
regarding the status of the current healthcare system and the need for reform.    on the challenges of health system reform being faced in the
While the current healthcare debate is often framed in economic terms, Dr.        United States. He began by stating that medicine in this country
Wilson said what is truly at stake in this debate is the health of the American   is perceived around the world as the most advanced and of the
people many of whom due to no or inadequate healthcare access put off or          highest quality. However, as with most healthcare systems there
postpone getting healthcare, filling prescriptions or reducing and skipping       are problems with our “multifaceted” or fragmented system
doses. In a recent letter to President Obama, the AMA highlighted a number        which includes private care, employer based care, special plans
of recommendations:                                                               and government insurance: it is the most expensive system
                                                                                  per capita, in the world; universal access is not provided to all
 • Coverage for all Americans                                                     people; and the abuse by the tort system, in his view, is just
 • Expand choice and eliminate denials for pre-existing conditions                “incomprehensible.” However, many other countries provide
                                                                                  universal coverage but not access as they are unable to deliver
 • Ensure healthcare decisions are made by patients and their physicians          healthcare effectively for all people. Among the issues facing the
 • Provide investments and incentives for improved quality and enhanced           United States in the healthcare debate are: fear of the single payer
   prevention and wellness                                                        model, a government insurance option, comparative effectiveness
 • Repeal the Medicare physician payment formula                                  research and end-of-life questions.

 • Implement medical liability reforms                                            Dr. Kloiber outlined some elements of a successful healthcare
                                                                                  system: dedicated funds (not under direct control of government);
 • Streamline and standardize insurance claims processing requirements
                                                                                  balanced powers between caregivers and payers (the cooperative
   to eliminate unnecessary costs and administrative burdens
                                                                                  model); clear and equal rules for all insurers, e.g., no exclusion
                                                                                  for pre-existing conditions (no discrimination); a defined “basket”
Areas of reform currently being discussed and advocated by the AMA                of care not under the sole control of the insurers and no adverse
include: increase support for wellness and prevention; invest to assure there     selection (risk adjustment).
are sufficient physicians in the workforce; strengthen private insurance
through insurance market reforms and remove burdensome regulations and
administrative nightmares. Dr. Wilson commented that nothing is final or
assured but that the status quo is hurting our nation. We have an opportunity                                                                            Caring Community Conference
and responsibility to make change, an opportunity that may not come again.                                                                                    September 16, 2009
                              PrIOrITIES fOr NOrTHEaST fLOrIda

                              Healthcare Disparities in the Age of Obama
                              Edward Waters College, Jacksonville, September 16-17, 2009

                                     he enthusiastic leadership of Dr. Floyd Willis produced a community conference of local leaders gathering to discuss and devise solutions to
                                     the health disparities found in Jacksonville, particularly in the African-American community. The major focus of the conference was to identify
                                     the top 4 to 8 priority disparity issues and devise an action plan to address the issues. The conference was sponsored by Mayo Clinic, the
                              UNF Center for Global Health and Medical Diplomacy, the Northeast Florida Medical Society, The Community Research Advisory Board, and Edward
                              Waters College.
                              The goals of the conference were:
                              • Identify the health needs and priorities in the African-American
                              • Inform leaders about on-going activities to address health disparities
                              • Recommend solutions to address health disparities
                              • Foster collaboration among community agencies and organizations

                              Panel 1: Contributing Factors to Disparities in Jacksonville included
                              brief presentations from: Dr. Trachella Johnson-Foy, a Family Physician
                              who has returned to her north-Jacksonville roots to practice primary
                              care medicine; Dr. Robert Harmon, Director of the Duval County Health
                              Department; Reverend Alton Coles and Reverend Charles Skinner.

                              Panel 2: Strategies and Practices for Innovative Solutions to Reduce/Eliminate Disparities included presentations from Dr. Helen
                              Jackson of the Duval County Health Department; Reverend Tom Rodgers, Healthy Start Coalition; Dr. Jim Burt, Medical Director, Volunteers in
                              Medicine; Ms. Jocelyn Turner, Community Relations Director, Duval County Health Department; and Rhonda Boyd, community member.

                              Keynote speaker: Karen L. Landry, President/Executive Director of the War on Poverty – Florida. Ms. Landry shared her extensive
                              experience in assisting communities build a strategic vision and to comprehensively revitalize their communities.

                              Breakout Groups: Participants divided into breakout groups to discuss health disparities issues and recommend solutions from three discrete
                              perspectives: the individual, the environment/community, and the system. Individual recommendations focused on efforts to increase knowledge,
                              promote attitudes conducive to good health, build skills, and address biologic or genetic risks. Environmental recommendations related to promoting
                              a healthy physical environment, addressing economic barriers and the social environment. Systems recommendations focused on fostering leadership
                              and collaboration, promoting a user-centered design to meet minority needs and improving science and knowledge about racial disparities.

           10                 Final Ranking and Next Steps: Participants reconvened to rank all recommendations using electronic audience response devices.
                              A workgroup has been formed to edit, refine and consolidate, if necessary, the top recommendations.

Caring Community Conference
     September 16, 2009

T                                                                                                                                                            “Patients do not care
        he Center for Global Health and Medical Diplomacy (the Center)          Physicians of the World Initiative (WMA/CPW), which works to
        at the University of North Florida was founded in February              improve the effectiveness of medical professionals around the world.
        2007 with the mission of promoting global understanding                 The Center collaborates with the WMA, the international business             how much you know,
and collaborative action to improve health and medical care. Center
objectives include promoting optimal health and medical education,
                                                                                school INSEAD, and Pfizer, Inc. to lead a Physician’s Leadership Course
                                                                                designed to enhance the skills and knowledge needed to advocate for
                                                                                                                                                               until they know
supporting leadership development in the health and medical                     healthcare reform and improved patient care. The six-day intensive           how much you care.”
professions, and integrating local, state, national and global participation    curriculum focuses on proficiency in decision-making, participation
in advisory committees, forums, research and education.                         in public debate and preparation to serve as spokespersons on key
                                                                                healthcare policy issues. Two Leadership Courses have been held thus
The Center planned and convened the 2007, 2008 and 2009 Caring                  far, in 2007 and 2008 at INSEAD, Fontainebleau, France; and a third           — SIR WILLIAM OSLeR,
Community Conferences, where northeast Florida community leaders                course is planned for Feb. 2010 at the Singapore campus of INSEAD.                 FATHeR OF
met to collaborate on long range plans to enhance the healthcare                                                                                              AMeRICAN MeDICINe
and biomedical economy of Jacksonville and northeast Florida. At                Well established as the neutral convener of health and medical care
each conference, healthcare and bioscience stakeholders discussed               institutions and organizations in north Florida, the Center continues to
issues, assets and opportunities relating to the individual health, public      facilitate collaborative efforts to improve the individual and economic
health and economic health of northeast Florida. Following the 2007             health of the region. In 2009 the Center served as a sponsor of the first
Conference, the Center facilitated the formation of the Healthcare and          Worksite Wellness Conference hosted by the Mayor’s Council on Fitness
Bioscience Council of Northeast Florida, whose members were                     and Wellbeing, and hosted the first annual Quality and Safety Forum
announced in April 2008. The Council’s mission is to address the Caring         in April 2009. The Center has been instrumental in the formation of
Community Conference Final Recommendations. The Center Director                 the Regional Quality Collaborative of Northeast Florida, which
currently serves as Council Chair.                                              supports the community’s desire to improve health and healthcare by
                                                                                sharing best practices for quality improvement. Many hours have been
The Center serves as a focal point for global health activities within the      spent working with the Quality Collaborative, developing a “Caring
University and broader community. Educational events, public forums,            Communication Course” to enhance communication skills for medical
seminars and conferences help to increase the visibility and awareness of       professionals in the region. Communication of caring, from physician to
local, national and global health issues. The Center is also the first global   patient, is paramount to building the trusting relationship that initiates
health organization to include a focus on Medical Diplomacy, in which           the healing process.
medical and healthcare assets are utilized globally through government,
private, and volunteer efforts to encourage positive relations between
communities and nations.
The Center holds a position of leadership in many global health                                                                                                            11
organizations, including the World Medical Association Caring
                                                                                                                                                                Caring Community Conference
                                                                                                                                                                     September 16, 2009
                              Consolidated Recommendations
                              for the Healthcare and Bioscience
                              Council of Northeast Florida

                              The Caring Community Conference of September 26 – 28, 2007, sponsored by the Center for Global Health and Medical Diplomacy at the
                              University of North Florida (the Center), resulted in 12 Final Recommendations to enhance the individual and economic health of northeast
                              Florida. Participants unanimously recommended that a Healthcare and Bioscience Council be formed to implement the 12 Recommendations.
                              The Healthcare and Bioscience Council of Northeast Florida (the Council) was announced on April 29, 2008.
                              The Center, an academic body with the mission to improve health and medical care, provides leadership and staffing for the Council. The Council is
                              comprised of diverse volunteer leaders from Northeast Florida committed to implementing the 12 Final Recommendations.
                              Council Workgroups have gathered information, researched best ways to address the Recommendations, initiated collaborations and implemented
                              programs. Some Recommendations are already being effectively addressed in the community. Others have been consolidated into four primary
                              areas of work summarized below.

                                                                     • Enhance Medical Education and Research in Jacksonville
                                                                     • Foster the Healthcare and Bioscience Industry
                                                                     • Improve Health and Patient Care (Quality and Safety, Access,
                                                                       Disparities and Wellness)
                                                                     • Advance Health Information Technology

           12                                                     Seeking Solutions through Science, Ethics and Caring
Caring Community Conference                      Enhancing Our Region of Excellence in Medical Care, Education and Research
     September 16, 2009
                                                                                                                                 Susan H. Black

                                                                                                                                Carl N. Cannon

                                                                                                                          Mike Cascone, Jr., Vice-chair

                                                                                                                              Yank D. Coble, Chair

                                                                                                                               Luther W. Coggin

                                                                                                                             Marshall M. Criser, Jr.

                                                                                                                               T. O’Neal Douglas
        he 2007 Caring Community Conference, hosted by the UNF Center for Global Health and Medical
        Diplomacy (the Center), convened over 100 northeast Florida community leaders from medicine,                          Lawrence J. DuBow
        healthcare, education, business, government and research. The purpose of the conference was to                          A. Hugh greene
discuss northeast Florida’s health issues, identify healthcare, medical and bioscience assets, and make specific
                                                                                                                               Robert g. Harmon
recommendations to enhance the individual and economic health of northeast Florida.
                                                                                                                                Preston Haskell
Twelve Final Recommendations resulted from the presentations, discussions, and workgroup sessions held over
                                                                                                                               Adam W. Herbert
the three days of the conference. At the conclusion, participants agreed that the next essential step would be
to form a Healthcare and Bioscience Council of Northeast Florida (the Council) to further study and                          W.A. “Mac” Mcgriff III
begin implementation of the recommendations. Founding members of the Council were announced in April                     Carol C. Thompson, Vice-chair
2008. Council members were chosen for their diverse expertise, broad community involvement and exceptional
leadership.                                                                                                                      Floyd B. Willis

                                                                                                                               James H. Winston
The Council’s mission is to put into action the Final Recommendations of the 2007 Caring Community
Conference. The Council’s goals are complimentary to those of the Center, as the Center seeks to improve health                 Arthur C. Wotiz
and medical care globally, while the Council works regionally in northeast Florida. Both the Center and the
Council are committed to the belief that collaborative community action can enable northeast Florida to better
utilize assets and address community health issues and inadequacies. Addressing these assets and issues will                Ex-Officio Members
enhance the individual and economic health of the community through improved medical care and bioscience
growth, thus empowering the region to compete nationally and globally as a center of excellence in bioscience           President John A. Delaney, UNF
and medical care.                                                                                                       Jacksonville Mayor John Peyton

The Council is an asset locally and nationally, serving as an impetus for change in this community as well as a         President J. Bernard Machen, UF
model for other cities striving to improve the individual and economic health of their citizens. This is a critical    President Kerry D. Romesburg, JU
time for healthcare in America and there is much the Council can do to assist in building a stronger northeast
Florida community, meeting the challenges of Improving Health and Patient Care, Advancing Health Information           The Honorable Frederick H. Schultz
Technology, Fostering Regional Growth of Bioscience and Healthcare Industries, and Enhancing Medical                    President Steven R. Wallace, FSCJ
Education and Research in Jacksonville.
                                                                                                                      President Claudette H. Williams, eWC
The 2009 Caring Community Conference presented an opportunity for Council members to address the
community, and for community members to become increasingly engaged in the process of enhancing healthcare
and bioscience in northeast Florida.

                                                                                                                           Caring Community Conference
                                                                                                                                September 16, 2009
Please visit our website for more on
the Caring Community Conferences

Save the Date: September 15, 2010
2010 Caring Community Conference

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