{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/mc8rb6z73t/manifest","type":"Manifest","label":{"en":["Dr. Thomas Weida"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2018-05-04 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Thomas J. Weida, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056","type":"Canvas","label":{"en":["Media File 1 of 2 - WeidaThomas_01_Access.mp3"]},"duration":2537.8335,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/056/original/WeidaThomas_01_Access.mp3?1760553665","type":"Audio","format":"audio/mpeg","duration":2537.8335,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056/transcript/85355","type":"AnnotationPage","label":{"en":["Dr. Thomas Weida Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056/transcript/85355/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape 1, side 1: Dr. Young: This is side 1 of tape 1 of the Oral History of Dr. Tom Weida, the leader of the payment Core Team of the Family Medicine for America’s Health. We’re recording this on May 4th, 2018. I’m Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nDr. Weida, do we have your permission to record this Oral History? Yes, you do.\n\nDr. Young: Would you please give us your name in full?\n\nDr. Weida: Thomas Weida.\n\nDr. Young: And your present title and position?\n\nDr. Weida: I’m a family physician and I’m a professor at the University of Alabama College of Community Health Science as well as being their Chief Medical Officer and Associate Dean for Clinical Affairs.\n\nDr. Young: Can you give us a sketch of your professional background?\n\nDr. Weida: I received my BA at Lehigh University in Bethlehem, Pennsylvania and that was actually a six year, BA, MD program designed to produce primary care physicians. And I guess in my case it actually did work. This was in conjunction with Hodiman (?) which has undergone a number of name changes but is now Drexel. I believe they change names most of the times to avoid creditors. And after graduating from Hodiman I then did my family medicine residency at Lancaster General Hospital under Nick Servano (?). After graduating from there I joined -- as a solo doc in a private practice in Lancaster County, in Rothsville, and we basically grew that practice over thirteen years from the two of us to four physicians and four nurse practitioners. During that period of time we won the SBFM Patient Education award for a number of things that we were doing which included newsletters and cable TV and Ask the Doc program and a Health Matters program. After about thirteen years I then was recruited by Hershey Medical Center, Penn State College of Medicine, to become their medical director at their faculty practice and was their medical director for about thirteen year and then became  medical director of the Family Medicine’s Department Information Technology section. Then about two and a half years ago I basically saw a job opportunity here at the University of Alabama College of Community Health Science as Chief Medical Officer and Associate Dean for Clinical Affairs and my wife and I moved on down here to practice in Alabama. That’s sort of the professional side of things. Do you want the organization side of things? \n\nDr. Young: Yeah, please share what involvements you’ve had with the Academy or other organizations.  \n\nDr. Weida: With the Academy I actually started as a student. Went to my first National Conference and enjoyed that experience so much so that when I went back to Hodiman I created a family medicine interest group and I was able to get the program director for the six year BA, MD program to pay for all the six year BA, MD students, to pay their dues. So I thought that was a great victory out of Hodiman. I then continued within the Academy of Family Physicians, rising up through a resident board position and vice-speaker to speaker and ultimately president. I was also involved in the Medical Society serving on their Inner-Specialty Committee and at one point also being on their board of directors. On the Academy, the American Academy of Family Physicians, I served on a number of different commissions and committees including the first Young Physicians Committee and also served on the original editorial board for Family Practice Management magazine. From there, eventually being a delegate at the Congress of Delegates, I actually became their vice speaker for two years and was the speaker for the Congress of Delegates for four years.  \n\nCurrently my involvement with the Academy is I serve as the AAFP alternate delegate to the AMA Relative Value Update Committee. And so I’m in the thick of things with regards to still with practice management and with payment. And, like I said, somehow I ended up on Family Medicine for America’s Health Payment Core Team. \n\nDr. Young: And how actually did you get invited to be a part of FMA Health?\n\nDr. Weida: I heard about it from my wife since she was, I believe, president of the AAFP Foundation at that time. And she mentioned it and, of course, it appealed to me since all my interest was in practice management and appropriate payment for family physicians. So I applied and was fortunate enough to be selected by their board as the core team leader. \n\nDr. Young: And were you looking particularly at the Payment Core Team?\n\nDr. Weida: Yes, I was looking particularly at the Payment Core Team or the Practice Team.\n\nDr. Young: Well, I suppose you’ve actually answered the next question, to some extent, that I was going to ask about which is what are the knowledge and skills that you see that have prepared you specifically for your work within Family Medicine for America’s Health and the Payment Core Team in particular?\n\nDr. Weida: I’ve always been involved in the practice management. In addition, I had an article in Family Practice Management about the six magic slides for evaluation in management coding. And believe it or not, we’re still using it here in this residency program. And every now and then people tell me they’re still using it, even though that was published probably a good twelve, thirteen years ago.\n\nDr. Young: As you look at healthcare in the United States right now, what’s your opinion of the state of the healthcare system?\n\nDr. Weida: Our current state of the healthcare system is probably the worst healthcare system we can’t afford. We’re obviously not best in rankings but we are best in spending money. And a lot of that is that we have built a healthcare system based on solving acute crises and applying high tech solutions to the last stages of a disease process rather than focusing the spend on family medicine, on primary care, on prevention management, on how to encourage lifestyle changes, on behavioral medicine. Those are the things that should actually take up 10% to 12% of the total spend of healthcare dollars that encompasses a good 40% to 50% of the clinicians providing that type of care. Right now it’s about 30% and the graduation rate from the medical schools is not sufficient to meet the demand. Although if you look at some of the numbers, depending on how you look at those, the medical schools often times say that we do graduate 40% primary care. But unfortunately that doesn’t take into account that a number of the folks who go into general internal medicine or general pediatrics, then sub-specialize.  So that data is not always accurate when you get three to five years out of graduation.\n\nDr. Young: So they’re just looking at what residencies’ graduates go into and not their career trajectory as a whole?\n\nDr. Weida: Correct. They’re looking at what residency they go into but not looking at where they end up as a career. And as a result, I think it skews the data.           \n\nDr. Young: Well, I need to ask what you think needs to be done to address these issues. And let me ask it at two levels: One would be as you look overall at healthcare in the United States, but then also specifically from the perspective of your core team.\n\nDr. Weida: I think overall obviously most students going into medical school end up with a huge debt burden because most are not financially wealthy going in. And the students who are most likely to go to family medicine are usually coming from rural backgrounds or maybe even lower socio-economic status. And so the finances become a significant concern when they’re choosing where to go next. I’ve heard many students say I’d love to go into family medicine but I have to worry about making a living. So I think the debt burden is one area and also just the overall inequity in income between the partialist and the comprehensivist, us being the comprehensivists in family medicine and the partialist being the folks that just focus on either one organ system or several different processes. So I think that’s a key component. I think another component is when these medical students are out in family medicine rotations they see the burden that family doctors have with billing, with the electronic medical records, with record keeping and with all the rules and regulations. And that’s another idea that I think could certainly be improved upon. And so where we’re going with this in the core team is really stepping back and say instead of having to fill out a form or a code for every tongue depressor and every time they look in an ear, that we really get paid comprehensively for what we do. So we are advocating comprehensive payment for primary care which would include a bundle of services that a practice would perform. And so that bundle may include --, may include being able to have a social worker, case managers, things that really help improve the health of the individuals that are going to primary care. It also improves the satisfaction of the family docs working in that kind of environment. And I think it basically is a more equitable way of paying primary care. But we have to be very careful that it’s not the old capitated health system in HMOs which basically discounted and only focused on office visits.\n\nThis type of comprehensive payment for primary care includes the global bundle of things that we do on a routine basis.\n\nDr. Young: Does such a payment system then sort of define how practices would be organized?\n\nDr. Weida: Well, such a payment system would definitely look at a team-based model. That type of system would then allow the use of technology, the use of telemedicine to help with access. It would help with providing social support for patients who need it. So I think it has a lot of advantages. I mean an almost similar model that is starting to grow is direct primary care because direct primary care also charges a per member per month for services that the family physician can provide and it encompasses all their services. Well, to me comprehensive payment for primary care is almost the same thing. The main difference is who’s writing the checks. And in that case for comprehensive primary care the checks would be coming from insureds or the government rather than having to come out of the pockets of the individuals. Because right now with direct primary care the patient has to pay that first dollar of coverage in that monthly fee. Well, unfortunately a lot of folks are either unable or unwilling to do that. And so what I would see as a really interesting model would be for the insurers to pay comprehensive payment for primary care for the first dollar coverage of that, to pay that monthly fee and then combine that with a high deductible plan. Which right now they’re having high deductible plans but not covering the primary care. So combining those both would be, I think, a much better way of addressing some of the healthcare crises that we have. And then making sure that that primary care spend is 10% to 12% of the total healthcare spend so that we look at not only quality, we look at socio demographic factor. But we also look at cost about practice improvement.\n\nDr. Young: So where are we in moving towards that sort of national system?\n\nDr. Weida: Our core team has developed a calculator that looks at some of those components for determining how to negotiate with an insurer for those things. So that’s some of what we’ve been working on and what we’ve been doing. So we’re really looking at helping practices in that way. What we would ideally like to do is to get some insurers excited about this and have them pilot it and see how it actually works in practice. But like I said, I think, in a sense, the test then, in a way, is the direct primary care but it relies on the patient to pay rather than the insurer. So to me what we’re really looking at for payment in a comprehensive payment model is to pay based on population of risk adjustment as a first step, to pay based on infrastructure. In other words, the Medical Home and having Medical Home principles embedded in the care. To pay based on quality which would be population in health management activities and improvement activities. And to pay on efficiency which would be basically looking at tying it into the triple aim of better population of health and improved patient experience and lower cost. \n\nDr. Young: Let’s take a step back a moment and let me ask the basic question of what is the charge of your core team within Family Medicine for America’s Health?\n\nDr. Weida: Well, the core team, we had a charge to help physicians and practices transition to a comprehensive primary care payment model. Also to help ensure as an industry transition to a comprehensive primary care payment model. Those were our first two charges. And then we realized that there was another tactic that was sort of missing in all this. That even if we got to a comprehensive payment model, how does that filter down to the physician who is creating the value in that model? And so we basically looked at what we call the Tactic 1.5 to examine how to compensate the value of primary care in a comprehensive primary care payment model. And that’s the one tactic that is very challenging and we’re still working on that process. \n\nDr. Young: And as of this date, in 2018, is your core team still in full operation?\n\nDr. Weida: Yes, our core team as of now, it’s full operation to the end of this year, 2018. We have the calculator done and we have the instruction manual so the calculator is done. We are close to publishing a paper on The Pathways of Comprehensive Payment which has looked at practices across the country that are making the transition to comprehensive payment. And then, like I said, we are looking at Tactic 1.5 to interview practices, interview groups that are, again, transitioning to comprehensive primary care payment and how do they structure what I call the secret sauce of paying the primary care physicians. And the reason for the report is that as you go to a value-based system, go to a comprehensive payment system, it’s not so much about the rigid productivity hamster wheel as it is about outcomes - and so those are the things that become more important. And that requires a different way of structuring because if I’m just paying based on RVUs, well, physicians aren’t stupid, they’re going to try to crank out RVUs and that may or may not serve the goals of decreasing re-admissions, decreasing hospitalizations and presenting secondary or tertiary complications of chronic disease. \n\nDr. Young: So it sounds like it’s a focus on the health of the patient and perhaps a practice’s patients, what those outcomes are as opposed to the individual steps that were paid for in the past procedure by procedure or encounter by encounter?\n\nDr. Weida: Correct. Basically, instead of paying for each separate little procedure we’re really looking at paying for the whole piece. So it’s the difference between having a price fixed menu in a restaurant versus an ala carte menu. A lot of people will get the dessert rather than a salad and that’s not as good for them as if they had a well-balanced price fixed meal.\n\nDr. Young: Have you done research at all to see how patients perceive this approach?\n\nDr. Weida: We haven’t really been able to do that research – again, because most practices are not really doing all of this. I think your best research probably right now, this instant, will come out of direct practice tier plans that could then see how patient satisfaction is with it. I would think on the whole that patients would be happier as well just because, again, they’re not facing unexpected initial primary care costs. \n\nDr. Young: Well, it certainly sounds like it matches the philosophy and approach to medicine of family medicine.   \n\nDr. Weida: Absolutely. Like I said, we’re comprehensivists and should be paid comprehensively.\n\nDr. Young: What’s been the reaction of payers?\n\nDr. Weida: I have been talking with Blue Cross Blue Shield at the University of Alabama here. There’s some interest in it. Again, they’re all sort of a little afraid because, again, it’s a model that they haven’t really used and probably also don’t have the actuarial basis to really feel totally comfortable with it. So, like I said, we’re in the process of trying to identify some insurers through some states that are willing to give this a go.\n\nDr. Young: And how about federal programs?\n\nDr. Weida: Federal programs? Probably the one that comes closest to this model is the current CPC Plus program. The problem with the CPC Plus program is, still, the large part of it is based on RVUs and it’s not a prospective patient payment but a retroactive payment. And so as a result most practices don’t have the finances to be able to frontload the changes that are necessary to really provide a comprehensive Patient-Centered Medical Home experience that can impact not only patient care and patient satisfaction but also cost.\n\nDr. Young: What interaction has your core team had with the other core teams?\n\nDr. Weida: We’ve gotten together semi-annually with them. Our general meeting, Family Medicine for America’s Health, was a core team meeting. And now that we have pared down to just three core teams, we actually are working in conjunction with the Practice core team to work on some projects jointly. One of those projects we’d like to move forward is an online resource center that would basically have resources available for any practices or even insurers that are wanting to move forward in practice transformation and in payment transformation with comprehensive payment. Additionally we have envisioned that site as being a one-stop site and shop for information that is pertinent to practice improvement among all the Family of Family Medicine. One of the things about the Family Medicine for America’s Health is that all the Family of Family Medicine, the various organizations, have come together to create this. And this also included for the first time osteopathic family medicine which I think was lacking in the first go-round when we originally had the Future of Family Medicine meeting. So I think having them all on board was a great thing. And being able to have something long lasting coming out of this that could be a resource center for all of them and direct physicians to whatever area or whatever organization they need to be directed to depending on their need at that time would be a tremendous benefit.\n\nDr. Young: Could you talk a bit about what the future will bring given that Family Medicine for America’s Health, I believe, was conceived with the concept of a start and an end but not of the work that Family Medicine for America’s Health would determine needs to be accomplished?\n\nDr. Weida: Right. And what will happen is these projects that we have or have done will fold back into the most relevant organizations. So payment, most likely most of that will fold back into AAFP. And, in fact, we’ve been meeting since January, we met with the Commission On Quality of Practice to discuss what we’ve been doing and to look ahead, look forward to their ongoing involvement in our activities after Family Medicine for America’s Health sunsets.\n\nDr. Young: And what sort of reception have you gotten?\n\nDr. Weida: From my aspect I think that commission has been very positive. It’s been very interested in what we’re doing. They’ve asked good questions and actually some of their questions have modified what we’ve been doing and what we’ve done. We also are actually really planning on a three stage approach to move the project forward. We’re going to be partnering with PCPCC which really brings together not only the family physicians and primary care but brings together industry. So we’re hoping to work there with their Annual Meeting to promote the 10% to 12% spend for primary care, that that’s critical to revitalizing healthcare in America. We want to follow that up with publications that actually highlight the results that we’ve gotten from all the teams for Family Medicine for America’s Health so that provides a peer review type journal, probably a special edition that really provides a longevity to the plan and then follow that up with this resource center. So it’s a three prong approach of the presentation moving industry forward, articles which are there for reference for people to be able to be thinking about it and to point back to another resource center that folks can use to move forward and actually create a change within their practice or with industry. \n\nDr. Young: And talk a bit about where the resource center would reside.\n\nDr. Weida: It’s currently in discussion as to where that would be. We’re currently in discussions with AAFP about that and they’re looking at the feasibility of that, the cost of that. And we’re hoping to make that case coming up in the next cluster for both staff and for the commission. So we’ve been working very closely with staff about this and they’ve had some good ideas, good questions. We actually have developed with the help of Jason Marker who is on the Practice Transformation Core Team. He has created a nice slide deck workup of what this could look like and how it could operate. So to me it’s a very exciting way of keeping this Family Medicine for America’s Health project alive moving down the line.           \n\nDr. Young: Are any of the other member organizations of Family Medicine for America’s Health interested to this point in this future work? You had mentioned the osteopathic group, for example.\n\nDr. Weida: Again, this will be some of the presentations that we will be making to the Working Party to judge their involvement and their excitement about the resource center. Because as we envision it, every organization that’s connected with family medicine should have a role and a piece in this resource center. That way it becomes a valuable product for family physicians, educators and insurers to use to really help foster a change.\n\nDr. Young: And that raises another question. In terms of the family, obviously among the organizations there’s a strong educational component. Either by those organizations or within just residencies and departments have you had any reaction to what’s going on, interest, desire to participate?\n\nDr. Weida: Actually, the Society of Teachers of Family Medicine has been very generous to us in allowing us to have significant air time at their both Annual Meeting and at the Practice Improvement Conference. And so we’ve been presenting the calculator, presenting where we’re going on multiple occasions and I think it has had some good responses there. Again, a lot will depend on the interest of insurance companies. And, like I said, I think this direct practice piece can help move us towards that.\n\nDr. Young: Any interface with employers?\n\nDr. Weida: As I said earlier, that’s an area that we’re investigating currently about whether we can get some employers interested in the PCPCC Conference that’s going to be coming up in the fall, is a good opportunity for us to start to engage and interact with employers. We recognize that five years is probably not enough time to change the entire U.S. healthcare system. We probably need five and a half. Actually, it’s taken ten years, when you think about when we first looked at the Patient-Centered Medical Home. It’s taken at least ten years, maybe twelve years, before that’s actually become common language and has been incorporated into the healthcare policy. So looking at comprehensive payment, I figure is also going to ultimately be a ten to fifteen year project.\n\nDr. Young: Putting on your educator hat then in your home state there, what sort of reaction do you get from residents? Are they aware of this project? Do they have any thoughts that they’re expressing, if they do?\n\nDr. Weida: Right now we haven’t really introduced the comprehensive payment part to them as much. We really have focused on getting certification for Patient-Centered Medical Home. When I came here two and a half years ago, none of our sites were Patient-Centered Medical Home certified and we now have gotten three of our sites level 3 Patient-Centered Medical Home certified and pediatrics, which is in our college level 2 certification. We’re currently working on an additional rural site that we have and hope to get that one certified this year. Actually, Dr. Jane Weida has been very instrumental in moving that project forward. What I see is that as we become more involved in value and the value propositions, then be able to introduce this, like I said, to Alabama itself and looking at whether that could be a model that they could use to help decrease their healthcare costs and improve the quality of care.\n\nDr. Young: This type of care is a team approach. Any reaction from other members of the team or any outreaches that have been made to the organizations representing such team members?\n\nDr. Weida: I think overall it’s been positive because they’re the ones who actually asked us to develop a comprehensive primary care model. So again, this is their charge and they own it. And so there have been changes obviously in the law that have moved us on that step towards that. I think that AAFP has submitted a proposal to, I think it’s PTAT (?) that looks again at moving a little bit further beyond the CPC Plus model that’s out there for Medicare – again, looking at getting a little more comprehensive in their approach. So it’s a transition rather than a jump into the deep end of the pool process.\n\nDr. Young: We certainly have a long history of very slow change in the healthcare system.\n\nDr. Weida: And sometimes we jump in the wrong pool. Indeed.\n\nDr. Young: Any comments on the core team that was created in process which I believe was the one on health disparities? \n\nDr. Weida: Yes. Just as the first Future of Family Medicine recognized that they had missed payment in their deliberations, we recognize that we missed health disparities in ours. But fortunately we were flexible enough to create yet another core team to really look at health disparities and how that’s interplayed. And actually that’s one of our components of our calculator, Social Determinants of Health, which looks at incomes, patient education levels, among other aspects, that has actually excited the American Family of Family Physicians as some of their calculators do not include that. And so having some of that data in that calculation is going to be very helpful for AAFP on a very immediate basis.\n\nDr. Young: Given your opportunity to participate in the evolution of the healthcare system for so many years, were you surprised at all about any changes in the United States between the time that this overall Family Medicine for America’s Health program was initiated and where we are now in 2018?\n\nDr. Weida: Well, I think the two major changes that occurred were the Affordable Care Act and then MACRA. And I think MACRA actually has made a significant change because it starts focusing payment on quality parameters. That MACRA process is changing. It certainly is not ideal, this process is not ideal. But one of the things it creates is the alternative payment model. There’s, I think, a tremendous opportunity, again, to trial a comprehensive payment model under that. The problem I see is that Medicare often wants a risk-based model for trialing and that’s a big jump to go from fee-for-service into comprehensive payment that is at full risk. And so there really needs to be an arena that you can study this and make sure that you get the bugs out.\n\nDr. Young: And how would that be accomplished?\n\nDr. Weida: Again, like I said, I think AAFP has put in a proposal that is starting to move us towards that direction. I think, again, as APMs (?) are formed in their local areas they may have the opportunity to think more creatively with their local insurers and with their local industry. So I think there are opportunities there. I know in Alabama they’re relooking at Medicaid and sort of thinking about creating kind of a pair (?) organization. That’s another opportunity that I think, again, allows the ability to move towards this. We need to get the message out that there can be an alternative. And like I said, I think our three-pronged approach that we have with regards to presenting at PCPCC and with regards to a publication and with regards to an ongoing interactive resource center is key to helping the United States move forward.\n\nDr. Young: To what extent is anything that’s going to be attempted to be accomplished impacted by national political decisions?\n\nDr. Weida: Well, we’re always impacted by national political decisions. Rhode Island I think just passed a law that really favors primary care and favors the 10% to 12% spend in primary care. So there’s a good opportunity in that state to be looking at this type of model because it fits perfectly within where they want to go and they recognize that by doing some coordinated effort on a statewide basis in their vaccine program, they were able to reduce cost and have the best vaccination rate in the country. So I think states may be the test steeds (?) for of it. And depending on how they legislate things, that could give great opportunity for a good type of payment plan.\n\nDr. Young: We’re going to pause for just a moment. (This ends side 1 of tape 1.)\n\nTape 1, side 2:     \n\n \n\nDr. Young: This is side 2 of tape 1 of the May 4th, 2018 interview with Dr. Tom Weida, team leader of the Payment Core Team for Family Medicine for America’s Health. \n\nDr. Weida, as we’re coming to the end of our interview for this Oral History, could you talk a little bit about how this differs as an overall project to Future of Family Medicine?\n\nDr. Weida: I think one of the ways it differs is that it is supported by all the family of family  medicine including osteopathic family physicians. And I think the other piece is that in this whole process we’ve had an outside consultant CFAR (?) really providing a lot of background help, helping organize the meetings and just really helping what I’ll call the interconnections. They’ve been the connector, so they’ve been able to pursue leads outside of AAFP and to really bring in additional folks as we need them and pursue leads that we discuss. So all of us are volunteers and so we can devote a certain amount of time to it but it’s not our fulltime job. And the funds remain available to really have CFAR invest a significant amount of time and resources in supporting all the core teams. That’s been invaluable. And Mal (?) O’Connor, who has been the project lead on this, has just been excellent to work with. He knows about practice dynamics and I think really how to get the most out of a group of folks. Now, I have to admit, when we had our first meeting for the --\n\ncore team, it was the worst meeting I’d ever chaired because we had probably six very strong individuals at the table with very strong ideas and no one was listening to anybody else and it was really a challenge. And between Mal and I, we were gradually able to get this together. And I would say at this point now it’s the strongest team that I’ve lead in that everybody’s unique strengths have really contributed to our product as a whole.\n\nDr. Young: So it sounded like a significant difference between the prior Future of Family Medicine is that fear there was a dedicated funded, talented staff that worked with all the rest of you all as volunteers - and obviously many hours of volunteer work and creativity. \n\nDr. Weida: Yes, and that’s been very good. And they’ve been knowledgeable. I know they brought on Keisha Davis, who is a family physician, who has also been very helpful in helping us organize meetings and keeping on track and helping us frame things or reframe things when needed. So that’s another one of the areas that now Keisha has been able to do, is help us frame things and  move forward rather than just sort of getting stuck in a rut in some areas. So really a good, helpful facilitation.\n\nDr. Young: So looking, say, five years into the future, or maybe you wanted a ten year horizon, where do you think this project will have gotten us to? \n\nDr. Weida: Well, looking ahead into the future I would say that this project will get us back to the joy of family medicine where we actually can spend time with our patients and be involved in their total care, where we are able to be comfortable financially and provide the services that best meet the needs of our communities that we work and live in. To me that’s the piece that we really then will be able to provide a Patient-Centered Medical Home experience to our patients and achieve the quadruple aim of healthcare. To me that’s really where we need to go and that’s what we have lost. And by losing that, by becoming so much a partialist system, we really have not improved the overall health of everyone.\n\nDr. Young: Putting on your educator hat again, are the people drawn to go into medicine and within family medicine moved by the same things now in 2018 as they were in past decades?\n\nDr. Weida: I think that the students still enjoy that comprehensiveness when they experience well-run offices, when they experience a family doc having the joy of practice. You build relationships – and humanity is all about relationships. What other practice other than primary care do you really get to establish life-long relationships? That, of course, needs to be then put in a framework of being able to provide care in a team-based manner, of being able to have the skills to manage a team and also to be put into the overall work/life balance which in the past I think family physicians have gravitated towards the work balance and not always to the life balance. But we really need to recognize that that work/life balance is an important piece. So combining that with an appropriate payment mechanism and a practice transformation is really going to be the key to having that joy of family medicine that will elevate healthcare in America. \n\nDr. Young: So that which is underway, that which is proposed, that which will be accomplished will in reality empower family medicine?\n\nDr. Weida: Correct, --.\n\nDr. Young: Dr. Weida, anything else that you would like to share?\n\nDr. Weida: No, I think this has been a great program as far as Family Medicine for America’s Health. I can’t speak highly enough of all the volunteers who have given so much time, work and effort. I know on our committee all of our committee members have really been instrumental in making this a success. And then we’ve also brought in other folks outside of the committee who have helped us. So it really has been a team effort of how we have done things.\n\nDr. Young: Would you like to share just who is on your core team and sort of what their area of expertise has been?\n\nDr. Weida: We have Stan Bork (?), who is an osteopathic physician, who really has been a consultant for the healthcare industry. We have Karen Smith, who has been very much involved in organized medicine and has been the Family Physician of the Year. We’ve had Rebecca Mallin (?), who is primarily a researcher and has really been very helpful for us in actually holding our feet to the fire with regards to being directed and focused in what we do. And then we have Steve Trajen (?), who really has been working mostly in the public health arena in California. And he has provided often times a 10,000 foot view and an outside the Academy side view of payment and the things that we need to be paying attention to. We originally also had Erika Bush (?) who was one of the creators and founders of the Direct Primary Care Initiative. And she provided us some valuable advice in the beginning of this project. Other folks that have helped us with this have been Mathew Harker (?), who is out of Duke, who was what I’ll call a public policy researcher. Katherine Harms (?) up in Michigan who worked with Rebecca Mallin on the Pathways To Comprehensive Payment interview project. Although again, not officially with the core team, has been very helpful. So these have all been folks. And I’m sure I’m missing some people, but these are all folks that have been highly instrumental in what we’ve accomplished.\n\nDr. Young: Dr. Weida, thank you ever so much for taking this time to share the work of the Payment Core Team and the overall activities of Family Medicine for America’s Health. \n\nDr. Weida: You’re welcome. It’s been a pleasure.\n\nDr. Young: This completes the recording of this Oral History with Dr. Tom Weida.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295056#t=0.0,2537.8335"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295055","type":"Canvas","label":{"en":["Media File 2 of 2 - WeidaThomas_02_Access.mp3"]},"duration":662.8095,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295055/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295055/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/055/original/WeidaThomas_02_Access.mp3?1760553662","type":"Audio","format":"audio/mpeg","duration":662.8095,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162271/file/295055","metadata":[]}]}],"annotations":[]}]}