As part of a lifestyle and aging series, we’re working with renowned photographer Terry Lorant to showcase inspirational leaders in the industry. Each month, we’ll feature an inspirational member of the Amazing Care Network community who is using his or her voice to empower others in the collective aging experience — and read, in their own words, what the Amazing Care Network’s efforts mean to them.

 

After being in Internal Medicine and Gastroenterology Private Practice in San Mateo County for 18 years, I moved to Granite Bay, CA in 1994 with my wife and started work as Medical Director at Foundation Health in Rancho Cordova, a managed care company. Eventually, Health Net of California merged with Foundation Health and welcomed Cora Tellez to run the California Plan; that’s where I met Cora. Briefly, she divided California into three units ( “Commercial North and South” and “Government Programs”) and appointed a friend of mine, David Friedman, as the Senior Executive for Government Programs (Medicare, Medicaid and Health Families); I was the Chief Medical Officer for Government Programs reporting to David. Upon her arrival, Cora summoned the three Chief Medical officers down to Woodland Hills and, off the cuff, set up a way to turn the company around. Cora focused everybody with her the three “vital few” initiatives: grow the business [profitably], control overhead, and improve health care costs. Cora turned the company around in 6 months, a brilliant accomplishment.

After Cora left Health Net, we reconnected and she asked me to be involved with a new project – an accountable care organization (ACO) for self-insured employer groups; this was a “commercial” version of the Affordable Care Act’s Medicare ACO project. This project is still on the drawing board.

Next, the Amazing Care Network idea came up and Cora contacted me again. We would meet about every 6 months or so for lunch in Fairfield, equidistant from our homes, and kick ideas around.

The most compelling concept for me was Cora’s thought that if you were a husband or a wife who took your spouse through end-of-life care, you were left alone; who was there for you? I’ve seen examples where the surviving spouse had little support (Boom) and where the surviving spouse had excellent support (Bloom). I realized that there are many support groups that are “disease specific”, but what would be innovative and beneficial for ACN members is a “needs specific” network…so I became involved and worked on a piece of ACN that dealt with actual heath care.

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At one of our lunches, I proposed the acronym “PFOF”, Physician Friend of the Family, denoting an avuncular (uncle-like) relationship. Most likely, PFOFs would be physicians retired from clinical practice. Cora liked this concept and I put some of my ideas to paper:

These PFOFs will function as knowledgeable extensions of the ACN member’s family and are an ideal vehicle to interpret clinical information for the member and provide friendly discussion. These PFOFs would not recommend specific care/investigations or interact with the attending physician, rather they would interpret the existing clinical situation (including testing and therapy) and discuss with the member.

PFOFs would provide this valuable input when:

  • The member feels confused or does not understand the ramifications of the attending physician’s recommendation[s]
  • The member is conflicted by advice from family and the attending physician
  • The member wants to understand the cost/benefit and Quality of Life of the suggested treatment option vs. alternatives
  • The member needs guidance regarding “coverage” of the recommended care (Digital EOCs must be provided.) All processes to be HIPAA compliant.

As a PFOF, the physician would be paid by the hour beginning with medical record review. Consultant no; explainer yes; invaluable, hope so…

Story and photos by Terry Lorant.