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Boise State Students Influence Health Care Reform in Idaho

Boise State is exceptional at involving students, both undergraduate and graduate, in research. The students’ involvement can impact their learning just as much as classroom instruction, perhaps more. The students also have opportunities to make a difference in their communities through their participation in research.

The benefits are not just for the students. Students also help research projects be more productive, which can impact the world around them. One example is the student research assistants for the Idaho Department of Health and Welfare’s Statewide Healthcare Innovation Plan (SHIP). Boise State has a sub-award under the University of Idaho for the State Level Evaluation of this initiative.

In 2016, the Idaho Department of Health and Welfare awarded a three-year, $3.6 million contract to a team of researchers to evaluate SHIP. The team is comprised of researchers from University of Idaho, the Idaho WWAMI Medical Education Program and Boise State University’s College of Health Sciences.

SHIP is redesigning Idaho’s health care system to improve Idaho residents’ health by strengthening primary and preventive care through the Patient Centered Medical Home and to evolve from a fee-for-service, volume-based payment system to a value-based payment system that rewards improved health outcomes.

During the 2016-2017 year, four Boise State students held assistantships with SHIP and agreed to participate in an interview: Tara Fouts, a Master of Health Science student with an emphasis in Health Promotion; Adiya Jaffari, a Bachelor of Science in Health Science Studies student with a Psychology minor; Michael Thomas, a Master of Science in Accountancy student; and Molly Volk, a Master of Health Science student with an emphasis in Policy.

During the interview, all expressed that they have a deeper understanding of the health care system than they did before their assistantship.

“I have learned that there is a lot of complexity to the way health care is delivered and tracked,” shared Thomas. “I also learned that in the health care world there are so many different stakeholders with their own different objectives. I found it interesting how complex it was to get all the stakeholders to agree on the right method of implementing changes in the health care industry.”

“This assistantship has introduced me to the impact of policy on health beyond what is discussed in the classroom,” states Volk. “I have had the opportunity to become familiar with the movers and shakers of health care reform in Idaho. Additionally, it was a valuable orientation to the nuances of working in public administration and with a federal grant.”

“My experience with SHIP has enhanced my understanding of crucial topics that are paramount to my ability to effectively maneuver the health care system both as a patient and future physician,” said Jaffari, who aspires to be a primary care physician. “Through my time as a research assistant with SHIP, I have gotten an inside look at the intricacies of health care delivery systems, the challenges of implementing health care reform, the arduous task of integrating care through programs targeting systems change, and the difficulty in altering clinical workflow and care coordination to accommodate a reform model on the part of the patient and provider. Understanding the current and inevitable future of health care in the United States will without a doubt increase my effectiveness as a physician, medical student, and lifetime patient.”

“From day one there was a very steep learning curve for someone not savvy with health care,” admits Thomas. “I feel though that my experience has helped me understand how change happens in the real-world.”

“Incrementalism is a reality that must be recognized when trying to make the world a better place, or in this case, reforming health care delivery in Idaho,” adds Volk. “The people that stay motivated and utilize creative thinking are the folks that can move the needle in health care reform.”

Thomas recommends the SHIP assistantship “to students who are looking for a real-world experience and that won’t shy away from complexity.”

Fouts agrees: “I think students who are interested in health care transformation, or anyone who is interested in the “big picture”, would enjoy this. I would also suggest it to students who enjoy health informatics, accounting, or anyone who is proficient in dealing with data. The SHIP staff tailored the workload to incorporate my Health Promotion emphasis into my experiences, and I think any Health-related student would benefit from this assistantship.”

“I would recommend this assistantship to any students studying health, policy, or public administration,” adds Volk. “This position provides an opportunity to gain a hands-on understanding of health care reform, policy change, and public administration in Idaho. You can’t learn this stuff from a textbook!”

“This assistantship has been a great opportunity to see health care change firsthand and to understand the amount of work and collaboration that needs to go into the process,” said Fouts, who wants to work in a position to improve overall health in the community. “It’s also helping me gain a better insight into all the components of the system. I think it has helped me reach my career goals just by solidifying my love for this field and how challenging and continuously changing it can be.”

The students are passionate about preventive health care and patient-centered health care.
“We all understand that health care is expensive and can be frustrating, but is also extremely important. Patient-centered care is vital because it treats patients as a whole person. It not only looks at a person’s social determinants that impact their overall health, but it also addresses them,” explains Fout. “Before, I would never imagine incorporating referrals to community resources such as the food bank as an element of health care. Now, I can’t imagine why we did not do this from the beginning. There are many life components that do impact a person’s health and being able to turn to trusted health care teams for help or for a connection to affordable resources seems like a great solution. Patient-centered care has many benefits and hopefully, in the long-run, patients will be more engaged in their own health care and become better self-advocates.”

“ I worked mostly with the patient-centered medical home transformation, so I see SHIP through a health care delivery transformation lens,” said Volk. “I envision (or hope for) a future in Idaho where all health care is patient-centered. I think that people should be in control of their own health and health care. They should be allowed to make decisions about what affects them. Patient-centeredness means to put the patient in the center of the care system and give them power and control over their own lives and their own care. I see the SHIP transforming the relationships between patients and providers. Health care professionals will no longer provide care to patients or for patients, but rather in partnership with patients. In theory, this patient centeredness will lead to monetary savings by reducing hospital and emergency department utilization, mitigating health disparities, and improving patient outcomes.”

“I hope the change to the new model will decrease the overutilization of the emergency department for minor issues because patients don’t know who to call or because it is after office hours,” reflects Fouts. “I also have often heard from patients that the same services (lab tests, imaging, etc.) were repeated in two different offices for numerous reasons. These repeated services not only add up financially, but can be frustrating to experience unnecessarily. I see the value of the patient-centered model to improve the quality of care through improved team-based care coordination and increased communication. This model can help relieve the immense workload from one individual and disperse it to an entire care team.”

“Patient centeredness will lead to monetary savings by reducing hospital and emergency department visits, mitigating health disparities, and improving patient outcomes,” said Volk. She laughs. “That is my rehearsed elevator pitch.”

Volk continues: “Most importantly to me personally, the patient-centered model values patients more than the traditional fee-for-service model. Through my research I have come to understand four key concepts of patient-centered care: respect and dignity, information sharing, participation, and collaboration. I believe that providers should listen to and honor patient perspectives and choices, communicate and share complete and unbiased information with patients in ways that are encouraging and useful, encourage and support patients in participating in care and decision-making, and collaborate with patients in all aspects of quality improvement.”

“Health care transformation is a difficult process,” admits Fouts. “The people involved in SHIP have done a tremendous job at implementing and forming a plan for Idaho, but SHIP is only a four-year grant. SHIP has paved the way for Boise State students, future health care professionals and public health professionals to be integral to continuing their efforts to improve health care in Idaho.”

“I have worked with SHIP for about nine months and I’m learning new things every day,” adds Volk. “If you want to learn more about the background of SHIP, you can find lots of information on our website. I also encourage those that are interested to look into the Centers for Medicare & Medicaid Services State Innovation Models Initiative. There are some pretty amazing things happening all over the country and states have had the opportunity to tailor initiatives to their own unique needs and goals. It’s awesome stuff!”

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