The Shared Context: Kaiser Permanente and the Columbia-Bassett Program.

Abstract

The Columbia-Bassett Program, begun in 2010, is a unique medical school program within Columbia University’s College of Physicians and Surgeons. The 4-year experience of the students in this program occurs in 2 sites: 1) in New York city at the College of Physicians and Surgeons and its affiliated health care facilities, situated in an urban community of roughly 14 million people spread over several hundred square miles; and 2) in Cooperstown, NY, at the facilities of the Bassett Healthcare Network (Bassett), serving a rural community of approximately 200,000 people living across 5000 square miles. The 2 communities are a striking contrast to each other, as are the health care systems serving them. The College of Physicians and Surgeons operates in a traditional academic health center with a fee-for-service reimbursement model, whereas Bassett operates a network of geographically dispersed facilities with a salaried model that is similar in many respects to that of Kaiser Permanente (KP). In 1931, Bassett briefly established the third prepaid health plan in the US, insuring individuals and families for a set annual fee. Henry Kaiser, American industrialist and cofounder of KP, was born and raised in Sprout Brook, NY, just 19 miles from Cooperstown. Bassett has been a teaching affiliate of the College of Physicians and Surgeons since 1947, serving as a site for medical student clinical rotations and postgraduate residency training. The Columbia-Bassett Program now provides a four-year experience for medical students that is characterized by two core themes that connect it to KP: 1) a longitudinal integrated curriculum,1 in which students follow a panel of patients throughout their major clinical year; and 2) a course called “Systems, Leadership, Improvement and Management,” in which students learn about health care delivery, health policy, and Lean Six Sigma performance improvement,2 incorporating a project to identify and to solve a problem in applied health delivery. This marriage of longitudinal physician-patient relationships and system improvement aligns the Columbia-Bassett Program with the approach to health care at KP. Not surprisingly, the Columbia-Bassett students are deeply interested in the findings and implications of the KP/Centers for Disease Control and Prevention Adverse Childhood Experiences Study,3 which provides physicians with valuable information about the root causes of many common and costly health problems. Recent research by Whitaker and his colleagues4 showed that dispositional mindfulness conferred resilience to the impact of adverse childhood experiences on adult health. These findings aroused interest and optimism among the students at Columbia-Bassett. These students understand the relevance of past adversity for current health and are exploring ways to communicate compassionately with patients about these matters and to alter the health system to address them.5