Four Questions With Arkansas Surgeon General Dr. Greg Bledsoe

As Arkansas’ surgeon general, Dr. Greg Bledsoe is Gov. Asa Hutchinson’s chief health policy advisor. Among his assignments is serving as a nonvoting member of the Health Reform Legislative Task Force, which is creating proposals to reform health care in Arkansas.

Being surgeon general is a part-time position. Bledsoe also is associate professor of emergency medicine at UAMS and has a joint faculty appointment at the College of Public Health.

Previously, he served five years on the faculty of the Johns Hopkins Department of Emergency Medicine. He also was chief editor of “Expedition and Wilderness Medicine,” a 700-page textbook published in 2008. He is the son of a physician, Dr. Jim Bledsoe, and a state legislator, Sen. Cecile Bledsoe.

During an interview with Talk Business and Politics, Bledsoe discussed the health care landscape.

TB&P: Arkansas is undergoing significant changes in its health care system, many of them underway before you became surgeon general. Which do you like the most, and why?

Dr. Greg Bledsoe: It seems like to me that the patient-centered medical homes kind of stand out as an innovation that a lot of people nationally have looked at and said that that’s something that could help a lot of other areas in the future, and also it seems to have been really well-received by primary care providers around the state. Of course, the details are always important, and how it actually gets implemented over the next few years is going to really tell the full story, but of all the changes that I’ve seen, the patient-centered medical homes seem to stand out as one that people by and large agree was a very positive step.

TB&P: What is a patient-centered medical home?

Bledsoe: Patients … enter into an arrangement where (their) primary care provider, usually a family practitioner, is sort of responsible for the totality of that patient’s care, and they are incentivized to have better follow-up, more coordination of the patient’s care with the hopes that if they can better coordinate things and manage the patient’s overall care better, that they’ll save the system money and thereby improve the health care system as a whole. And part of the model is that the primary care provider… will have a percentage of whatever those savings are that he or she will be given at the end of the (care).

TB&P: If you could change one thing about the health care system, what would it be?

Bledsoe: I think more and more, we’re seeing a centralization of decision-making on the national level, and regulations and governmental dictates coming down from groups that aren’t local, that necessarily aren’t engaging with local entities, and it’s creating a lot of problems.

My concern is, when I talk to individuals who are actually practicing medicine or who are doing clinical nursing and really on the ground, especially in our rural communities, you talk to individuals who are trying to run a hospital in a rural community or trying to practice medicine in a rural community, those are individuals that are very concerned about the direction of our health care system because they don’t think that their concerns are being heard on the national level.

Specifically, I think if you look at, going back to the Medicaid issue, I’ve spent the last eight months studying Medicaid and ways that we can improve it in the state of Arkansas. Almost without exception, every regulation, everything that is a set-in-stone law or whatever, that we would need to revise, with a few exceptions, is set nationally. And we’re talking about a system that was implemented and designed 50 years ago. We’ve been nibbling around the edges when actually, in my opinion, the Medicaid system needs a significant federal overhaul, and it’s long overdue because we’re trying to put a square peg in a round hole to fix our national health care problem, and we’re not going to be able to.”

TB&P: Do you catch yourself looking at things from too much of a physician’s perspective, and then having to back off from that?

Bledsoe: A lot of people have asked me similar questions, and what concerns me a little bit is, is that there seems to be a narrative going around medicine today and health care today that clinical individuals are not the best people to be making decisions about the health care system because they’re so biased because they’re in it. And my response to that is simply that everyone approaches these health care issues with a bias. You look at an insurance executive. They have a bias. A government bureaucrat has a bias.

I really feel like my clinical background and my expertise in the world of clinical medicine is only an advantage when I’m looking at these health care issues. Now definitely, I think you need additional training. You need additional understanding of health care economics, but I would go so far as to say that it’s a lot easier for a clinical person to make that transition than it is for someone who has no clinical training, who simply studied, for instance, business or accounting, and try to make really good decisions regarding our overall health care system.

I do think that as a physician, it’s important that you use these other lenses to look at our health care system, but at the same time, I don’t think being a physician biases me so much that I feel like I’m having to correct it significantly.