By the year 2020, when many in my generation of physicians are no longer practicing, healthcare will look very different due to the Affordable Care Act (ACA). The road ahead will require a lot of collaboration between physicians, hospitals, health plans, patients, and more. Physician leadership is now needed and wanted at all levels. And I think it is very important that younger physician leaders—the physicians who will actually be practicing in the future—join in the planning for and leadership of that future.

I am never surprised at just how talented and well-rounded physicians are. And I am not just talking about physicians that I work with, but all who successfully navigated med school.  So the question is not whether there are enough good young leaders, but how they can most effectively be engaged and then empowered to lead?

Back in the old days medicine was practiced through home visits.  In the early 20^th century, as healthcare became institutionalized and medical insurance replaced ‘pay-as-you-go’, home visits became a thing of the past. Today there are a multitude of factors that are giving the practice of home visits a second look, and I think this is a positive development.

Rapid advances in mobile technology open the door to health records and devices that previously could not have been accessed in a home such as blood tests, monitors, collaborating with digital photos, and even x-rays. For patients who are in-between needing the services of a SNF yet need care and have a difficult time getting to the provider, a home visit can be much more effective than a phone call.

The patient navigator shows how a small scale change and modest expenditure could quickly yield improvements in ED resource utilization while at the same time providing much needed support to patients. This could be a “win win” for patients, hospitals and ED staff.

Patient navigator programs, an example of which is currently in use at Sutter Health emergency departments in Sacramento, attempt to broaden the help given to ED patients. The program at Sutter General and Sutter Memorial Hospitals is still very new, with the pilot phase just completed in the fall of 2011.  It places patient navigators, usually trained social workers, in the ED.  Their job is to assist patients who do not have access to follow-up care.