David Blair combines duties of doctor and administration
Blair is one of the leaders taking Advantage Health, which has 19 offices and clinics from Sparta to Caledonia and 117 primary care physicians, down a new path.
As the health care environment changes — with continued economic pressure, pending health care reform and Spectrum Health's creation of its own medical group — Advantage Health is responding with another business model. A new part of the business will link medical practice business functions and clinical support functions, not only for Advantage Health's primary care physicians staff but also for primary care doctors who are not part of Advantage Health and for local specialists who practice primarily at Saint Mary's Health Care.
"We really are out to build an organization that is very tightly aligned and intentional about the process of care, but we are not out to employ every physician in the process," Blair said.
The Clinical Integration Organization is governed by eight physicians, he said. Four are primary care doctors, four are specialists; four are employed by Advantage Health and four come from the 80 to 100 represented in the 17 specialist groups that currently contract with Advantage Health. Blair will be medical director.
The changes ahead for Advantage Health are another step along what he calls his "evolutionary" career — from residency at Saint Mary's to leader of its growing cadre of physicians without ever changing jobs.
Born in Midland, Blair grew up as the eldest of three sons born to Etcyl Blair, a Ph.D. chemist for Dow Chemical Co. and a violinist, and his wife, Ruth, a homemaker. He's the only one with a health care career.
"Interestingly, I never thought of being a doctor when I was growing up," Blair said. "My father was a chemist. I went to college thinking I was a chemist. … After my freshman year, I said, 'Well, I'll go ahead and major in chemistry, but I'm going to use it to help me do something more working with people.'
"Science was what I was good at, but what I wanted to do was work with people. I enjoy interacting with people, so I knew I wanted to do something that had a lot of human contact."
DR. DAVID BLAIR
"This is where I wanted to come," Blair said. "Grand Rapids actually seemed to have a nice balance between being a large enough community to have a diverse, interesting set of things to do (while) at the same time not being so big that you just felt like you were in this concrete world.
"I grew up in a small town. I went to medical school in a great, big city. I didn't want to go back to a small town, but I didn't want a city as big as Detroit. I wanted something in between, and Grand Rapids fit very nicely," Blair said. "I never regretted the choice for a single day."
The federal Health Maintenance Organization Act of 1973 brought a new approach to health care in the U.S. called "managed care." Blair started his primary care practice at the same time that HMOs brought managed care to West Michigan. During his second year in practice, Blue Cross Blue Shield of Michigan's Blue Care Network arrived in Grand Rapids.
"My practice grew rapidly with these patients in this HMO. And I have been busy with managed care patients," he said.
The concept of managed care has taken a beating over the years, with critics arguing that it sometimes encourages cost-savings over prudent health care. But Blair disagreed.
"It's never been a bad word to me; it's always been a good word," he said.
Blair became involved with BCN's quality improvement committee early on.
"I like to plan into the future and so I like to get my head around projects and ideas and trying to create improvement and change," he said.
In the mid-1980s, the forerunner to Saint Mary's owner Trinity Health started an HMO called Care Choices. Blair became its quality committee chair and, in the 1990s, he was named medical director. That is when he reduced the time devoted to his practice and increased the amount of time he spent on administrative duties.
With the advent of Advantage Health, which is owned by Saint Mary's and governed by a committee of its administrators and doctors, Blair became vice president of clinical services there. Five years ago, he was named president.
Today, Blair devotes about 30 percent of his working hours to his primary care practice — rounding in the hospital, fielding phone calls and prescription requests and seeing patients in office visits. His days begin and end with his patients.
In addition to being a part of the job that he enjoys, Blair said maintaining an active practice also fuels his leadership post.
"It allows me to continue to have credibility with my physician-partners who otherwise would think I don't really understand what they face," Blair said. "I live with the same models (of care) they do. It helps inform my relationships with the specialists because they know I really am involved. I see patients; I send them patients. I understand how they practice with patients and it keeps me very actively involved.
"And I begin to understand some of the opportunities to create change that we think can improve this health care model we have in the country."
Blair describes himself as an "inclusive" administrator.
"Nobody necessarily has it perfect. So we all have to work with each other," he said. "I certainly don't have all the good ideas; in fact, I've only got a limited set of ideas. What I look at is how do I bring out the excellent skills of others. I see my job as mostly helping other people do their job, and they help the whole organization move from good to great. … I see a lot of strengths in people and want to help coordinate and understand those."
With the new orientation and a wider net of physicians, Blair said he thinks patients will notice only an improvement in the "user-friendly" system, with more seamless communication between primary care and specialty offices.
What they won't see is the heavy lifting in the background as Advantage Health finds a place in a health care system that is moving toward more integration to cope with reform at both the state and nationals levels. What those reforms will be and how they will shape health care is still unclear, but politicians are expected to be debating and voting on bills this summer.
"One of the things that we're recognizing is that the payment model from the government is likely going to change," Blair said. "We're anticipating in the next two months that there may be new legislation out of Washington that may create a very different model. When you start to talk about bundled payments, which is one of the things they're talking about, we will need to have our physicians in relationships with each other so we actually have conversations about how do we unbundle this payment so that everybody gets an appropriate share of this.
"If the government moves to a model that goes back toward what capitation was 25 years ago and 20 years ago — global capitation — in the past, the IT infrastructure wasn't there to manage that sort of thing. There's much better infrastructure for this."
Blair said he looks to his 86-year-old father as a mentor.
"He was excited to start every day. He was positive practically all the time. He was very much can-do, full of energy, ideas, creative — still is," Blair said.
The father of three young adults and his wife, Cheryl, a doctoral-level educator with the Kent Intermediate School District, plan to celebrate their 25th wedding anniversary this year with a Mediterranean cruise. Travel is something that Blair enjoys, when he has time. An aficionado of U.S. National Parks, Blair jogged and hiked until knee arthritis sidelined that fun.
The doctor practices what he preaches, however; he still works out and he weighs the same as when he graduated from college.
"I still practice in the hospital that I started training at 30 years ago," he added. "I have professional colleagues I've had for 25 years. So I've never had a different job in the sense that I'm still part of the same organization. I've moved and evolved as the organization has grown."