Telling the Patient No
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The ultimate strategy for Piedmont will be to move to a single inpatient and outpatient database, which is two to three years away.
“In the meantime, there are workarounds if we can get the data and produce it in the right manner.” Piedmont currently uses a claims-based system that helps it retrieve critical data, even if it’s not in the most user-friendly format yet, says Sams.
“We’ll make do with it until we can get to a single database,” he says. “If you put docs in a room and say, ‘Okay, let’s keep an eye on what’s best for the patient,’ that seems to work pretty well.”
Piedmont is also involved with a limited primary care initiative on the medical home with Cigna, the Philadelphia-based payer. Through care coordination and management of referrals, the theory is that savings will result, and Piedmont will participate in those shared savings. The end of June will mark one year in the program, at which time Cigna will evaluate Piedmont’s quality and cost data compared to the rest of the Atlanta market.
If any health system has integrated evidence-based medicine and the concepts of the patient-centered medical home, it’s Dartmouth-Hitchcock Medical Center in Lebanon, NH.
“To help us understand our population and the illness burdens of those populations, we have been working with our clinical physician champions to develop evidence-based clinical content around those diseases,” says Barbara Walters, DO, the senior medical director for Dartmouth-Hitchcock. “Then we worked with the healthcare delivery team to develop a best care process pathway that would support evidence-based practice.”
When a health system does that groundwork on the most prevalent disease states, Walters says, it begins to get a lot of overlapping processes that apply to many diseases. That information can lead to a patient-focused “super-registry approach,” she says, “where you’re developing an infrastructure that organizes data in such a way so that you’re able to get a snapshot of what they need when they come in based on their disease.”
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