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Primary Care Finds a (Medical) Home

Joe Cantlupe, for HealthLeaders Media, June 13, 2013
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Under an ACO, physician groups and hospitals leverage their resources to tap into services ranging from case management to nutrition. "We are a group of docs coming together for a shared goal. We view the patient-centered medical home as the center of our ACO," Dom Dera says. With preventive care as a major focus, the physicians group partnered with Emmi Solutions, a Chicago-based patient engagement communications company, to nudge diabetic patients who need yearly retinal eye exams. Physicians made calls to patients to encourage them to obtain eye checkups.

"It was important that these calls were personal and from the physicians, and the patients' feelings were 'Hey, this message is coming from my doctor,' " says David Littlejohn, RN, quality improvement director of the Summa Health Network. "Still, we weren't sure what the impact would be. But we were very surprised and pleased."

Over a six-week period in September and October 2012, the Ohio Family Practice Centers physician group showed a 13% improvement in retinal eye exam rates, based on 523 patients with diabetes. The percentage of patients contacted by Emmi that either updated their records or scheduled appointments was calculated at more than 22% based on responses from 24 of 105 people.

Success key No. 3: Improved patient satisfaction

Physician groups are developing their own medical home programs and increasing patient satisfaction.

 That is happening at Cornerstone, a High Point, N.C.–based physician-owned multidisciplinary practice of more than 360 doctors and midlevel health professionals in more than 85 locations in central North Carolina, serving a population of 200,000.

 For Cornerstone, improved patient satisfaction has been the result not only of coordinated care but also homing in on patient response to that care. Cornerstone's medical home focuses on recruiting more adult Medicaid and low-income Medicare patients, most of them with complex and costly illnesses.

 Like physician medical home teams elsewhere, Cornerstone employs a support team that ensures longer one-on-one appointments with patients. With the extra time, the health professionals provide in-depth disease education or stress counseling as part of their services, if needed, according to Michael Ogden, MD, chief clinical integration officer at Cornerstone.

 Using electronic medical records, primary care physicians on the support team receive periodic updates about all their patients, enabling the doctors to quickly identify aberrations in blood pressure, blood sugar, or medication reconciliation that might be a concern. Cornerstone also operates what Ogden terms "transformational models" that include the clinics that serve the polychronic patients and provide dietary or social work specialists and psychologists who coordinate care with nurse navigators. "A psychologist spends a lot of time figuring out ways to overcome barriers to good health," he adds.

Cornerstone made its improvements after several failed attempts at boosting patient satisfaction scores, realizing it needed a more concentrated approach to ensure success. So, several years ago, Cornerstone first surveyed patients to understand how they viewed their patient experiences, examining responses from 360 providers in 85 locations, serving a population base of 200,000. They set a goal of improving patient satisfaction scores by 10% each year, he says.

The sample size for the patient satisfaction surveys has been from 250 to 400, Ogden says. "We have been paying attention to patient satisfaction especially the past two years," he adds. "For the entire team the focus is to have the best experience possible."

 Attaining good patient satisfaction only results with continued improvements in the "culture of the primary care practice," Ogden says. That culture focuses on follow-up care, such as "identifying patients who have gaps in care, the diabetic who doesn't have the eye exam or foot exam."

 Cornerstone committed to improving patient relations by paying attention to what may seem like small customer service details. Scripts for phone messages to patients were rewritten. When patients waited in physician offices, employees would come out from behind their desks to notify patients periodically about the delays. New name badges were distributed that prominently showed the first name of a provider.

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