The Extensivist Model
By one estimate, incorporating extensivists fully into the primary care system could save 6% of U.S. spending on healthcare.
This article first appeared in the September 2016 issue of HealthLeaders magazine.
With primary care physicians already stretched to the limit but still facing demands to pay more attention to the patients requiring the most time and resources, some healthcare organizations are embracing an extensivist model that uses specially trained physicians and advanced practice registered nurses to provide comprehensive and coordinated care to patients with multiple complex medical issues.
Extensivists typically take their scope of practice beyond the hospital and into the home or other settings, with a focus on keeping patients healthier and reducing readmissions.
Some organizations incorporate extensivists into their primary care lineup, while others operate separate full-service clinics with extensivists, usually with small patient panels to allow a more intense focus on each patient. The impact of extensivists can be significant, with the global management consulting company Oliver Wyman estimating that incorporating them fully into the primary care system could save 6% of U.S. spending on medical care.
An extensivist model can address one of the biggest threats to patient safety and optimal outcomes—the patient handoff, says Arnold Milstein, MD, MPH, director of the Clinical Excellence Research Center at Stanford (California) University and medical director with the Pacific Business Group on Health, a not-for-profit business coalition based in San Francisco.
Milstein first came across the extensivist approach in the CareMore Model, developed by the CareMore health plan focusing on senior care. The model focuses on reducing the risks from handoffs and improving care after discharge. CareMore is an HMO/HMO SNP plan with a Medicare contract, based in Cerritos, California.
"Primary care doctors generally are not set up to respond to urgent occurrences, waiting for the patient to call them and feeling responsive if they can schedule the patient within a week of discharge," Milstein says. "With older patients, and especially with the shorter inpatient stays that are common now, they have a lot of needs after discharge and they can get in serious trouble fast."