Froedtert & the Medical College of Wisconsin, a network of three hospitals and 30 clinics, has intentionally avoided lumping women's health services together under one department and puts its focus on population health.
With all the attention primary care physicians get—their declining numbers amid an increased demand to cope with more insured patients and their leadership needed to accommodate the rise of patient-center medical homes—it is easy to overlook that obstetrician-gynecologists are facing similar pressures while providing similar care.
Like primary care providers, ob-gyn physician numbers are also falling. The American Congress of Obstetricians and Gynecology estimates a shortage of 9,000 ob-gyns by 2030. The declining numbers, says ACOG, are due, in part, to physicians retiring and to the cap on federally funded residency slots.
And just as primary care providers who are leading care teams, ob-gyns are stepping up as leaders to coordinate care for women. In some cases, the approach is trumping the care model that places women's health under one roof.
For example, Milwaukee-based Froedtert & the Medical College of Wisconsin, a network of three hospitals, including an academic medical center and 30 clinics, has intentionally avoided lumping women's health services together under one department.
"We're focused on population health," says JoAnne Hill, MD, JoAnne Hill, MD, medical director of care management and patient experience for Froedtert & the Medical College of Wisconsin's Community Physicians. "We're not doing something specifically for women. Our focus is to risk-stratify populations to deliver the most appropriate care."
Hill says the development of patient registries through its electronic health record allows physicians to catch gaps in care. If a woman misses a breast cancer screening, the physician knows, and can follow up quickly.
Holistic Care
"We continue to advance those registries so it's capturing more holistic care," says Hill. "We also know a lot more about them. We know if they're diabetic."
Diabetes is a particular area of research for Timothy Klatt, MD, head of the division of general obstetrics and gynecology and chief patient safety and quality officer. Klatt, who also sees patients, is at the center of health care for women.
He retains his focus on providing traditional ob-gyn care, but explains that because of focusing on women's health before conception, he is able utilize resources outside of that traditional sphere to care for his patients' health holistically.
"We get to meet the cardiologist, the endocrinologist, the neurologist, all the people in the different specialties," says Klatt. "We have not only professional relationships, but personal relationships that make the referrals and information flow work in the best interest of our patients."
Focus on Prevention
Klatt's focus on a woman's health before she becomes pregnant, specifically her blood sugars, is due to his interest in reducing preventable birth defects, such as cardiac and neural tube defects. The American Diabetes Association recommends a glycohemoglobin level of <6.0% before conception. If that level exceeds 7.0% the risk of birth defects increases.
Klatt says providers already have a good relationship with endocrinologists and other specialists who can help a woman who is already pregnant with high blood sugars. But he aims to coordinate care further with the system's primary care physicians because the birth defects can be deadly.
"From the referrals we get in, it's really disheartening to be on call in the middle of the night covering a transfer of a baby with a major cardiac problem and see that the mom's sugars were elevated at the time of conception, and think, 'That was possibly preventable.' That's where urgency for change is coming from," says Klatt.
The Clinical & Translational Institute of Southeast Wisconsin recently awarded Klatt a $25,000 grant that is aimed at reducing birth defects by identifying women with elevated blood sugar levels before getting pregnant, and by coordinating care with primary care providers, where appropriate. But in some cases, Klatt acknowledges, that an ob-gyn may be the de-facto PCP for women.
"The hard part for the primary care docs is they have to focus on so much," says Klatt. "A diabetic specialist may be so focused on her kidneys or other aspect of the diabetes that they just miss she's not effectively preventing pregnancy."
Data Mining
Highly coordinated care at Froedtert & the Medical College of Wisconsin is the norm. Nearly all of the system's 27 primary care practices are recognized by the NCQA as Level 3. Primary care providers, like Hill, are routinely diving into the EHR to identify care gaps.
Klatt's grant will dive even deeper to "mine" the database to find women, aged 18-45 with high blood sugars, and make that information available real-time. A preliminary look at the data showed more than 600 women who fit that profile.
The ultimate goal is to reduce preventable birth defects. But by working across specialties, Klatt may end up being an alternate door to enter the health care system, at least for women.
"Who knows where we get to touch the patient in our healthcare system?" says Klatt. "Sometimes the first time we catch them is when they come on a helicopter through our ER."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.