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Practice Transformation Hinges on Adaptability to Change

Analysis  |  By Debra Shute  
   October 27, 2016

An initiative that aims to boost primary care delivery performance emphasizes efficiency and adaptability among providers.

"This isn't just a project; it's a transformation," says Sara Lander, MD, internist at Internal Medicine of St. Luke's in Chesterfield, MO, one of three sites selected by the Peterson Center on Healthcare to participate in an initiative to test a high-performance model for primary care delivery.

Launched last spring, the nonprofit Peterson Center, which describes itself as an "organization dedicated to making higher quality, more affordable healthcare a reality for all Americans," began working with three average-performing primary care practices.

In its Limited Market Test, Peterson faculty and other experts stay in close contact with the groups to help them apply a model derived from Stanford University's Clinical Excellence Research Center.

The idea is that once the test practices refine the model to suit their practice and patient needs, it will be easier and faster to replicate the model in more groups during ensuing phases of the project.

So far, the work of practice transformation has been intense but rewarding, says Lander, St. Luke's co-clinical lead for the project.

"We're doing this not just for Peterson, but we're doing this for ourselves and we're doing this for the long-term outcome," she says. "It's incredible what we've accomplished in the first six months."

The Gift of Efficiency
The model consists of 22 actionable modules based on 10 key characteristics of high-value providers, such as conscientious conservation, upshifted staff roles, and responsible in-sourcing.

Some of the most impactful changes for St. Luke's surround practice and staff efficiency. For example, a new medical assistant (MA) prep process gives MAs a larger role in filling gaps in care, thereby streamlining physicians' day and allowing them to spend more time on medical care.

To allow MAs to do more top-of-license work, the practice hired a clerical employee to handle faxes and other administrative tasks that took MAs away from patients.

Like many medical groups, the four-physician practice has struggled with physician dissatisfaction and staff turnover, says Lander.

Stop Ignoring Physician Burnout

"I think we're still in the process [of solving the problem], but using our staff efficiently and effectively makes our lives easier. We can really focus on the medical issues and taking care of the medical needs of our patients, which I think is really the joy of practice for a lot of us."

Readiness for Change
Much of the work Lander and her team are doing now, including improving efficiency, expanding patient access, and optimizing portal use is also setting the groundwork for the group to become a patient-centered medical home.

"I think it's going to put us at an advantage when we go through that transition," Lander says.

She also expresses confidence in weathering the shift to value-based care, including MACRA implementation. "We work a lot on meeting care gaps and standards of care, with focus on high blood pressure and diabetes control, for example. We have processes in place to ensure that we're capturing that and doing that care the best we can."

Evidence of Success
Predictably, the practice, which is part of St. Luke's Medical Group, is already seeing improvement in its patient and employee satisfaction scores.

But there have been qualitative wins, too, says Lander. "Our staff will tell you that there's more teamwork," she says. "People are doing less of what we used to call scut work."

What's more, the little wall at the checkout desk where staff members can post thank-yous and shout outs to coworkers is getting more crowded. "You can physically see there's this sense of teamwork and patient satisfaction that has really grown," Lander says.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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