Keep­ing the fo­cus on pa­tients

Team-based care, in­creased ac­cess add to a bet­ter med­i­cal home, pan­elists say

Modern Healthcare - - Opinions Webcasts -

Editor’s note: The fol­low­ing is an edited excerpt of the tran­script of a June 22 editorial we­b­cast, “Build­ing a Bet­ter Med­i­cal Home” con­ducted by Modern Health­care. The pan­elists were Dr. Karen De­Salvo, com­mis­sioner of health for the city of New Or­leans; Dr. Jim King, med­i­cal di­rec­tor of Prime Care Med­i­cal Cen­ter in Selmer, Tenn., and former pres­i­dent and chair­man of the Amer­i­can Academy of Fam­ily Physi­cians; and Dr. So­mava Stout, vice pres­i­dent of pa­tient­cen­tered med­i­cal home de­vel­op­ment at the Cam­bridge (Mass.) Health Al­liance. Modern Health­care reporter An­dis Robeznieks mod­er­ated the we­b­cast. The we­b­cast was spon­sored by El­se­vier Gold Stan­dard.

An­dis Robeznieks: I had heard some crit­i­cism that the pa­tient-cen­tered med­i­cal home is re­ally in fact a physi­cian-cen­tered med­i­cal home. Can you de­scribe how per­haps some prac­tices go astray in this man­ner, and can oth­ers avoid this pit­fall?

Dr. So­mava Stout: I think that the idea of a pa­tient-cen­tered med­i­cal home ini­tially grew of pe­di­atrics, which ac­tu­ally is where the model is about how you im­prove care for pe­di­atric pa­tients with chronic pe­di­atric dis­eases. And then it be­came a pri­mary-care work­force is­sue, as we saw providers weren’t—since pri­ma­rycare providers weren’t sus­tain­able in their prac­tice. And I think the con­ver­sa­tion sort of be­came re­framed about how to help pri­ma­rycare providers stay in prac­tice. What we found is it needs to be about both, and fun­da­men­tally hav­ing the fo­cus be about pa­tients and about cre­at­ing—think­ing about it as cre­at­ing sort of sus­tain­able hu­man in­fra­struc­ture, sus­tain­able teams that are shar­ing the care of those pa­tients, and em­pow­er­ing the en­tire team to not just see them­selves as be­ing as­sis­tants to the physi­cians, but as be­ing em­pow­ered to pro­vide care in a mean­ing­ful way to pa­tients has, I think, it’s been a huge—it’s a very dif­fer­ent mes­sage when you say it that way. But we found that we have to like that way too. So that means the in­for­ma­tion and med­i­cal knowl­edge that med­i­cal as­sis­tants or front-desk mem­bers bring, which we even­tu­ally found to be price­less.

Robeznieks: I have heard sto­ries too that the in­creased ac­cess that you talk about and the fast- track­ing of pa­tients, some pa­tients mis­in­ter­pret that as, you know, they’re used to the long waits, and then when they can see a doc­tor right away they think, ‘Well, maybe the prac­tice is in trou­ble and that’s why they can get in so quickly.’ And I was just won­der­ing if there were any other aspects of the med­i­cal home that per­haps pa­tients mis­in­ter­pret or don’t feel com­fort­able with right away?

Dr. Jim King: I’ve re­ally not heard any­thing neg­a­tive in any of the changes that we’ve had in our own prac­tice. Of course, I’m in a ru­ral town, so ev­ery­one knows me and knows my part­ners as well, so they know that we’re try­ing to make this change to add more ser­vices to them. And it is amaz­ing. You know, I gave the story of our fast-track pro­gram. I’ve hon­estly had pa­tients’ moth­ers who’ve come in and al­most were in tears thank­ing us be­cause, you know, they have two other kids to take care of, and just know­ing that we saw them at their time—we have tried to show that we care about their time is just as im­por­tant as our time is a very im­por­tant as­pect that the pa­tients ap­pre­ci­ates. They ap­pre­ci­ate us wor­ry­ing about their health in­stead of just try­ing to solve a prob­lem ev­ery once in awhile. Fam­ily medicine is one of the great­est things in the world. We’re one of the few groups that get to meet with our friends all day and maybe, just maybe, have a pos­i­tive im­pact on them.

Robeznieks: Does a med­i­cal home have to be pri­mary-care cen­tered or does a spe­cial­ist have a role?

Dr. Karen De­Salvo: The spe­cial­ists have a role in pa­tient-cen­tered med­i­cal home and par­tic­u­larly, as we’ve learned from the pe­di­atrics world, that they’ve been suc­cess­ful in us­ing that frame­work to de­velop spe­cialty-fo­cused med­i­cal homes for kids with ma­jor chronic is­sues. I think in adult pop­u­la­tions, if you think about in­di­vid­u­als on dial­y­sis, can­cer pa­tients, heart­fail­ure pa­tients, it’s clear ac­tu­ally that some of those spe­cial­ties have al­ready cre­ated team­based care in that kind of ap­proach. So, there are al­ready mod­els that ex­ist in the wild I’ll call it, and so ab­so­lutely this—what this gets down to for us in Louisiana is that it is a struc­ture for good pa­tient-cen­tered care that’s us­ing ev­i­dence-based pro­to­cols, that’s us­ing ev­i­dence­based think­ing, pop­u­la­tion-based ap­proach, high ac­ces­si­bil­ity and a team to wrap around pa­tients and pop­u­la­tions. We have too long marginal­ized that as a part of over­all health. It makes it clunky to build and pay for in pri­mary care, but there are some mod­els—not only in Louisiana but in other big in­sti­tu­tions like Kaiser and the VA—that are try­ing to bridge those two worlds fi­nan­cially and struc­turally so that pa­tients don’t have to have a gap in those ser­vices, that those hand­offs are warm hand­offs that hap­pen in a more in­vis­i­ble way and in a more pa­tient-cen­tered way than they have his­tor­i­cally.





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