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Isn't it time to become the STAR of your own HEALTH?

Patient-centered medical home philosophy boosts patient, physician satisfaction

UCLA-USC intervention could encourage more new docs to enter primary care

By Enrique Rivero October 08, 2013

The common refrain about health care is that it's a broken system. A new joint program between UCLA and USC demonstrates a way to mend the system with a new patient-centered program that is getting rave reviews from patients and from the residents and nurses who provide their care.

 

The program, Galaxy Health, debuted at Los Angeles County+USC Medical Center in 2012 with the goal of substantially improving an on-site clinic for residents and demonstrating to county officials that intuitive and inexpensive interventions can dramatically improve patient care and physician and staff morale.

 

A new UCLA–USC study published online in the JAMA Internal Medicine, a peer-reviewed journal of the American Medical Association, outlines how the Galaxy model works in a public setting, with a favorable effect on both patients and medical residents.

 

"We all know that fewer and fewer young physicians are choosing careers in primary care because of the difficult work schedules, lack of support and lower salaries," said lead study author Dr. Michael Hochman, who conducted the research as a Robert Wood Johnson Clinical Scholar in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. "What we did here was to move in the direction of a team-based approach, and it resulted in improved satisfaction for physicians-in-training with their primary care experiences."

 

Dr. David Goldstein, an associate professor of clinical medicine at USC's Keck School of Medicine and chief of the division of geriatric, hospital, palliative and general internal medicine at LAC+USC Medical Center, was the study's senior author. He conceived the Galaxy Health program.

 

"My hope was that Galaxy would reveal that a minimal investment and reorientation in delivery focused on the patient and enhanced access to care could improve the satisfaction of patients, staff and physicians, even in an underfunded public environment," he said. "I think it worked out well. It's not rocket science."

 

The Galaxy model established round-the-clock, seven-day-a-week access to physicians, made urgent clinic appointments available within hours and coordinated care in the ambulatory environment. It was based in part on increasing interest in a concept known as the patient-centered "medical home," which provides a team-based, coordinated approach to care that aims to make the primary care team central to the patient’s health needs. While the concept may not sound that different from the traditional vision of high-quality primary care, Galaxy's innovation is making this vision a reality in a complex, disconnected health care system.

 

"Galaxy Health has proven its value and effectiveness, as measured by patient satisfaction, access to care and provider satisfaction, in an incredibly challenging clinical environment," said Christina Ghaly, interim CEO of LAC+USC Medical Center. "Its remarkable success is to the benefit of our patients at LAC+USC Medical Center and can be a model for other safety-net, resident-run clinics struggling with implementing patient-centered medical homes."

 

The project was funded primarily by a three-year, $750,000 grant from UniHealth Foundation.

 

The study findings also support further investment in primary care, particularly in teaching settings, where the next generation of primary care leaders will be developed, said Hochman, now medical director for innovation at AltaMed Health Services, a large federally qualified health center in Southern California. There is currently a shortage of primary care physicians, and the situation is expected to become more acute as baby boomers continue to reach retirement age.

 

The researchers conducted their study at three primary-care internal medicine clinics at LAC+USC, an urban academic medical center serving a safety-net population. They focused on expanded access to care, enhanced care coordination and team-based care. Galaxy Health included the creation of a call center staffed by two care coordinators, telephone renewal of prescriptions and the availability of up to five urgent care appointments each day.

 

Input from patients and staff during prior focus groups was incorporated into the study. The researchers surveyed patients and residents before the intervention and again one year later. They also analyzed emergency room and hospital visit rates.

 

Though the clinics did not satisfy all the elements needed to qualify as a patient-centered medical home, overall their score jumped from a previous 35 to 53 out of 100 possible points. The satisfaction rating from patients increased from 48 percent to 65 percent in the intervention clinic, compared with a jump from 50 percent to 59 percent in the controls. Patients were particularly pleased with access. Satisfaction with urgent appointment scheduling increased from 12 percent to 53 percent in the intervention clinic, compared with an increase from 14 percent to 18 percent in the control clinic. 

 

The composite satisfaction score for residents went up from 39 percent to 51 percent in the intervention clinic but fell in the control clinic from 46 percent to 42 percent.

 

The study noted that emergency room and hospital visits were not reduced.

 

"This was an anticipated finding, because we expanded access to care to an underserved patient population, and frequently when this happens, there's a spike in emergency and hospital room utilization," said study co-author Dr. Arek Jibilian, assistant professor of clinical medicine in the Keck School's division of geriatric, hospital, palliative and general internal medicine. "However, we believe that a sustained commitment to primary care will ultimately reduce emergency and hospital utilization, and this is something we hope to see as the program continues."

 

Study co-authors are Steven Asch, Arek Jibilian, Bharat Chaudry, Ron Ben-Ari, Eric Hsieh, Margaret Berumen, Shahrod Mokhtari, Mohamad Raad, Elisabeth Hicks, Crystal Sanford, Norma Aguirre, Chi-hong Tseng, Sitaram Vangala and Carol M. Mangione. Additional contributors include Becky O'Neal and Roman Corral.

 

The demonstration was primarily funded by the UniHealth Foundation in Los Angeles. In addition, the study was funded by grants from the Robert Wood Johnson Clinical Scholars Program; the U.S. Department of Veterans Affairs (grant 67799 to UCLA); the UCLA Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA Grant P30-AG021684; and the NIH/NCATS UCLA CTSI (grant UL1TR000124).

 

The Keck School of Medicine of USC , founded in 1885, is among the nation's leaders in innovative patient care, scientific discovery, education and community service. It is part of Keck Medicine of USC, the university's medical enterprise, one of two USC-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has more than 1,500 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and postgraduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or sub-specialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as the USC-affiliated Children's Hospital Los Angeles and Los Angeles County+USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Eye Institute and the USC Institute of Urology.

 

General Internal Medicine and Health Services Research is a division within the department of medicine at the David Geffen School of Medicine at UCLA. It provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work. The division's 100-plus clinicians and researchers are engaged in a wide variety of projects that examine issues related to access to care, quality of care, health measurement, physician education, clinical ethics and doctor–patient communication. The division's researchers have close working relationships with economists, statisticians, social scientists and other specialists throughout UCLA and frequently collaborate with their counterparts at the RAND Corp. and Charles Drew University.

 

The Robert Wood Johnson Foundation Clinical Scholars program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policymakers on issues important to the health and well-being of all Americans. This program is supported in part through a collaboration with the U.S. Department of Veterans Affairs.

http://newsroom.ucla.edu/portal/ucla/patient-centered-medical-home-248773.aspx

Improving Health Care, Controlling Costs – Rutgers Launches New Initiative

One key factor sets Robert Wood Johnson Partners apart from other attempts at reform – the Accountable Care Organization has the power of a major research university behind it

Monday, October 7, 2013

By Andrea Alexander

Credit: Nick Romanenko

Nurse Donna Bonavitacola assists as Alfred Tallia examines Barbara Carcich.

'This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care. This was not possible before. Now we have all the pieces under one roof.' – Alfred Tallia

 

Meet the some of the collaborators and researchers behind Robert Wood Johnson Partners:

 

Lynn Clemow, a clinical associate professor in the RWJMS Department of Family Medicine and Community Health, coordinates a program to place graduate students from the Department of Psychology and the Graduate School of Applied and Professional Psychology at the Monument Square primary care practice. The graduate students work with patients to quit smoking, take their medicine and on more traditional mental health issues. "Mental health services are a nightmare of poor reimbursement and poor access,'' Clemow said. "This cuts through the stigma of seeking out services and having to call an 800 number, talk to a clerk about your issues and get a list of providers, many of whom arent taking patients or on the plan anymore, Clemow said. About 15 percent of patients recommended for mental health services outside the office make an appointment, but closer to 90 percent of patients do in an integrated system, she said. "Depressed people don't take as good care of themselves, they don't take their medications because they don't seem to have the energy to do that, Clemow said. "If you treat the depression, everything works better.''

 

Xiaomu Zhou, an assistant professor in the School of Communication and Information, wants to study how access to information through the patient portal can improve communication between patients and doctors. "I want to understand how information technology can be designed to provide more information access to patients, facilitate communication and lead to better health outcomes,'' Zhou said.

 

Professors Kang Li and Susan Albin, in the School of Engineering, will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. "The availability of services from a patient care coordinator could reduce patients frustration obtaining care, fulfill doctors’ plans for how best to help the patient, and reduce the cost burden on the whole community with fewer emergency room visits and hospital admissions,'' said Albin, a professor in the Department of Industrial and Systems Engineering.

One Rutgers, A World of Discovery

The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In an online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond.

– The Editors

During nearly three decades as a primary care physician, Alfred Tallia has identified a daunting list of flaws with the nation’s health care.

Specialists rarely coordinate care for patients with chronic illnesses such as diabetes and high blood pressure – which can lead to repetitive, expensive tests.

In most doctors’ offices, no one is responsible for developing plans with patients to lose weight, exercise and change their diet – or for following up with those patients to help them meet their goals.

But Tallia, chair of the Department of Family Medicine and Community Health at Robert Wood Johnson Medical School – now part of Rutgers – is getting ready to launch a solution he believes will deliver more effective care at a lower cost.  

“The idea of improving quality and controlling costs, that is something here to stay,’’ Tallia said. “We can’t keep spending 18 percent or more of the Gross Domestic Product on health care, not cover everybody and have disappointing outcomes. That is what we have now.’’

Tallia is spearheading the creation of an Accountable Care Organization, called Robert Wood Johnson Partners, that will coordinate treatment among doctors, other health professionals, and hospitals through better use of electronic health records. The project also involves restructuring doctors’ offices to improve communication with patients, and directly involve them in developing plans to benefit their health.

Although similar efforts have been rolled out around the country since health care reform became law in 2010, one key factor sets Tallia’s work apart :

Robert Wood Johnson Partners has the power of a major research university behind it.

Tallia and others in the medical school – in partnership with Robert Wood Johnson University Hospital and Health System – are teaming up with researchers across different disciplines at Rutgers to find the best ways to improve care and curtail costs. This includes the School of Engineering, the Department of Psychology, and the School of Communication and Information.

Credit: Nick Romanenko

Physician Alfred Tallia at Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square.

 

“The reason for Robert Wood Johnson Medical School and Rutgers to be involved is to answer the many outstanding questions about how a system should work,’’ Tallia said.  “We are in the best position not only to deliver care, but to also do the research to make it better.’’

For example, a professor in the School of Communication and Information plans to study the use of a patient portal, an online information hub that would allow patients to access test results and other health information. The technology will also allow patients to schedule appointments, request or renew prescriptions, pay bills and ask questions about their care.

Graduate students from the Department of Psychology in the School of Arts and Sciences and the Graduate School of Applied and Professional Psychology will work in a primary care practice to help patients quit smoking, improve eating habits and address other behavioral health issues.

And professors in the School of Engineering will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. The person in this position would be dedicated to helping patients adhere to plans for their health – which could involve communicating with pharmacies to make sure prescriptions are filled, keeping tabs on exercise plans and coordinating appointments.

“Part of what the engineering department is going to do is help us make our care more efficient so we can spend more time on things that really matter,’’ said Elizabeth C. Clark, an assistant professor in the RWJMS Department of Family Medicine and Community Health.

“If doctors are spending less time doing paperwork they will have more time to spend with patients,’’ Clark said.

The medical schools, nursing, pharmacy, and other professional programs at Rutgers can also build on lessons learned to train a team-based workforce suited to meet the health care needs of the future, Tallia said.

Brian L. Strom, the incoming chancellor of Rutgers Biomedical and Health Sciences who is also a primary care physician, echoed concerns about the health care system and called Tallia a “national leader in this area.’’

“As a nation, we need to move away from an episode-based disease management system,’’ Strom said.

“This will require a multidisciplinary approach to population health, and a multidisciplinary approach to evaluating the new models of care that emerge, like the ACO planned by Dr. Tallia. Rutgers, with its depth and breadth across health and non-health fields, is enormously well positioned to be a leader in this field."

A Timeline for Providing Care

Robert Wood Johnson Partners is seeking approval to start treating Medicare patients early next year. The Affordable Care Act encourages the creation of such Accountable Care Organizations for Medicare patients, but most have been developed around hospital systems.

Rutgers would be one of the first academic institutions to launch such an organization, Tallia said.

Tallia is also talking to some of the state’s major health insurance companies including Horizon Blue Cross Blue Shield and Aetna to expand into a statewide organization next year called Rutgers Health Partners.

In the meantime, the Robert Wood Johnson Partners would be modeled on the restructuring of Rutgers Robert Wood Johnson Medical Group’s Family Medicine office at Monument Square in New Brunswick. The primary care practice, which is part of the Robert Wood Johnson Medical School, has been organized into a “patient-centered medical home,” where medical providers share information and work with patients to closely coordinate care.

Nearly 30 additional primary care practices have signed contracts to participate in the upcoming rollout of Robert Wood Johnson Partners.

The partnership would also include the 500 specialists in the Rutgers Robert Wood Johnson Medical Group along with clinicians on staff at Robert Wood Johnson University Hospital and the other hospitals within Robert Wood Johnson Health System.

Medicare and insurance companies offer financial incentives for such reform efforts that meet benchmarks for improving care while moderating costs. Participating doctors, hospitals, and other providers would receive a share of the savings. And in Robert Wood Johnson Partners, patients may also share in the benefit.

A Difference Patients Will Notice 

What this will mean for patients is seamless care, much like the experience Lou and Barbara Carcich have with the doctors at Monument Square, where some of the changes have already been introduced. When Barbara Carcich went for a follow up visit after a hospital stay, the doctor had all the information about her illness and treatment at his fingertips.

“I didn’t have to go through the whole thing again: why I went in, what happened,’’ said Carcich, of Somerset. “You know the information you usually have to retell, it was all there. My doctors in the hospital communicated and all care was coordinated with Dr. Tallia and his nursing team at Monument Square."

And Lou Carcich finds it reassuring that Tallia and his cardiologist receive the results of his blood work simultaneously. “I feel very confident and comfortable knowing that I have two doctors working for me who are both on the same page," he said.

What the Somerset couple doesn’t see is the coordination behind the scenes. Tallia and the cardiologist both have access to Lou Carcich’s electronic medical records. If there is an issue Tallia wants the cardiologist to look into, he can make a note in the record for the cardiologist.

Tallia and other members of his team are looking forward to forming new partnerships with faculty from other academic units and research institutes at Rutgers – including the College of Nursing, the School of Social Work, the Edward J. Bloustein School of Planning and Public Policy, Rutgers Center for State Health Policy and all the units of the new Rutgers Biomedical and Health Sciences – as Robert Wood Johnson Partners moves ahead.

“This is one of the first tangible benefits of how the new Rutgers is going to serve the state of New Jersey in health care,’’ Tallia said. “This was not possible before. Now we have all the pieces under one roof.’’

http://news.rutgers.edu/feature/improving-health-care-controlling-costs-%E2%80%93-rutgers-launches-new-initiative/20131006#.UlKy71CsiSp

Arizona insurers must pay for telemedicine

Angela Gonzales

Senior Reporter-Phoenix Business JournalJun 4, 2013, 6:00am MST

Gov. Jan Brewer has signed the Telemedicine Reimbursement Parity Act into law, requiring telemed services in rural areas of Arizona to be covered by health insurance.

Beginning in 2015, insurers must cover services provided through the telemedicine service programs if the insurers pay for those same services when they are provided in a traditional clinic or hospital setting.

The Arizona Legislature established the Arizona Telemedicine Program in 1996, which now links 70 Arizona communities at 160 sites, said Dr. Ronald Weinstein, co-founder and director of the program.

“Our telemedicine program is a critical link to health care,” he added. “We primarily are devoted to improving access to specialized medical care throughout the state of Arizona.”

The new law defines telemedicine services as the delivery of health care, diagnosis, consultation and treatment, and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient.

Kathi Beranek, manager of government relations and public policy for Blue Cross Blue Shield of Arizona, said BCBS worked closely with advocates on the terms of the bill.

“Looking toward 2015, the bill will allow more people, especially in rural communities, access to better care combined with potential cost savings,” she said.

Aetna Inc. : Aetna Launches Patient-Centered Medical Home Program in New York

05/20/2013| 12:55pm US/Eastern

-- Rewards Primary Care Physicians for Improved Patient Care Coordination --

Aetna (NYSE: AET) announced today the launch of its Patient-Centered Medical Home (PCMH) program in New York. The program recognizes primary care physicians (PCPs) who more actively coordinate and manage their patients' care across the health care system. By strengthening the role of PCPs, the PCMH program aims to improve patient health outcomes.

"Patient-centered care is something Aetna has always advocated. Our PCMH program rewards PCPs who focus on the patient's entire health needs, not just a single condition," said Elizabeth Curran, head of National Network Strategy and Program Development for Aetna. "As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care, and greater engagement. The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes."

Primary care providers who participate in Aetna's networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna were considered for the PCMH program in New York. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

• Improved access to care, such as the ability to reach health professionals outside normal business hours;
• Proactive and planned preventive care (screenings, physicals, labs);
• Improved access through e-mail, web or telephone visits; and
• Access to nurses and other health care professionals, allowing more focused physician visits.

Aetna serves 880,000 commercial members in New York. More than 200 physician practices are currently part of the growing program.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

Aetna

Media Contacts:
Susan Millerick, 860-273-0536
MillerickS@aetna.com
or
Tammy Arnold, 860-273-8553
arnoldtd@aetna.com