As part of the Alternative Payment Model (APM) Pilot, clinics have been taking part in a learning collaborative focused on Advanced Care Models (ACM). This blog is going to profile some of the ACM topics being discussed by the group and how the clinics are going about implementing new approaches.
What if the person giving you medical advice was more like your friend or a trusted mentor and you weren’t limited to 5 minutes? That’s the idea behind an approach called “health coaching” that is spreading in the world of primary care to help patients understand their chronic conditions and learn self-care.
Health care has four principles that are considered the “golden rule” of ethical care: beneficence, non-maleficence (i.e., do no harm), respect for patient autonomy, and justice. Many have said that our current system of care does not allow doctors and other health care providers to actually achieve these four principles—and that’s one of the reasons some systems are establishing health coaching for their patients.
Too often, it is low-income or ethnic minority patients who have the most barriers to understanding clinical information provided by a physician. Coaching shifts the care model—instead of a brief visit with a clinician being the source of all information, the critical health information comes from a support person, who is given more time, is trained in communicating well, and can make a personal connection with the patient. Continue reading A New Paradigm: Health Coaching to Manage Long-Term Health
By Glenn Kautz, MPH
It’s been estimated that upwards of nine million Americans now have health insurance as a result of the Affordable Care Act (check out this impressive visualization). While it is clear that more primary care physicians are needed to meet the demands of this newly covered population, of equal importance is the type of primary care physician that is needed. Primary care physicians of the future will need diverse skillsets in areas such as behavioral health and community organization, along with strong analytic skills to effectively care for their patient populations.
Alternative Payment Models (APMs) highlight the need for such a primary care physician, as individual clinics and groups find innovative ways to deliver quality care more efficiently. Approaches utilizing Population Health Management, Health Information Technology and Quality Improvement necessitate physicians trained in disciplines such as statistics, finance and informatics.1,2 With training in analytic fields, physicians are able to collaborate with experts and generate solutions to complex problems incorporating patient-, clinical- and population-level elements through an analytic lens. Armed with such skills, physicians will also possess the knowledge needed to advocate for more effective payment models that facilitate the best care for their communities.
Continue reading Counting on Analytically-Minded Physicians
Today we are featuring some links focusing on primary care:
- Medical Care published a special supplement, featuring articles discussing the Safety Net Medical Home Initiative: “a multistate, multiyear initiative to bring the medical home model of primary care to the most vulnerable U.S. populations, including low-income and underserved communities.”
- Our research collaborators at Oregon Health & Science University and Kaiser Permanente Center for Health Research published an Op Ed in The BMJ. They discuss the Oregon Experiment and how increasing access to primary care will improve health.
- A recap of Oregon Health and Science University’s Center for Health System Effectiveness conference on Health Care Reform
The next wave of health centers has come on board to the Alternative Payment Methodology (APM) pilot. The APM pilot is a health care payment system where Medicaid pays participating community health centers a set amount per patient per month for each enrollee, whether or not the person seeks care. For the past year, our research team has been studying the first wave of APM clinics; we are trying to understand whether this shift in payment is changing the way clinics provide care. Now a whole new group of centers will be tackling these important changes.
The first phase of the pilot program started in March 2013 with three Oregon Community Health Centers: Virginia Garcia Memorial Health Center, Mosaic Medical, and OHSU Family Medicine at Richmond. These first three APM care systems actually worked with the state and other organizations to develop the model. Now, in Phase II of the APM pilot, five more health centers are starting to implement APM: Coastal Family Health Center in Astoria, Community Health Centers (CHCs) of Benton and Linn Counties, Multnomah County Health Department in Portland, OHSU Scappoose in Scappoose, and Yakima Valley Farm Workers in Yakima Washington.
The second-phase APM adopters represent a range of regions and health center sizes. For example the Coastal Family Health Center in Astoria is a small, semi-rural clinic, but their managed care organization was interested in becoming part of the pilot. Multnomah County, on the other hand, is a big health center treating an urban population. Yakima Valley Farm Workers Clinic, which has several Oregon sites in addition to Washington, is the first clinic to start the APM with a different Electronic Health Record (EHR) system. All of the health centers voluntarily chose to participate in the pilot.
Continue reading A Warm Welcome to the Next Wave of APM Health Centers
Rethinking health care teams
The clinics at the forefront of implementing the Alternative Payment Methodology (APM) are very excited to think more about new ways of providing care to their patient populations. Under APM, clinics receive a capitated per-member per-month rate, thus shifting the financial incentive from office visits with a physician towards providing team-based care. According to the Oregon Primary Care Association (OPCA), the APM model “removes old bottle necks,” and enables community health centers (CHCs) to transition from “the provider centric model of care delivery to a more advanced, team-based model.” The hope is this payment model will enable patient-centered primary care homes (PCPCH) to address a wider range of health factors.
These organizations on the frontlines of rethinking primary care have an opportunity to revisit some basic questions: What’s the ideal patient panel size? Who manages the patient panel? And more generally, what does the care team look like?
Physicians as medical care specialists
The role of the physician is evolving during the transition to PCPCH. While it may seem counter-intuitive, medical staff point out that the medical component of a typical clinic visit is only a small piece of the time they spend at the clinic, and many patients do not need to see a medical person at all. It is in this light that the medical care provided by the physician can become a highly trained specialty within the overall health care team.
Laurie Francis, a Senior Director of Clinic Operations and Quality with the Oregon Primary Care Association (OPCA), explains that many patient needs can be addressed by other members of the care team and don’t require the expertise of a physician. “When I’ve talked to family practitioners and the internal medicine doctors who are doing this work, they estimate that maybe about fifteen to twenty percent of their day is actually needed for a medical visit. This means for eighty percent of the day, most of the patients don’t need to see a medical person. They need social support, economic support, psychological; all the things that we know cause people to be chronically ill for a long period of time.” Continue reading A Nurse a Day Keeps the Doctor Away