Experts at the eHealth Initiative's annual conference, held Jan. 19-21 in Washington, D.C., offered their advice on how to accomplish coordinated care "in the real world."
Robert Fortini, chief clinical officer at the Bon Secours Medical Group, part of the Bon Secours Health System, said medical homes are key to providing a uniform level of care in a health system. This will be particularly important, he said, because Bon Secours plans to double its number of doctors this year from roughly 250 to 500.
"Variation is the enemy of efficiency," he said.
According to Fortini, Bon Secours will redesign its bricks-and-mortar delivery system, supplying three or four exam rooms for every doctor. The system will also form care teams of doctors, nurses and embedded case managers who will do a workflow rehearsal to make sure all teams are performing care uniformly. Nurses will be assigned to do follow-up calls to prevent hospital readmissions.
Fortini said Bon Secours will also focus on changing its reimbursement model from fee-for-service to "fee-for-value" and increase the organization's capacity to treat more patients more efficiently. With the advent of the baby boomer generation, health systems will have to find ways to increase their capacity for care, he said.
Bon Secours also plans to focus on patient medication compliance."The most underutilized resource in healthcare is the patient," Fortini said. In order to do this, Bon Secours will leverage the use of electronic health records, he said.
Bruce Hamory, MD, executive vice president and managing partner at Geisinger Consulting Services, said the Geisinger Health System focuses on case management to give the most aggressive cases the ongoing care they need.
Geisinger's provides patients with an appointment with a physician within 24 hours, while some specialty appointments are scheduled within two weeks, Hamory said. The ability to provide more efficient care resulted from "an enormous culture change," he said.
Geisinger also uses care bundles in some areas, including perinatal and cardiac care, resulting in a 7 percent decrease in costs, sustained over the past three years. "We've been able to show we can improve outcomes through evidence-based medicine," he said. Doctors are paid incentives for achieving certain quality measures.
Charles Kennedy, MD, vice president for health information technology at WellPoint, said his organization is trying to focus on streamlining the approval process for care that deviates from the norm. For example, if a patient requires a colonoscopy within four years of the previous one – rather than 10 years, as is the standard – WellPoint will be able to approve the colonoscopy by looking at the pathology report and last colonoscopy report within the patient's electronic health record without having to bother the doctor for an approval.