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May 2, 2013

Bassett's 'medical home' system scores high marks

By Richard Whitby
The Daily Star

---- — Bassett Healthcare Network’s adoption of the “medical home” concept is changing the way care is delivered at its 23 primary-care centers.

The patient-centered medical home approach, or PCMH, recently achieved a Level 3 rating — the highest — from the National Committee for Quality Assurance, a nonprofit dedicated to improving patient care.

“It’s more of a change in philosophy, I think, that really puts the patient at the center and engages patients to be part of their own healthcare,” said Dr. Carlton Rule, a family practitioner and a “physician champion” for Bassett’s PCMH program.

Under the program, which covers all patients at the primary-care centers, Rule and other doctors lead teams of medical professionals to plan and coordinate patient care.

“I work with an RN (registered nurse), an LPN (licensed practical nurse), a front-office staff that are all part of the process now,” Rule said. “In the past, maybe a patient would come in, see me in my office for a few minutes and leave. Now, I have an RN who’s calling a patient to see how they’re doing with their sugar control. Or they come out of the hospital, and the RN will call within a day or two to check and to see: Do they need to get right back in to follow up? Are they having trouble after leaving the hospital?”

“It’s a lot more coordination, so you need more than just me in the room for a few minutes,” he added. “It’s all this background work and extra work outside of the visit that’s starting to happen.”

The goal is to reduce long-term costs, Rule said.

“The government and insurers are starting to pay for it – this extra coordination – because it keeps people out of the hospital, out of the emergency room, prevents re-admissions, so it saves money in the long run,” he said. “To fund that extra work to prevent higher costs later is the idea. I think that’s why it’s getting the national attention.”

Key to the process centralized collection of digital medical records – at least from Bassett providers. Rule says he still has to request paper records from some providers outside the Bassett network.

This collection allows doctors to check the results of their patients’ consultations with specialists and their records from hospital admissions.

It’s also the backbone of MyChart, a web interface that allows patients to review prescribed medications, including dosage and frequency information; request prescription renewals; request and cancel appointments; review future and past appointments; review their immunization histories and allergies; and receive test results with comments from their primary care providers.

Eventually, the digitized records will create a database from which the medical professionals can assess the effectiveness of the nationally recognized treatment standards the centers have adopted as part of the shift to PCMH care.

“We’re trying to latch onto national standards — what we call evidence-based medicine — so it’s not just ‘This is how I always did it, as I was taught in medical school,’ because things change,” Rule said. “So we have to stay up on the latest science and the most-current recommendations and all try and agree to accept those, and then follow it to see how we do.”

Transparency for patients already is part of the process, but Bassett plans to take it further.

“Making public our results is going to be part of the process going forward,” Rule said, adding that he expects that to happen “within the next year.”

“That’s a bit of a culture change,” he said.