October 2, 2014Topic: "Diabetic Neuropathy"
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November 2, 2014 - November 3, 201413th Annual Fall Conference and Expo "Case Management: 2.0"
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Patient-centered care successful in primary care clinics
By Carrie Thomas, RN
In the autumn of 2010, 14 medical groups throughout Oregon began a three-year pilot project called High Value Patient Centered Care. The project was conducted by the Oregon Health Leadership Council, a collaborative of health systems and payor groups addressing the Institute for Healthcare Improvement’s Triple Aim to reduce primary health care cost, improve health care quality and improve patient satisfaction.
Two Legacy Medical Group clinics participated in this project, receiving a per-member-per-month payment from the patient’s insurance company to help with the costs of employing a nurse case manager. Legacy Medical Group–Northwest utilized its existing nurse case manager while Legacy Medical Group–Tualatin added the position. At the conclusion of the pilot, each clinic was given a share in any cost savings realized by the insurer. As a result, Legacy received more than $900,000 for its two clinics. It was the largest payout among all participants. Legacy Medical Group shared these savings with Legacy Good Samaritan and Legacy Meridian Park medical centers.
Developing a close therapeutic relationship
The two case managers spent three months building a panel of 200 and 160 patients for the two clinics. For three years, these patients received full spectrum case management services, including care coordination, care transition, disease management education, motivational interviewing, interactive treatment plans, medication management, and proactive engagement to decrease hospital admissions and emergency room visits.
During this time, the greatest emphasis was to develop a close, therapeutic relationship between the patient, the provider and the nurse case manager. The primary care provider (PCP) introduced the nurse to the patient/family. The case manager then explained case management services and how it could meet the patient’s needs. When patients are in the clinic, the nurse case manager participated in the appointment, addressing concerns and questions between the patient and PCP. At conclusion of the visit, the case manager reviewed the treatment plan, provided education and answered questions as the provider moved onto another patient. A few days or weeks later, the nurse case manager followed up with the patient to again address adherence, treatment effectiveness and need for changes. After the visit, the patient could call their case manager, who knows their history and health status, conducts a thorough assessment, clarifies treatments and collaborates with the PCP. The case manager could educate the patient/family on the plan, their understanding and adherence.
Improved satisfaction, reduced provider workload
The relationship between the patient and nurse case manager resulted in high patient satisfaction; the patients felt heard and cared for by their team. They valued being able to call one person who knew them well and addressed questions and concerns efficiently. That the contact person was a nurse was also valued because of quick access to expert knowledge on a variety of topics; they called sooner and more often. This prevented further complications.
Providers found the involvement of a nurse case manager beneficial for improving patient adherence and lessening their workload. Initially there was concern that having a case manager at the clinic visit would lengthen the appointment time. The opposite turned out to be true; one provider stated that the case manager decreased her work load for those patients by 50 percent.
This model of care was shown to meet the Triple Aim for improving the quality of care, lowering the cost of care and improving patient satisfaction. Due to the success of its Patient-Centered Primary Care Home, Legacy Medical Group has extended this model from one clinic in January 2009 to 16 clinics today.
Carrie Thomas, R.N., is a case manager at Legacy Medical Group–Northwest & OMCMG President
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