Can Providers Really Work Together to Achieve Patient-centered Care?

By Melissa Hagstrom, contributor

October 31, 2012 - It's one of the biggest questions in healthcare right now: Can hospitals, primary care physicians, specialists, clinics and insurance providers really work together to achieve coordinated, patient-centered care?

The answer seems to be a qualified “Yes.”

Despite the difficulties of reaching across organizational boundaries, practice environments and systems, healthcare providers and organizations across the country are implementing various initiatives to arrive at a holistic care model where the patient really is the top priority.  And in each distinct program that has found success, common threads have emerged--including collaboration, teamwork and the timely sharing of information.

Among the success stories, several initiatives supported by The Commonwealth Fund’s Patient-centered Coordinated Care Program have found that when primary care providers in the same community band together to share local resources, such as quality improvement coaches or care coordinators, they can enhance their capacity and improve performance.

One such initiative, led by Ann S. O’Malley, MD, MPH, senior fellow at the Center for Studying Health System Change (HSC), recently published its results in the Journal of General Internal Medicine. O'Malley and her colleagues examined models where primary care practices had implemented after-hours care systems so that patients wouldn't be left hanging or forced to call 911 or head to their local emergency department if they had a non-life threatening medical emergency.

O'Malley and her team found that incorporating the local populations' healthcare needs, sharing electronic health records between the after-hours care providers and that patient's regular primary care provider, and incorporating after-hours initiatives as part of the overall approach to access were some of the top factors for a successful program.

"I think the key message in all these models is that the after-hours provider has to communicate with the primary care provider and systematic processes have to be set up where they can exchange data about patients," she said.

Virtually every type of practice model can begin to transition to more patient-centered, coordinated care using the lessons learned from the research.

"We found an enormous range of models, from the smallest, solo two-physician practice in primary care, trying to provide after-hours care and be there for patients in some way--either through extended hours or by email and phone after hours--to the opposite end of this range, where we see larger primary care practices that develop contractual relationships with a third party, urgent care clinic or after-hours clinic."

Partnering with insurance companies, like Docs on Call, part of Primary Care Partners, P.C., in Grand Junction, Colo., did, is also a great way for providers to collaborate for better care.

"They basically negotiated with insurers for a unique payment code to apply to after-hours services so they could cover some of their costs and staff their providers in a way to offer extended hours across their practices," O'Malley explained.

"When a problem arises, we need to make after-hours care more accessible to patients in a setting that is most appropriate for their level of clinical need, and in most cases it is not the emergency room, but some form of a less acute setting," she added.

Tricia Barrett, vice president, NCQA, says that moving from a more provider-centric focus to a patient-centric one can lower costs, improve quality and raise satisfaction rates for both providers and patients. Photo credit: NCQA.

Providing after-hours care is only one focus in the big picture of patient-centered care, and Tricia Barrett, vice president, product development, with the National Committee for Quality Assurance (NCQA), is also involved in a program supported by The Commonwealth Fund that has developed criteria for primary care practices to achieve accreditation as medical homes--an important distinction in patient-centered care.

As of September 2012, more than 23,000 clinicians at more than 4,800 primary care practices have officially been recognized as patient-centered medical homes.

"Moving from being more provider-centric to more patient-centered has a huge amount of rewards," she explained. "The studies are showing that delivering care in this way improves patient satisfaction, lowers cost of care, improves the quality care and also improves physician and staff satisfaction. That connection to the patient makes life and work feel more meaningful to the provider."

Both O'Malley and Barrett agree that engaging patients in their care and getting them more involved with the overall approach will be a boon to the patient-centered care movement. Not surprisingly, this engagement also involves collaboration and increased communication.

"Making communication back to the patient-centered medical home a possibility for the patient, either through email, phone, web portals, etc., should be a priority," O'Malley said.

"Incorporating team-based care and getting feedback directly from patients is key," Barrett said, adding, "Making sure your patients are clear and aware of how to get in touch with you, and recognizing it is hard to navigate our healthcare system, will help providers deliver this patient-centered care."

"It's a dual effort of having patients and physicians empowered to manage care together in a way that is tailored to the patient's needs, but we also need to have the system-level support so the providers have the systems and infrastructure in place to actually be able to carry it out," O'Malley concluded.

For more information on current initiatives, visit The Commonwealth Fund's Patient-centered Coordinated Care Program.