Recent articles in national and Colorado media put patient-centered care, compensation to primary care physicians and HealthTeamWorks in the spotlight. The coverage highlights insurers’ adoption of new payment strategies for primary care — approaches that acknowledge the value of front-line care and its role in preventing high medical costs down the line.  

The Wall Street Journal described the intent of WellPoint Inc., a major national healthcare insurer, to pay primary care doctors 10 percent more — with the possibility of up to 50 percent from bonus payments. The article notes that primary care currently makes up a tiny 2.8 percent of the nation’s healthcare spending, yet holds enormous potential to curtail high costs through prevention, screenings and patient education. Wellpoint leaders hope that by investing in the patient-centered medical home (PCMH) model of care — which applies care coordination, improved access, patient self-management strategies, standardized care protocols and tracks patients’ outcome data — the company’s projected medical costs could drop by up to 20 percent by 2015, the article states.

John Bender, MD, and his practice, Miramont Family Medicine in Fort Collins, Colo., are featured as participants in the Patient-Centered Medical Home (PCMH) Pilot convened by HealthTeamWorks.

Although Meredith Rosenthal, PhD, the Harvard researcher evaluating the pilot, notes that the PCMH model has not yet demonstrated cost savings, “Wellpoint said its savings are based largely on its own data from medical-home pilot projects,” the article says.

Anthem to pay Colorado primary-care providers for patient-centered care

In Colorado, Anthem Wellpoint, the state’s largest private insurer, announced it will pay bonuses to its 2,500 contracted primary-care doctors because of the success of the HealthTeamWorks-convened PCMH pilot. An article in The Denver Post on Feb. 2 stated that “Anthem found that paying primary-care doctors more to coordinate patient care cut hospital admissions by 18 percent and emergency room use by 15 percent.”

According to Elizabeth Kraft, MD, Anthem’s chief medical officer, paying primary care providers more to deliver PCMH-model care “creates a return on investment of 2.5 times to more than four times.”

Those financial results from the pilot convinced Anthem to take its payment model for patient-centered primary care nationwide, the article states. Other leading healthcare carriers, such as Humana and UnitedHealthcare, are expected to follow suit.

Northern Colorado newspaper features local practices in PCMH Pilot

The Northern Colorado Business Report featured the PCMH Pilot, focusing on results from Miramont Family Medicine and Internal Medicine Clinic of Fort Collins. In return for a monthly per-patient fee, pilot practices offer patients round-the-clock access to providers and same-day appointments, and involve patients in treatment decisions. The practices take a population management approach to patients with chronic conditions such as diabetes, ensuring that all get regular blood-sugar checks, eye and foot exams and know the dangers of high blood pressure and smoking. By reaching certain measures for patient care, practices receive bonuses from the participating health plans.

By extending the value-based primary-care payment model to providers nationwide, healthcare payers are establishing the PCMH as the paradigm. This is an important step toward a transformed healthcare system that provides personal, efficient, measurably effective care.
 

The employees of HealthTeamWorks were proud to nominate our CEO, Marjie Harbrecht, MD, for the 9News Leader of the Year Award. Although she was not ultimately selected, Marjie was among the eight finalists.

Marjie responded to her staff by saying: “I cannot tell you how honored I was to even be considered for this and want to thank Eric Palmer, one of our quality improvement coaches, who introduced the idea, Allyson [Gottsman, HealthTeamWorks Executive Vice President] and the rest of the staff who ran with it, and Cissy Kraft, MD [HealthTeamWorks board chair]; Alfred Gilchrist [CEO of the Colorado Medical Society]; Scott Hammond, MD [Westminster Medical Clinic] and Tracy Hofeditz, MD [Belmar Family Medicine] who were kind enough to write letters of support. All of this meant more to me than the award itself.

“I truly believe the accomplishments achieved to date have been a TEAM effort – I could not do this without all of you,." Marjie continued. "You are at the forefront of changing healthcare and I’m proud to be working with all of you to help lead this effort!”

We regret that 9News did not select Marjie as the leader of the year, but regardless, she is our Leader of the Year.

The HealthTeamWorks staff

AgeWell Medical Associates aims to build better seniors

Part of that ambition involves the transformation into a patient-centered medical home (PCMH). AgeWell joined HealthTeamWorks’ PCMH Foundations program in August 2010. “Our founder, Dr. Jeffrey Kulp [a geriatrician], is a visionary,” says Willemyns. “He felt there was a better way to deliver primary care than being a slave to the 15-minute visit. He believes the medical community needs to become more efficient and effective. The PCMH Foundations program gave us the avenue to get there.”

Kulp says,“The PCMH concept equips primary care practices to do their part in achieving the “triple aim” of health care reform – better patient experience, population health and reduced costs.”

Measuring clinical success

With the help of HealthTeamWorks’ Quality Improvement Coach BJ Dempsey, AgeWell has made great strides. “At start of the program, 18 percent of their diabetic patients had hemoglobin A1C* measures of 9 or higher — now it’s less than 8 percent,” Dempsey says. “They used to screen 27 percent of their diabetics for depression; now they screen 99 percent. Before, only 51 percent of their patients achieved the target (geriatric) blood pressure of 140/90 or less, now 75 percent are there.”

Because the elderly often present with a variety of chronic conditions, AgeWell aims to “optimize their health, minimize the number of medications and focus on the entire person — including behavioral health,” Willemyns says. “This means depression, loneliness, substance abuse, isolation. These issues are not unique to older people, but they present confounding challenges.”

The journey to PCMH offered new challenges. “For us to have tried to do this without HealthTeamWorks — I can’t envision it,” says Lori Trivelli, AgeWell’s practice manager.  “The coaching has been invaluable. We are so grateful to have that kind of experience in our corner. Dr. Kulp’s leadership and vision, and Kathy’s role as [PCMH] champion helped us work out solutions to the challenges we encountered. PCMH work comes with tremendous culture change, but it’s gratifying to watch the team come together and focus on the complete panel of patients and the practice as a whole.”

Trivelli and Willemyns recognize that achieving PCMH status is not an endpoint. “We realize the work is never done,” Willemyns says. “We continue to set the bar a little higher and achieve new goals. As we adopt an EHR we will look at new ways to connect with patients.”

*Hemoglobin A1C is a laboratory test that indicates blood sugar control

Men’s health often gets less attention than women’s health, perhaps because men are 24 percent less likely than women to have seen a doctor within the past year.¹ Just over half of U.S. men (57 percent) visit a doctor, nurse practitioner or physician assistant for routine care, compared with 74 percent of women.² Regardless, men need certain preventive tests and screenings on a regular basis to ensure good health.

Prostate cancer: To screen or not to screen

Unique to men is screening for prostate cancer. Screening can detect cancers early and treatment may be more effective for early disease. Screening is done by digital rectal exam (DRE) or a blood test for prostate-specific antigen (PSA). In DRE, the clinician inserts a gloved, lubricated finger into the rectum to feel the prostate, estimate its size and feel for any abnormalities. 

The PSA test measures the level of PSA in the blood. Prostate cancer can cause an elevated PSA level, but many factors, such as age and race, can also affect it.

The most recent evidence suggests that PSA testing does not lower the risk for death from prostate cancer. A 13-year follow-up report published in the Journal of the National Cancer Institute concluded that there is no evidence of benefit from PSA screening. The test can, in fact, cause harm because of false-positive tests and overdiagnosis.³ This finding extends the trial's 10-year results, which also showed no mortality benefit.

The Centers for Disease Control and Prevention and other federal agencies follow the prostate cancer screening guidelines set forth by the U.S. Preventive Services Task Force, which state that there is not enough evidence to recommend or discourage routine screening for prostate cancer using PSA or DRE.⁴

Other preventive screening tests

Men — as well as women — should consider a number of other routine screening tests to maintain optimal health:⁵

Body mass index* — Your body mass index, or BMI, is a measure of your body fat based on your height and weight. It is used to screen for obesity. Find your BMI.

Cholesterol — Once you turn 35 (or once you turn 20 if you have risk factors like diabetes, history of heart disease, tobacco use, high blood pressure, or BMI of 30 or higher), have your cholesterol checked every five years. High blood cholesterol is one of the major risk factors for heart disease.

Blood pressure — Have your blood pressure checked every two years. High blood pressure increases your chance of getting heart or kidney disease and for having a stroke. If you have high blood pressure, you may need medication to control it.

Cardiovascular disease* — Beginning at age 45 and through age 79, ask your doctor if you should take aspirin every day to help lower your risk of a heart attack. How much aspirin you should take depends on your age, your health and your lifestyle.

Colorectal cancer* — Starting at age 50 and through age 75, get tested for colorectal cancer. You and your doctor can decide which test is best. How often you'll have the test depends on which test you choose. If you have a family history of colorectal cancer, you may need to be tested before you turn 50.

Other cancers — Ask your doctor if you should be tested for prostate, lung, oral, skin or other cancers.
Sexually transmitted diseases — Talk to your doctor to learn whether you should be tested for gonorrhea, syphilis, chlamydia or other sexually transmitted diseases.

HIV — Your doctor may recommend screening for HIV if you:

• Have sex with men.

• Had unprotected sex with multiple partners.

• Have used injected drugs.

• Pay for sex or have sex partners who do.

• Have past or current sex partners who are infected with HIV.

• Are being treated for sexually transmitted diseases.

• Had a blood transfusion between 1978 and 1985.

Depression* — If you have felt "down" or hopeless during the past two weeks or have had little interest in doing things you usually enjoy, talk to your doctor about depression. Depression is a treatable illness.

Abdominal aortic aneurysm — If you are 65 to 75 years old and have smoked 100 or more cigarettes in your lifetime, ask your doctor to screen you for an abdominal aortic aneurysm. This is an abnormally large or swollen blood vessel in your stomach that can burst without warning.

Diabetes* — If your sustained blood pressure is 135/80 or higher, ask your doctor to test you for diabetes. Diabetes, or high blood sugar, can cause problems with your heart, eyes, feet, kidneys, nerves and other body parts.

Tobacco use — If you smoke or use tobacco, talk to your doctor about quitting. Get tips online on how to quit or call the National Quitline at 1-800-QUITNOW.

Alcohol use — Moderate drinking levels for men are no more than 14 standard drinks on average per week and no more than four drinks on any occasion. Men older than 65 should drink half of what is recommended for younger men (seven drinks on average per week and no more than three on any occasion).

Remember, preventive medical tests benefit you AND your family and loved ones. 

*Denotes HealthTeamworks guideline
 

Sources

1. Agency for Healthcare Research and Quality. Healthcare Cost & Utilization Project and Medical Expenditure Panel Survey data.
2. Agency for Healthcare Research and Quality. Men Shy Away from Routine Medical Appointments. AHRQ News and Numbers, June 165, 2010. www.ahrq.gov/news/nn/nn061610.htm
3. Andriole GL, et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: Mortality results after 13 years of follow-up. http://jnci.oxfordjournals.org/content/early/2012/01/06/jnci.djr500.abstract JNCI J Natl Cancer Inst (2012)doi: 10.1093/jnci/djr500First published online: Jan. 6, 2012
4. Chou R, Croswell JM, Dana T, et al. Screening for Prostate Cancer: A review of the evidence for the U.S. Preventive Services Task Force.  www.uspreventiveservicestaskforce.org/uspstf12/prostate/prostateart.htm. Oct. 2011.
5. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Get Preventive Medical Tests. www.ahrq.gov/healthymen/prevent.htm

Pediatric safety-net clinic improves asthma care with clinical registry

Community Health Services (CHS), a busy safety-net clinic for low-income children in Adams County, is a convert to the power of technology. “We can’t see a future without technology. We want to know: ‘How can we use it more?,’” says Rebecca Lusk, PNP, one of the providers. The organization adopted a clinical registry in late 2010 and “It’s been a wonderful first step for us, to use data to support the job we do. We have tightened the use of clinical guidelines, and we have seen improvement in asthma care by using flow sheets for daily [patient] management. The registry helps us know what things will be like when we get an electronic medical record (EMR).”

CHS joined HealthTeamWorks’ Patient-Centered Medical Home Foundations program in October 2010 after taking the SBIRT* training for substance abuse screening that HealthTeamWorks provides, and from technology guidance as part of HealthTeamWorks’ partnership with the Colorado Regional Health Information Organization. HealthTeamWorks Quality Improvement Coach Shelli James helped CHS establish the ReachMyDoctor patient registry, which allows a practice to monitor its care for specific patient populations — such as children with asthma.

Restructuring processes, culture to improve patient care

“The asthma flow sheet [generated by ReachMyDoctor] helps us do a thorough job,” Lusk says. “It increases the number of action plans we give out to families, reduces the number of prescription refill requests and improves our follow-up care for kids with persistent asthma.” In addition, she says, “ReachMyDoctor allows us to cross-check whether our patients have received flu shots.”

James says that the five CHS clinics in the PCMH Foundations program have made significant changes in the way they provide care for patients and their families, and for asthma patients in particular. “They hit the ground running, writing new protocols and revising tools, using their registry for planned care and completing action plans. The clinics made their medical assistants (MAs) an integral part of the team — responsible for data collection, outreach to patients, and with greater involvement in patient care. The clinics are continually examining their processes to learn how they can improve. CHS clinics are an invaluable asset to Adams County.”

Only source of primary care for many children

Nonprofit CHS was established more than 30 years ago in medically underserved areas of Adams County to provide primary and preventive healthcare services for children from birth to age 21. Nurse practitioners provide most of the care, with oversight from a part-time pediatrician. Commerce City, where five CHS clinics are located, has no private medical practices; CHS is the only medical organization that specializes in pediatrics. It also operates clinics inside two middle schools and two high schools. A sixth CHS community clinic is in Westminster, where private practices are unwilling to serve the indigent. 

“Our patient population is low-income — over 60 percent are Spanish-speaking only,” Lusk says. “Many are covered by Medicaid and CHP+; others are uninsurable and uninsured.  We offer these families assistance in applying for Medicaid/CHP+ or the CHS sliding fee. It’s also a transient population. We are the only source of primary care for some kids.”

“Accountable to the data”

In addition to the registry, HealthTeamWorks has helped CHS improve its work flow and encouraged the organization to give more responsibility to MAs, freeing time for other healthcare professionals. Lusk says that the MAs “have enjoyed the additional responsibility and greater involvement in patient care.” Because of HealthTeamWorks’ process redesign, CHS now devotes time during provider meetings for data review: “We are now accountable to the data and use it to guide us.”

Elated over their clinical progress with the registry, CHS employees “want to do more,” Lusk says. “Technology doesn’t take that much time and the benefit is apparent to providers. We hope to get an EMR so we can manage childhood obesity [ReachMyDoctor does not do this]. We want to incorporate what we’ve learned with asthma for other conditions.”

*Screening, Brief Intervention, Referral to Treatment
 

Did you know that a daily dose of a certain B vitamin can reduce birth defects by 46 percent?¹ Folic acid helps the body make new cells. In a developing fetus, it can help prevent some major birth defects of the brain and spine by 50 percent to 70 percent.²

Everyone needs folic acid. However, women — particularly women who want to get pregnant — need at least 400 micrograms (mcg) daily to ensure proper development of a fetus. Many multivitamins contain 400 mgc of folic acid. Taking that amount of the vitamin before conception is essential for a fetus’ neural tube to develop fully. The neural tube is the initial, formative part of the spine and back. When the neural tube fails to form completely, the baby may be born without parts of the brain and skull (anencephaly) or with part of the spinal cord exposed (spina bifida).

Jan. 8-14 is National Folic Acid Awareness Week, part of National Birth Defects Prevention Month. HealthTeamWorks, along with the federal government, wants to ensure that people know the risks of insufficient folic acid intake on a developing fetus.

"Promoting protective factors, such as taking a daily multivitamin containing folic acid, eating well and exercising, and reducing risk factors such as smoking, alcohol use, obesity and poor mental health, is critical for the health of all women and any potential offspring," says Linda Archer, MSN, RN, CNS, Maternal Wellness Project specialist with the Colorado Department of Public Health and Environment.

Consuming folic acid daily before and during early pregnancy will help reduce the risk for neural tube defects. Healthcare providers should encourage every woman to consume 400 mcg of synthetic folic acid daily from fortified foods or supplements, or a combination of the two, in addition to getting folate that occurs naturally in certain foods. Good sources include: 

• Leafy green vegetables such as spinach, broccoli and lettuce;

• Okra;

• Asparagus;

• Fruits such as bananas, melons and lemons;

• Beans;

• Yeast;

• Mushrooms;

• Meat, including beef liver and kidneys; and

• Orange and tomato juice.³

In addition, since 1998, federal law has mandated that food manufacturers add folic acid to cold cereals, flour, breads, pasta, bakery items, cookies and crackers.⁴ Folic-acid fortified foods can help people increase their intake of the nutrient.

HealthTeamWorks’ clinical Guideline for Preconception and Interconception Care puts folic acid at the top of the list of factors that affect fetal health and development. Because 39 percent of pregnancies in Colorado are unplanned⁵ (50 percent nationwide⁶), and because folic acid intake is such a simple way to promote fetal health, we urge providers to counsel their female patients of child-bearing age about the importance of getting enough folic acid.

Anna Kelly, MD, who serves on the Healthy Women Healthy Babies Roundtable, participated in the committee that developed the HealthTeamWorks Guideline for Preconception and Interconception Care, says "While numerous individual preconception interventions are known to improve pregnancy outcomes, the HealthTeamWorks Preconception and Interconception Care guideline strives to summarize, simplify and prioritize interventions that have the strongest evidence. [It does so] in a manner that can serve as a foundation for provider- and consumer-focused preconception projects in Colorado and beyond."
 

Sources
1. Jan. 6, 2012, 60(51);1746. National Birth Defects Prevention Month and Folic Acid Awareness Week — January 2012. www.cdc.gov/mmwr/preview/mmwrhtml/mm6051a6.htm?s_cid=mm6051a6_e. Accessed Jan. 5, 2012.
2. Centers for Disease Control and Prevention. Facts about folic acid. www.cdc.gov/ncbddd/folicacid/about.html. Accessed Jan. 5, 2012.
3. WebMD. Folic acid. www.webmd.com/vitamins-supplements/ingredientmono-1017-FOLIC%20ACID.aspx?activeIngredientId=1017&activeIngredientName=FOLIC%20ACID. Accessed Jan. 5, 2012.
4. Ibid.
5. Colorado Department of Public Health and Environment, Health Statistics Section (2010). Colorado MCH Data Set 2010. Retrieved October 12, 2010 from www.cdphe.state.co.us/ps/mch/mchadmin/mchdatasets2010/profiles/colorado.pdf.
6. Finer LB, Henshaw SK. Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001. Perspectives on Sexual Reproductive Health, 2006:38:90–96. 

Care management, one of the cornerstones of the patient-centered medical home (PCMH), focuses on both wellness and illness. Directed at patients with long-term and/or complex care needs, it encompasses prevention and patient education, as well as treatment of acute sickness and/or injury. Care management means comprehensive care, addressing a person’s psychosocial and spiritual well-being, as well as physical health.

A PCMH that manages patients’ care ensures that:

• Every patient  has an individualized care plan;

• Each care team member has access to patients’ care plans;

• Care is standardized according to clinical guidelines;

• Care team members work as a group; and

• Each team member knows her/his role in providing care.
   

Care management aims to turn acute, episodic care into planned care. For example, to forestall breathing difficulties in an asthmatic patient and potential visits to the emergency room, the PCMH care team carefully monitors her medications. They work with her to determine her asthma triggers so she can avoid them, and teach her self-management techniques. The care team establishes regular office visits to assess the patient’s lung function and the effectiveness of her medications. The goal of both the team and the patient is to help her attain control over her condition and enjoy a high quality of life.

Thus, care management:

• Turns acute, episodic care into planned care;

• Focuses on high-risk, high-cost patients; and

• Emphasizes prevention, disease management and patient engagement.

Technology assists care management. A patient registry allows a practice to identify all patients needing care management, such as those with asthma, high blood pressure, diabetes or coronary artery disease. Clinicians can devise and apply care plans for these populations, including regular office visits, screenings, medication monitoring, tests and appointments with specialists. The registry helps them schedule and track this care. An electronic health record (EHR) allows the care team immediate access to patient data and secure sharing with other providers.

Top care-management practices include:
 

• Multidisciplinary care teams;

• Pop-ups on the EHR to alert the care team about patients due for exams, lab work, etc.;

• Staff roles adjusted to give patients focused, personalized care;

• Online patient portal allowing quick access to the care team, scheduling and test results;

• Labs drawn in advance so the care team can focus appointment time on treatment and patient education;

• Team huddles prior to appointments, so all members know the care plan and their roles in promoting it;

• Checklists to ensure thorough care; and

• Program evaluations to ensure quality care.

The National Committee for Quality Assurance lists care management requirements in its 2011 PCMH standards.¹ To identify and manage patient populations, a practice must:
 

• Collect demographic and clinical data for population management;

• Assess and document patient risk factors; and

• Identify patients for proactive and point-of-care reminders.

For individual patients, a practice must:
 

• Perform previsit planning;

• Assess progress toward treatment goals;

• Address barriers to achieving treatment goals;

• Reconcile medications at each visit and after hospitalization; and

• Use e-prescribing.

Care management, integrated into a practice’s daily flow, will produce better outcomes, more satisfied patients and providers, and reduce the frequency of costly emergency room visits and hospitalizations.

Source
1. National Committee for Quality Assurance. Comparison: PPC-PCMH 2008 with PCMH 2011.  www.ncqa.org/LinkClick.aspx?fileticket=RdzaHTOsgxI%3D&tabid=1412, pp. 3-4.

HealthTeamWorks, which extols wellness and self-care as part of its mission to improve the healthcare system, puts its muscles where its mouth is. The Lakewood, Colo.-based nonprofit’s approach to health and wellness for its own staff might serve as a model for other firms.

Each month, staff members compete to see who can log the most workouts, who can take the most steps, who can exemplify a heart-healthy lifestyle. “I organized the program to motivate myself,” says Sara Schwankl, who started the HealthTeamWorks wellness program a year ago, expanding on the idea of a colleague. “Most adults don’t get anywhere near enough exercise to meet national activity goals. By keeping each other supported and motivated, it’s easier to achieve activity targets. This program keeps us all accountable.”

Teams of four, with names like the FitWits and the Queens of Cardio, get credit for each member’s daily workouts of at least 30 min. Lifting weights, running, a brisk walk, skating, cycling, yoga — almost any activity counts if it increases the heart rate. 

Participation is voluntary, and nearly half of the 40-member staff has joined the initiative. Employees compete fiercely to end each month with the most workouts. Staff members — who range in age from 22 to 66 — exchange good-natured taunts and eye the tally board to see who’s leading. Members of the winning team get their choice of $10 gift cards.

A separate contest pits individuals against one another: Who can take the most steps in a month? Schwankl issued staff pedometers so everyone can record each day’s distance in a log.

Logically, HealthTeamWorks’ wellness efforts are in step with one of the clinical guidelines it develops for Colorado primary care physicians. The adult obesity guideline helps clinicians assess and treat overweight patients according to the best and most current medical evidence.

The company’s program also aligns with a number of national wellness initiatives, such as First Lady’s Michelle Obama’s Let’s Move program, designed to combat childhood obesity, and the Presidential Active Lifestyle Award, which promotes wellness for people of all ages. 

“This fitness program is great fun for the staff, and emphasizes our companywide belief in wellness and prevention,” says Marjie Harbrecht, MD, HealthTeamWorks’ CEO. “The coaching that we provide to medical practices includes a focus on healthy lifestyle, weight management and cardiac fitness. Thanks to pressure from my teammates, now I get to the gym more often!”

What does your organization do to encourage a healthy staff? We’d love to hear about it.

Tracking patients who visit the emergency room or need hospitalization represents an important challenge for medical practices. Because you want to ensure that your patients receive all necessary care, you want to offer follow-up services for emergent episodes. In addition, you want to learn whether ER or hospital visits could have been prevented by your intervention, patients’ self-care or patients’ awareness of appropriate ER use.                                                                                                                                                                            

Family Care Southwest, a five-provider practice in Littleton, Colo., has developed a tracking system to identify and follow patients seen at emergent facilities outside the group’s affiliated hospital system. The two physicians and three physician assistants use a spreadsheet to record such visits and follow up with patients. The spreadsheet’s columns list the reason for the hospital visit; facility; emergency department date; admission date; discharge date; first, second and third follow-up calls; when a letter was mailed; appointment date, etc.

Helen Story, MD, one of Family Care Southwest’s physicians, says, “Open communication with hospitals, hospitalists and specialists we refer to is essential for high-quality patient care. The hospital has our patient data in their system, and we know whom to call for patients’ records. We try to have good working relationships with the information technology folks at all our referral facilities, and with insurance plans, so we receive notification when our patients go to the hospital or urgent care.” She notes that patients appreciate follow-up calls from her office when they are in the hospital and after they return home from the hospital or emergency room — “They like the connection with their primary care provider, and they feel cared about.
                                                                                                                                                           
”The tracking system helps the practice stay on top of emergent episodes. “A tickler system lets us know to follow up with hospitals and specialists if we have not received a report from them within a week,” Story says. “We also use the system as a reminder for the provider or care coordinator to make follow-up calls to patients.”The practice asks nearly all patients to come in after hospitalization. “We want to let the patient know we provide quality care, review discharge medications and instructions with them and answer any questions they may have,” Story says. In addition, providers want to encourage patients not to use the emergency room to receive primary care.

“Like so many of our PCMH protocols, this effort relies heavily on the staff to maintain the tracking sheet, make the calls, gather the records, arrange the appointments, and have everything ready for the provider,” Story notes. “We encourage patients to bring a support person with them. Patients and families really appreciate the chance to sit down and understand the care they received during their stressful emergent encounter. We make it a point to discuss how to avoid future problems.

“All of us are happy that hospitals and insurance carriers are recognizing that primary-care follow-up is crucial to better outcomes. Systems are evolving: Some hospitals now notify us when one of our patients has been admitted, and most of the time the hospitalists call us when the patient is being discharged. The insurance carriers’ notifications have been a welcome addition, but many still incur some lag time. We look forward to the implementation of a statewide database for more thorough records access.”

The epidemic of obesity in the United States has claimed one-third of adults — 33.8 percent. Obesity is defined as a body mass index (BMI) of 30 or higher. (Those with a BMI of 25-29.9 are considered overweight.) As the Centers for Disease Control and Prevention notes, “During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20 percent. Thirty-six states had a prevalence of 25 percent or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas and West Virginia) had a prevalence of 30 percent or more.”¹

The CDC’s Healthy People 2020 program aims for a 10 percent reduction in adult obesity over the next nine years.² The agency, along with the healthcare industry, wants to stem the surge of obesity-related conditions that include heart disease, stroke, type 2 diabetes and certain types of cancer. Not only do these conditions cause premature death, they also generate enormous medical costs. In 2008, obesity-associated healthcare costs were estimated at $147 billion; the medical costs paid by third-party payers for obese people were $1,429 higher than for those of normal weight.³

HealthTeamWorks has developed a clinical guideline on adult obesity to help providers address this often-difficult issue with patients. Easy to use and comprehensive, it covers clinical assessment, diet, physical activity, weight-loss medications, surgery, tips for families, goal-setting and approaches to counseling that engage the patient. An associated action plan for patients allows providers to work with them to set goals for reaching a healthy weight. Goals pertain to nutrition and physical activity; the provider can assist with the care-team support section, which has spaces for referrals, medications and community resources.

The guideline assists clinicians regardless of the cause of a patient’s obesity: genetics, inactivity, poor diet/eating habits, lifestyle, quitting smoking, pregnancy, lack of sleep, medication, age, socio-economic issues or medical problems.⁴

Because obesity represents such a major public health problem, and because losing even a modest amount of weight can prevent or improve morbidity, it’s imperative that clinicians address the issue with patients.

Sources
1. Centers for Disease Control and Prevention. Overweight Obesity — U.S. Obesity Trends. www.cdc.gov/obesity/data/trends.html, accessed Nov. 15, 2011.
2. Centers for Disease Control and Prevention. HealthyPeople.gov. Nutrition and Weight Status. http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29#141, accessed Nov. 15, 2011.
3. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Aff September/October 2009 vol. 28 no. 5 w822-w831.
4. Mayo Clinic. Obesity. www.mayoclinic.com/health/obesity/DS00314, accessed No. 22, 2011.