A Story That Illustrates How GBMC is different

We have been building our system of care to drive towards our vision for six years now. In 2010, we put a stake in the ground that we would become the health care system where everyone, every time, got the care we would want for our own loved ones. Our vision statement talks about physicians leading teams to deliver this. We have had a dialogue among us in the GBMC family, that we want the best health outcome and the best care experience with the least waste of time and money with the most joy for those providing the care. We chose the patient centered medical home as a design to deliver this. We already had a great hospital with excellent physicians and nurses and a great hospice, but, the medical homes were required if we were truly going to maximize people’s health and not just wait until they got really sick and needed to be admitted. Our patient-centered-medical homes are different from typical primary care because they are no longer dependent on a visit to the doctor. This model is about a relationship between a physician, her team and a patient. It is about a promise to that patient to work with him or her to maximize his or her health. It is about having the time to reflect on a patient’s health between visits, to make sure that they are getting what the evidence says will keep them well.

On a bad day, I am concerned that many people in our community don’t know how we are different or don’t believe that we are different. So let me tell you a recent story in the words of Dr. Sarah Whiteford, of Family Care Associates:

“I wanted to share this wonderful letter from a very appreciative patient whose life was quite possibly saved by the efforts of PCMH and our population health outreach.  In brief, this lovely patient of mine received a call from our care coordinator, Shelly Deckelman (go Shelly!), who was going through the list of patients aged 50 and older in our practice who had not yet had a colonoscopy.   This day of Shelly’s call happened to be her 50th birthday and her name clearly “fell onto the list.”   She was quite surprised to receive the call but it prompted her to immediately schedule her colonoscopy (which she admitted would have likely been many months later if left to her own devices).  Much to everyone’s surprise, her colonoscopy revealed a large, ominous rectal mass.  She had no symptoms at all. Despite a negative initial pathology, she was sent for urgent surgery for removal of this mass as its malignant potential was quite high.  Fortunately, her surgery was successful and the mass was ultimately a very high grade polyp which most certainly would have become malignant if not removed in a timely manner.” 

Dr. Whiteford thanked all of her team and congratulated them for making the medical home concept a reality.

Physicians and other clinicians practicing in regular primary care are smart and care about their patients just like Dr. Whiteford and her teammates. It’s just that in regular primary care after the visit, it’s on the patient. If the patient never comes in for a visit, and they don’t know the evidence about care that can save a life, they are not likely to get that care unless someone is looking out for them. This story is one of many that shows how we are different. Without the patient centered medical home, this patient may not have had her mass found until it was too late!  Let me add my thanks to all of my GBMC colleagues who are moving us closer every day to our vision.

Taking it to the street…

In the last blog post, I spoke of the great work of our patient-centered medical homes and how we have truly transformed care to become more patient-centered. It has been very difficult for us to get the word out about this transformation. I believe that the average member of our community does not know how we are innovating and what it means for individual patients, families, and the local economy. We’ve made progress, but, we still have a lot of work to do to “get the word out” to the community.

So, last week, I was the featured speaker at a “house party” with the folks at Quarry Lake Condo Association. The purpose of the meeting was to share GBMC’s vision and our quadruple aim—better health and better care with the least waste and the most joy for those providing the care. I was truly excited at this opportunity to speak directly to patients and prospective patients.

At the event, I had the pleasure of meeting the host, Mrs. Rozzie Brilliant, who received oncology support care at GBMC and whose own daughter also received life-saving testing and care at GBMC. During her presentation, Rozzie, a four-year survivor of ovarian cancer, explained her personal story and connection to GBMC and her oncologist, Madhu Chaudhry, M.D. Rozzie hosted the event out of her desire to give back to GBMC and to assure that all of her friends knew of our work.

I spent a few minutes speaking of our vision and our vision phrase: To every patient, every time, we will provide the care that we would want for our own loved ones. I told those in attendance that in America, it was clear that we have the best doctors, nurses and other clinicians in the world, who are working very hard, but, that the system they work in needs to be redesigned to help them get the job done. I told them that the biggest challenge was how to coordinate care for those with chronic disease and how we were redesigning just about everything at GBMC to become more patient-centered and to meet this challenge. They listened attentively as we discussed advanced primary care and our hours of operation. They were intrigued by our disease state registries and how we were working to assure that everyone had evidence based colon cancer screening among other things. I reminded them how good our specialists are, how we have outstanding surgeons and that surgery at GBMC costs much less than surgery at most other local hospitals and with outcomes that are at least as good if not better. The participants had many questions and we had a great dialogue. Greg Shaffer, Director of Marketing, and his team were there to help me answer questions and to provide more information about how to access our care.

I felt very good about this session where I was speaking directly to those who benefit the most from our redesign work…members of the community. We will do many more of these sessions. Do you have a group that you would like us to address?

It Is Not What You Say, It Is What You Do

Marketing tag lines are pervasive in our society. If a concept is “in vogue,” organizations want you to believe “oh yes, we do that, too.” A good example of this in healthcare at the present is the term “patient-centered.”  The consumer should be wary of healthcare organizations who are using this term and they should check to see if the organization is really putting them in the center of what they do or are they just saying it.

To become patient-centered, you have to start by listening to what it is that the patient wants. Most patients want the care to be accessible when they need it. This is the reason that urgent care centers have sprung up.  Primary care offices were not open or did not have appointments when the patient had a need. Most patients, especially those with chronic disease, also want care from clinicians who they know and respect. They don’t want to have to keep introducing their problems to new people who will have a different treatment plan. Patients don’t want their time wasted. They want fast, but, first and foremost, they want the correct evidence-based care because they want to get well. Most patients would agree that getting an antibiotic that they really shouldn’t take just so the provider can get them out of the office faster is not an example of being patient-centered.

So what has GBMC been doing to be patient-centered?

A good example of true patient-centeredness is in our advanced primary care practices, our Patient-Centered Medical Homes. For these practices, it is no longer about the visit. It is about a relationship between a physician or advanced practitioner and a patient and a promise to that patient to help him or her stay well or get well when they are sick. The team is available when the patient has an acute need, but, moreover, the team studies the patient’s health and preventive care needs at regular intervals and works with the patient to assure that they get what they need. A good example of this is our work to assure that everyone who should have colorectal cancer screening gets it. We don’t wait for the patient to make an appointment. If we see that the patient is due for a colonoscopy, we contact the patient to help get it done.

The Medical Homes have significantly improved their availability. They are open Monday through Friday 7AM to 7PM and have Saturday and Sunday hours. As a group, they have provided office hours on major holidays as well. It is much easier to close at 5PM and not be open on weekends and holidays….but that isn’t patient-centered nor is it patient-centered to send patients to emergency departments for non-emergencies or to urgent care centers for acute care because it isn’t convenient for the primary care offices to be open.

The Medical Home is a model that emphasizes care and communication and transforms primary care into ‘what patients want it to be’ – a partnership between patients and their doctors to improve health, to improve the patient’s satisfaction with the way the care is delivered and to reduce cost. So, at GBMC we are well on our way towards our vision and we are not just talking patient-centeredness…we are doing it!