Adapting to changes in healthcare

Ben Boulden

Primary care doctor, Tobias "Toby" Vancil, M.D.

Primary Care, Patient- and Family-Centered Care, Regional Centers, Patient-Centered Medical Homes

While the health care sector nationwide is in the early stages of fundamental, economic change, UAMS already is adapting to that change.

It is leading by example with an expansion of primary care, an emphasis on patient- and family-centered care, a more
integrated partnership between UAMS’ main campus in Little Rock and its regional centers across Arkansas, and the move to model of care called patient-centered medical homes.

“All these changes are related,” said Richard Turnage, M.D., UAMS College of Medicine executive associate dean for clinical services. 

“These are the themes of health care change: Excellence, teamwork, working toward a common goal and leadership. Everyone has to be involved in performance improvement.”

PRIMARY CARE EXPANSION

Primary care is increasingly at the center of new efforts to better manage chronic conditions and head off health problems before they become critical.

UAMS is focused on providing an exceptional experience in every aspect of care.

Assisting this effort are new financial incentives from the federal government and private insurers compensatingPrimary care map health care providers to encourage more effective preventive and team-based care.

“We’re moving toward getting paid for better health outcomes rather than for services and procedures performed for patients,” said Charles Smith, M.D., director of the UAMS primary care service line. “It’s the old volume of services versus the new emphasis on the value and quality of health care and the important outcomes for patients.”

Along with 14 other areas of care at UAMS, primary care recently was organized into its own service line to improve care while finding new efficiencies. Called the Integrated Clinical Enterprise, the effort brings together everyone involved in a patient’s care in a particular area such as primary care, cancer, mental health or labor and delivery.

Orthopedic clinic

UAMS also expanded access to its orthopaedics services in 2015 by opening a UAMS Orthopaedics Clinic in west Little Rock led by C. Lowry Barnes, M.D., one of the region’s foremost joint replacement experts. The new location at 2 West Shackleford provides easy access for those with orthopaedic injuries. The clinic is open five days a week and allows patients to drive right up to the front door. UAMS also continues to see orthopaedic patients at its main campus.

Communication is improved along with understanding about each person’s role. It replaces the older, traditional model in an academic health center in which a patient moves from department to department.

To reach patients in the timely manner that makes preventive care possible and to engage them in other initiatives, UAMS has to be closer to them physically and more accessible.

That’s one reason it has established UAMS Neighborhood Clinics at Rahling Road in Little Rock and in Maumelle. A third is planned to open soon near the Capitol Mall in downtown Little Rock.

All of these clinics operate from the patient-centered medical home model that emphasizes team-based care, along with improved access to appointments and easier communication with the providers and the clinic staff.

Smith said UAMS also is making even more use of telephone contacts, computer outreach, electronic health records and care management nurses to open communication between provider and patient. UAMS’ MyChart system enables patients to email their physicians or a nurse to ask a question and to better determine if an office visit is necessary.

“A substantial part of my communication with patients is going on through the online portal,” Smith said. “You’re not going to have a thriving practice without it in the future. It’s silly to go to a doctor’s office just to get a question answered.”

REGIONAL PROGRAMS

Not only does UAMS provide high-quality medical care at its main campus and Neighborhood Clinics, Arkansans throughout the state can find care at family medical centers located at UAMS regional centers.

These UAMS family medical centers are helping meet the challenge presented by a largely rural population. They are located in Fayetteville, Fort Smith, Jonesboro, Magnolia, Pine Bluff, Springdale and Texarkana. Each has earned the highest level patient-centered medical home recognition from the National Committee for Quality Assurance (NCQA).

Through these centers and with local hospital partners, UAMS educates resident physicians in family medicine while providing primary care and outpatient services.

regional programs map

With the move to the Integrated Clinical Enterprise, the distance between the clinics and the Little Rock campus requires close coordination, said Tim Hill, vice chancellor for Regional Programs.

In time, he said, Regional Programs will likely become its own defined service line, and then he and other UAMS leaders will look at how to integrate it into the overall clinical enterprise at UAMS.

Not just with patient care, but with its mission to educate resident physicians and to look for operational efficiencies, incorporating the regional clinics into the overall UAMS structure can only strengthen the program.

“I think integrative strategies that leverage the strength and value of UAMS make sense,” Hill said.

One such strategy in the planning stage is for each regional center’s health library to be integrated into a single library delivery system in coordination with the main UAMS library in Little Rock.

Additionally, the regional centers may cooperate in service contracts for its buildings, procurement of supplies, human resources, risk management, contracting and revenue cycle.

Physicians trained by regional programs counties in Arkansas

PATIENT-CENTERED MEDICAL HOMES

By helping patients manage chronic conditions, the heath care team is providing better care while better managing costs.

Health professionals at UAMS South Central in Pine Bluff d

Health professionals at UAMS South Central in Pine Bluff discuss a patient’s treatment.

For several years, UAMS has been working toward implementing the patient-centered medical home care model within its family medical centers statewide.

By 2014, all original family medical centers statewide had earned national recognition by the National Committee for Quality Assurance (NCQA) as Level III  — the highest level patient-centered medical home recognition.

The NCQA is a private, nonprofit organization dedicated to improving health care. It has worked with leading national medical organizations like the American College of Physicians and the American Academy of Family Physicians to develop PCMH recognition standards.

The care model is a clinical setting where health professionals work as a team to address patients’ immediate and long-term medical needs.

The UAMS family medical center in Little Rock led the way by achieving Level III in 2010, followed by Fort Smith in 2013. In 2014, UAMS family medical centers in Jonesboro, Fayetteville, Pine Bluff, Magnolia, Springdale and Texarkana also attained Level III status.

“I’m immensely proud of our UAMS family medical centers in Regional Programs for accomplishing this significant task,” said Hill. “Not only does it mean we will obtain better outcomes for our patients, but this new team-based model of care will mean a better experience for our providers.”

The patient-centered medical home creates partnerships between individual patients, their physicians and the patient’s family. Care is facilitated by registries, information technology and health information exchange so patients get the indicated care when and where they need and want it.

It also means for patients same-day appointments, quickly answered telephone calls, an on-call resident they can reach after hours and on weekends, and overall improved care coordination. 

With the patient-centered medical home model, more frequent communication takes place outside the exam room between each patient and each center’s physicians and staff. Between visits, more is done to monitor a patient’s condition and help the patient stay on a treatment plan.

In addition to improving patient outcomes, the model promises to cut costs by reducing the need for hospitalization or emergency room care.

Nationally, about a quarter of the primary care practices have adopted the patient-centered medical home model.

PATIENT- AND FAMILY-CENTERED CARE

In addition to expanding access to patient care, UAMS has also shifted focus to a patient- and family-centered care Patient and family centered careapproach that allows UAMS to offer the best patient experience while providing the best medical care. It redefines the relationships in health care.

“Patient- and family-centered care is a philosophy and way of relating to patients by engaging them in the care process. The patient-centered medical home is a way of organizing providers —and patients — around that idea,” said Julie Moretz, UAMS associate vice chancellor for patient- and family-centered care (PFCC).

Patient and family centered carePFCC seeks to empower patients to be involved in their own care decisions to the fullest extent they want to be. It also recognizes the vital role that families play in ensuring the health and well-being of patients. The approach allows UAMS to reshape its policies, programs, facility design and staff interactions to promote a healing atmosphere to patients and families.

For instance, families are considered allies, not visitors, and as such, are welcome to visit and stay with patients anytime day or night as opposed to formal visitation hours.

Also, family members are invited to participate with the patient and care team during rounding and communication boards are in every inpatient room to let families know who is caring for their loved one and other aspects of care.

Seven patient/family advisory councils are active at UAMS to advise on inpatient and outpatient process improvements.

Moretz serves on the Service Line Medical Directors Committee and the Integrated Clinical Enterprise Implementation Team to help ensure the patient- and family-centered care philosophy is woven into the new service line organization and other innovative changes that are occurring.

This includes a physician five-star rating system UAMS introduced in fall 2015 in an effort to be more transparent and provide patients with information they can use in making decisions about their health care. The ratings by patients are posted online, making UAMS the first hospital in Arkansas and among the first in the nation to do so.

EVER-EVOLVING CHANGEPFCC advisory

All of these initiatives are helping UAMS adapt to the ever-evolving climate of health care system change.

“The service lines are aligning the physician’s efforts toward patient care with the hospital’s efforts toward patient care,” Turnage said.

Turnage sees one of his chief missions to be clearly communicating to UAMS physicians how the changes can improve  efficiency and effectiveness. UAMS has reorganized its medical staff committees and restructured administration throughout to drive performance improvement.

Interprofessional education and collaborative professional practice are renewing focus on educating students and clinicians to work in patient care teams.

“The way to look at these changes in health care is as a big wave,” Turnage said. “The goal of this response is to surf on top of the wave and to not be consumed by it. I think we are doing pretty well. We are on top of the wave.”