Finding Solutions

With chronic disease on the rise, U.S. health care costs skyrocketing and the old model of medicine failing to provided solutions, many are calling for a 'patient-centered' approach to health care.

Patient-Centered Medicine in Practice

The health care providers featured in the Rx film all have one thing in common: they put the patient at the center of medicine, with positive results. While this is the common thread that runs through these people and organizations, how they implement patient-centered care is as unique as the populations that they serve. “There’s definitely a curiosity and a search for answers on how to empower people to be partners in their care. The four sites we chose for the film use simple and innovative methods that are reproducible,” says Dr. Jennifer Mieres, Rx executive producer.

David Loxterkamp, MD

Dr. David Loxterkamp

David Loxterkamp is a family physician in Belfast, Maine who co-founded a clinic called the Seaport Community Health Center (SCHC). In 2006, the clinic participated in the two-year national demonstration project, where they (along with 35 other participating practices across the country) pilot-tested a new model of patient-centered care that has since been gaining traction. Called the “patient-centered medical home”, the model has a number of core principles such as team-based care and the idea that patients should have one primary physician. On its website the SCHC lists the features that define its approach, which they call “The New Medical Home”:

Personalized Care: From a doctor who knows you, cares about you.

  • Same Day Access: Our front office and triage nurse will make an appointment for you or provide an answer on the same day that you call.
  • Team-Based Care: It takes everyone in the office, each doing our part, to provide the services, education, and support you need.
  • Online Records: Through our on-line portal, you will have 24-hour access to your test results, office notes, medication list, and vaccination record.
  • Care Management: For patients who require more attention and special services, we assembled a special team of nurses, educators, and social workers.
  • Integration: We not only work alongside counselors, pharmacists, & therapists, but also with them to better understand and meet your needs.
  • Teaching: We are committed to educating the next generation of health professionals for the needs of rural communities.
  • Co-Location: For your convenience, we have brought together the essential services necessary for optimal primary care.
  • Community Minded: We recognize that our patients live and work in the community. And we must too, in order to understand and coordinate the health resources that abound there to help our patients.

The primary goal of this style of medicine is to redirect healthcare from its hyper-focus on procedures and diagnostics back to the patient. The SCHC sees its efforts as a kind of re-integration into the community — and by extension, into its patients’ lives.

Since adopting this model, the SCHC has seen some modest successes, especially in the area of care management and prevention. They were referred 150 patients who needed special one-on-one care and close follow-up. These tended to be new or uncontrolled diabetics, smokers who expressed a desire to quit, and patients with complicated social lives or medical conditions. Of those referred for smoking cessation, 1/3 have successfully quit. Diabetics with uncontrolled blood sugar saw an average drop in blood sugar of more than 100 points.

In addition, SCHC has sought out and enrolled up to 10 patients a week in a Marketplace insurance plan, expanding healthcare access in a rural part of Maine that has been ravaged by the prescription drug abuse.

Katherine Gottlieb

Katherine Gottlieb

Katherine Gottlieb & the Southcentral Foundation

In 1982, the Southcentral Foundation was established in Alaska as a healthcare organization for the underserved native population. Katherine Gottlieb, herself a tribal member of the village of Old Harbor and Seldovia Village, joined Southcentral in 1987. She currently serves as the organization’s president, and has overseen its expansion from fewer than one hundred employees to over one thousand.

Southcentral Foundation practices a type of health care known as the “Nuka” model. Named after an Alaska Native word meaning “strong, giant structures and living things”, the Nuka model focuses on building relationships with patients. Instead of having a single point of contact with the healthcare system, patients are treated by a team of dedicated medical professionals who work together to provide the patient the care they need.

The model has been extremely successful and the South Central Foundation has reported impressive numbers:

  • 93 percent customer satisfaction for 2014
  • 23 percent decrease in emergency room care from 2008 to 2015
  • 25 percent decrease in primary care visits from 2008 to 2015

People have begun to take notice of these numbers, and word of the Nuka model is spreading. They now host an annual conference and have been invited to speak at events as varied as the South by Southwest music festival and Harvard Medical School.

Kristi Henderson

Kristi Henderson

Kristi Henderson & the Center for Telehealth

On average, Mississippi residents live over forty minutes away from specialist health care providers. This creates a significant barrier to quality care in a state that is both largely rural and has some of the highest rates of obesity and diabetes in the country.

This inspired Kristi Henderson to start the Center for Telehealth at the University of Mississippi Medical Center in 2006. She has led the development of UMC’s telehealth program which has been essential in reaching out to and providing healthcare for Mississippi’s remote and rural population.

The UMC Telehealth program connects specialists to patients virtually. Using what are essentially video conferencing tools, a patient can visit their local practitioner and patch into a video conversation with a specialist who is more often than not located at a large medical center like the one located at University of Mississippi.

The Center for Telehealth now includes 35 specialties, provides 8,000 telemedicine visits a month and 100,000 a year across the state. As a result, small hospitals in the state saw their costs drop 25 percent because they didn’t have to rely on temporary doctors paid under contract to work in their emergency departments. At the same time, their admissions rose 20 percent because patients weren’t being sent to larger hospitals.

In August of 2014, UMC Telehealth launched the Diabetes Health Network, which employs wireless electronic tablets loaded with a care management application called “Care Innovations”. Diabetic patients capture their health data, such as weight, blood pressure and glucose levels, and transmit the information to clinicians daily. “We’re already hearing such great patient feedback about how the Diabetes Telehealth Network is empowering patients to take better control of their diabetes from their home, yet still have the guidance and oversight of clinicians,” said Henderson in a press release about the program.

A patient sends her glucose data for review through the UMC Telehealth Diabetes Health Network.

A patient watches a tutorial on how monitor glucose levels on a wireless tablet provided by UMC Telehealth.

On Lok Lifeways

Founded in 1971, On Lok’s goal is to allow frail and elderly seniors with chronic illnesses or disabilities — who would normally require nursing home care — to live with dignity in their own home. On Lok’s solution, a program called PACE (Program of All-Inclusive Care for the Elderly), provides an array of services both medical and domestic. Depending on the participant’s needs, a home care assistant may visit weekly or even daily. The assistant may help them shave, get dressed, organize medicine and do some basic shopping and errands.

Participants in On Lok’s PACE program.

Seniors socializing at On Lok’s ‘daycare’ center.

On Lok also shuttles participants to a kind of “daycare” center that serves as a point of access for healthcare and a place to socialize. Seniors have access to physician care, physical therapy, meals customized to their diet, cultural events, and even a chaplain.

In 1979, On Lok launched a Medicare-funded demonstration project of their model of long-term care. An interdisciplinary team (physicians, nurses, physical and occupational therapists, social workers, dietitians, health workers and drivers) formulated coordinated care plans and provided all medical care and social services. The program was successful, and the cost of care was 15% less than the traditional fee-for-service systems.

In 1983, On Lok obtained waivers from Medicare and Medicaid to test a new financing method for long-term care: In exchange for fixed monthly payments from Medicare and Medicaid for each enrollee, On Lok was responsible for delivering the full range of healthcare services, including hospital and nursing home care – bearing full financial risk. A permanent Medicare and Medicaid waiver followed in 1986, and since that time On Lok has had no cost overruns and has been able to place a percentage of operating revenues in a risk reserve fund each year.

On Lok’s model has become popular and is spreading across the country. In January 2015, the 107th PACE program opened in Indiana, bringing the total number of states participating to 32.

 

 

Defining Challenges

A disease-based, doctor-centered medicine served us well for the first half of the 20th century, but economic pressures and a changing population are revealing its shortcomings.

A PRODUCTION OF

PBS