Making Medical Homes Self-Sustaining

Karen Minich-Pourshadi, for HealthLeaders Media , August 1, 2011

The practice also used IHI scheduling strategies and within one year patient access was reduced to three days, though the team is still working to bring that to one day.

"Access has been a great success for us," says Lyons. "You have to get a handle on supply and demand. How many patients are calling in for appointments for the same day? And once you do that, you need to create a contingency schedule to handle [clinical staff] vacations."

What the practice found was that patient access influenced other areas the teams were trying to address, such as care management. Although the practice had a nurse practitioner already in place when the pilot started, the practice added two care managers through the Physicians Health Organization of Maine.

Already paid for through the practice's dues to PHO, these two individuals began working in the office two days a week to contact chronically ill patients, such as those with diabetes, depression and heart issues.

"Our goal was to keep these people out of the ER. We asked, 'How can we accommodate these individuals – to see the ones that need support more often? By improving the patient's access, and getting them in to see the primary care physician or nurse practitioner when they need it."

However, after several months of the care managers contacting patients over the phone, the group realized that this model wasn't working for them. Lyons says because the practice had so many chronic disease patients, the team couldn't keep up with the patient demand. So the organization changed tactics. First, a full-time nurse practitioner was added solely to do chronic care outreach.

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