Medical home uses technology to improve care

http://www.mpnnow.com/news/x1310200782/Medical-home-uses-technology-to-improve-care

Rochester, NY – Patients involved in one of Rochester’s first medical home projects have dramatically improved their health in the first two years of the program.

Data shows that patients are better managing chronic conditions and more patients are getting cancer screenings. The more than 33,000 patients in the Rochester Medical Home Initiative (RMHI) are on average performing better on certain health measures than 90 percent of the national population with similar health issues.

A medical home is a collaboration between patients, physicians and a team of professionals to better coordinate care, especially for patients with chronic conditions such as diabetes and heart disease.

Excellus BlueCross BlueShield and MVP Health Care are coordinating and paying for the three-year program. The initiative began in the summer of 2009 and includes 21 doctors at seven area practices.
“We learned that if you work collaboratively with clear focus and alignment, you can demonstrate dramatic improvements in health care,” said Martin Lustick, M.D., senior vice president and corporate medical director, Excellus BCBS.
The following are examples of how patients improved their health from September 2009 to July 2011:

• Reduced bad cholesterol: On July 2011, 75 percent of heart disease patients and about 70 percent of diabetic patients had bad cholesterol (LDL) levels below 100. Fifty percent more patients were at this optimum level in July 2011 compared to September 2009.
• More cancer screenings: The percentage of eligible patients who had colorectal cancer or breast cancer screenings increased from about 60 percent of patients in September 2009 to about 75 percent of patients in July 2011.
• Improved blood pressure: About 80 percent of patients with hypertension had blood pressure readings at or below 140/90 in July 2011, compared to 65 percent in September 2009.

The project’s most dramatic improvements came from the redesign of doctor and staff work flows that resulted in more personalized care for patients, said Geoffrey G. Morris M.D., of the medical home at the University of Rochester Medical Center’s Pulsifer Medical Associates practice.
“Instead of only focusing on patients during a regular visit, our team also reaches out to them outside the office to ensure their care is more comprehensive,” he said. “This includes monitoring to know when patients are overdue for colonoscopy, mammogram, blood pressure and cholesterol checks; calling patients at home to provide support with issues such as diabetes care; and greater assistance scheduling tests and consultations so they do not have to navigate the medical maze alone.”
The medical homes at Unity Family Medicine at Chili Center and Unity Family Medicine at St Bernard’s enhanced electronic tools and hired nurse care managers to help patients with chronic conditions better manage their health, said Michael Nazar, M.D., vice-president, primary care and community services at Unity Health System.
“Patients are finally able to control their blood sugar and reach healthy cholesterol levels thanks to the extra resources and personal attention that comes with being in a medical home,” he said.
Many patients at the medical home at the Lifetime Health Medical Group’s Perinton Health Center have also improved their health, exceeding many local, state and national averages.

“Patients are more engaged in their health care and tell us that they appreciate the accessibility and open communication with their care team,” said Mark Cohen, M.D., of the Perinton Health Center.

Going forward
“Our medical home project has served as a catalyst for other medical homes in the area,” said Stephen H. Cohen, M.D., vice president of medical affairs, MVP Health Care. “Whereas few practices operated as medical homes when the project first started, many more doctors have since embraced this concept.”
The University of Rochester Medical Center, Unity Health and Lifetime Health Medical Group, for example, have since turned all of their primary care practices into medical homes. Rochester General Health System is also in the process of converting their primary care practices into medical homes.

The first two years of the medical home project focused heavily on improving patient care, especially for those with chronic conditions. The next step is to decrease patients’ need for certain services, such as reducing hospital readmissions and emergency room visits.
The following primary care physicians are involved in the medical home initiative:

• Drs. Morris, Ann Shamaskin and David Dobrzynski of Pulsifer Medical Associates, Brighton;
• Drs. Joseph DiPoala, Jr., Nancy Shedd, Robert Caifano, Robert Thomson, Sara Zaka, and Shelly Kane of Ridgeview Internal Medicine, Irondequoit;
• Drs. Sheryl Holley, Michael Nazar and Shazia Janmuhammad of Unity Family Medicine at St. Bernard’s, Rochester;
• Drs. Bill Pum, John Bank, Scott Stratton-Smith and Sue-Ann Novak of Unity Family Medicine at Chili Center, Chili;
• Dr. William Bayer of Jefferson Family Medicine, Rochester;
• Dr. Robert Smith of Finger Lakes Family Care, Canandaigua;
• Drs. Cohen, Harneet Kohli and Catherine McPhee of Perinton Health Center, Perinton.

A virtual care visit is currently not covered by insurance companies or by medicare as they do not recognize the efficiency and value of this type of visit. Therefore, the patient becomes responsible for the cost of this visit that ranges from $25 to $50 depending on the length and nature of the visit. We believe that empowering patients to decide how they will receive care, rather than the insurance company dictating how care will be rationed out is a much better model to treat patients.

Please ask our staff to set up a virtual care visit with Dr. Smith. You will need a computer with an internet connection and a webcam equipped with a microphone and speakers. Our staff may direct you to NowDox.com in order to assist you in preparing your computer for our virtual care services. Once your system is ready to go, simply drop into Dr. Smith’s Vidyo Room at the agreed upon time and your virtual care visit will begin.

Thank you for your interest in Virtual Care. We believe it is the next big thing in delivering healthcare in an affordable and accessible manner. It also promotes a better patient physician relationship because it leaves the insurance company and other third parties out of the relationship!

Robert L. Smith, MD, MS

(CNN) — As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.

“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ ”

The bride may have been doing great things for her wedding, but she was sabotaging her own care — and it was a really important visit, as she was newly pregnant.

Talking on your cell phone in the examining room, forgetting what medicines you take and lying to your doctor about your personal health habits are all ways of compromising your health.

“The doctor-patient relationship is like a business partnership,” Rankin says. “We need to work together. Trust me to guide you but be willing to do your part.”

From interviews with a gynecologist, a cardiologist, a rehabilitative medicine specialist, a fertility doctor and an internist, here are the Top 10 things patients do to mess up their own care.

1. You talk on your cell phone.

This is your health we’re talking about. Other calls can wait. Turn the thing off.

2. You lie.

“I need to treat you the best way I can, so if you’re gay, tell me. If you drink a bottle of tequila every night, I need to know. If you’re having an affair and not using condoms, let me know,” says Rankin, who blogs at “Owning Pink.” “I promise I won’t judge you.”

3. You do a sloppy job describing your pain.

Is it stabbing or burning? Sudden or constant? Tingling or hot? The answers will help your doctor make the right diagnosis.

“You should describe the exact location, how intense the pain was, what provoked it and how long it lasted,” says Dr. Nieca Goldberg, director of the New York University Women’s Heart Program.

The week before your appointment, keep a diary of your pain and your other symptoms, too, advises Dr. Loren Fishman, a clinical professor of rehabilitative medicine at Columbia University College of Physicians and Surgeons. He suggests using this time to also think about the questions you want to ask your doctor and what you hope to get out of your appointment.

4. You don’t state up front all the reasons for your visit.

If your ear hurts, your knee pops out when you run and you have a sty in your eye, state all three concerns at the beginning of the appointment so your doctor can plan your visit efficiently, advises Dr. Howard Beckman, an internist and clinical professor of medicine at the University of Rochester.

5. You don’t state up front your expectations for your visit.

If you have certain hopes or expectations — the doctor will pop that sty in your eye or prescribe antibiotics for your sore ear — say so. The doctor can then explain if your expectations are realistic, and you’ll be happier in the end.

“Sometimes patients are out of proportion to what the reality is, like the 44-year-old woman who hopes to get pregnant in one IVF cycle,” says Dr. Jamie Grifo, program director of the New York University Fertility Center. “If they don’t communicate their expectations, then I can’t address them.”

6. You don’t know what medications you’re taking.

“Patients should bring a list of medications they’re actually taking, not what they believe they are supposed to be taking, or what they think I want them to take,” Beckman advises.

If you take supplements, Rankin suggests you bring them in, since supplements aren’t standardized like prescription drugs, and your doctor will want to see all the ingredients.

7. You leave with unspoken questions and concerns.

If a question’s in your head, ask it, even if you think the doctor is rushed. If you’re worried your headache might be a brain tumor, say it even if you think you sound like a hypochondriac.

8. You don’t bring your medical records or images with you.

Yes, even in this day and age, many doctors rely on the fax machine to send medical records to and fro. Faxes goof up, so unless you absolutely, positively know your doctor has your records and images from another office, bring them with you, doctors advise.

9. You’re too scared to disagree with your doctor.

If your doctor suggests you need an antidepressant and you don’t want to take it, say so instead of nodding your head, taking the prescription and throwing it away the minute you’re out the door. Or if she suggests a medication you can’t afford, just say so.

“I know many of you are programmed not to question your doctor, but we can’t read your mind, so we need you to communicate,” Rankin says. “If the treatment plan I suggest doesn’t resonate with the intuitive wisdom of your Inner Healer, please tell me, instead of ignoring what I suggest.”

10. You don’t comply with the treatment plan.

For doctors, this is the granddaddy of them all. If you’ve followed all the advice above, you should have a treatment plan that makes sense to you and one you’re able to execute.

“Please follow through and do what you’ve agreed to do,” Rankin says. “And if you don’t, please tell me so I don’t mistakenly assume the treatment failed. I won’t jump all over you. I just need to know.”

How about having an easy way for a patient to signup and authorize having their family members schedule a time to just “drop in” to a secure virtual consult room, but the “room” is MOBILE, and available to be accessed from a Tablet (Xoom or iPad for example) or a mobile workstation on wheels, or even a 4G connected Smartphone.  The patient could have one type of device at the bedside, the nursing staff could introduce or start the visit from a tablet, and perhaps the family are sitting at their own laptop, PC, tablet, etc….all visiting at the same time.   Then the nurse or patient could click the button to show the “other camera” and all can see the new baby or discuss any issues.  Later, one could have the covering obstetrical physician drop in if able, and answer a few questions, getting everyone “on the same page”.