With the Institute for Healthcare Improvement’s Triple Aim as its guide, Health Quest Medical Practice (HQMP) is optimizing the outpatient medical experience by implementing an organizational governance model that empowers physicians to shape the processes and procedures they use to improve patients’ lives.
William Heffernan, MD, Chief of HQMP’s Primary Care Division and Chair of the EMR and Innovation Committee, left, Glenn Loomis, MD, FAAFP, Chief Medical Operations Officer at Health Quest and President of HQMP, and John Choi, MD, general surgeon and Operations Committee Chair, review coordinated care initiatives across primary and specialty services.
In today’s healthcare landscape, where reimbursement is often linked to quality measures and patient satisfaction, physicians are uniquely positioned to make medicine safer, more effective and less onerous for patients. Often, doing so requires overcoming a disconnect between clinical and administrative leaders.
“Physicians like to talk about cases and diseases,” says Glenn Loomis, MD, FAAFP, Chief Medical Operations Officer at Health Quest and President of HQMP. “They focus on the individual and the anecdote. Administrators tend to speak about processes, procedures, populations and cohorts. This difference in focus sometimes causes misunderstandings.”
Dr. Loomis, who assumed leadership of HQMP in January 2016, has helped create a truly physician-led organization within the integrated Health Quest system by implementing an approach that pairs physician leaders with administrative counterparts.
“By using a dyad model pairing physicians who provide clinical leadership and administrators who focus on management, we get the best of both worlds,” he says. “We think in terms of populations and processes, but we don’t forget about individuals.”
“As a not-for-profit organization, our mission allows us to focus on patients. The only thing every physician has to think about when he or she sits down with a patient is what is best for that person.”
— Jed Turk, MD, Medical Director of the Division of OB/GYN and Chair of the Board of Directors at HQMP
Jed Turk, MD, Medical Director of OB/GYN at HQMP and Chair of HQMP’s Board of Directors, left, and Dr. Loomis discuss recent adjustments approved by the HQMP Board of Directors.
The Power of Two
When Dr. Loomis joined HQMP last winter, he immediately set about empowering physicians in every aspect of the group’s clinical care and operations, beginning at the organizational level and filtering down to each of the practices.
“One of the first things we did was make our Board of Directors a true governing body for HQMP,” he says. “As part of Health Quest, we’re a not-for-profit entity, so the system board needed to retain the ability to direct certain things. However, we wanted HQMP’s day-to-day functions to be within the purview of our board.”
Next, committees formed to oversee quality, operations, finance, EMR, innovation and provider compensation. Physicians and midlevel providers sit on each committee, and a physician leader and an administrative leader oversee each one. Committee membership is open to all of HQMP’s more than 200 physicians and midlevel providers.
Committee members chart HQMP’s course on a range of issues. For example, family medicine physician and Quality Committee Chair Anthony D’Ambrosio, MD, and colleagues craft the quality measures each specialty follows. The Primary Care Division alone tracks more than 30 quality indicators. Some of these, dealing with diabetes and heart failure, for example, overlap with those of other specialties and require careful coordination. General surgeon and Operations Committee Chair John Choi, MD, and fellow committee members work to increase patient satisfaction and access to care.
“Our streamlined decision-making process has enhanced our ability to get things done,” says Jed Turk, MD, Medical Director of OB/GYN and Chair of HQMP’s Board of Directors. “If, for example, the Operations Committee makes a decision about a certain office function, they create a work plan, the Board of Directors considers it, and if it’s approved, the physician lead and practice manager execute it in short order.”
The final piece of HQMP’s governance reorganization is putting the dyad model in place at the practice level, a process that is ongoing. Where this model already exists, a physician lead and a practice manager share responsibility for running the practice; the former is in the driver’s seat when it comes to clinical decision-making.
“The administrator’s job is to make the trains run on time; the physician devotes most of his or her energy to seeing patients but carves out time a few hours a week to consult with the administrator about the practice’s day-to-day management,” Dr. Loomis says. “The physician provides the clinical leadership and patient advocacy, and the administrator brings expertise in running an efficient practice.”
“Previously, some offices had strong physician leaders who spent a lot of their time performing managerial tasks. At other offices, physician leadership was less evident, and practice managers led the way. Neither of those scenarios is ideal. With the balance of the dyad approach, the physician lead and practice manager provide the full spectrum of skills needed to move the practice forward.”
Dr. Heffernan consults with a patient.
Creating a Better Patient Experience
The dyad leadership model is proving effective at helping HQMP meet the tenets of the Triple Aim framework: improving the patient experience and the health of populations while reducing the cost of care.
To boost patient satisfaction, HQMP has:
- Created a central scheduling system that patients can use to make appointments at almost any HQMP facility
- Hired nearly 50 new physicians in 2016 to enable patients to receive more timely care
- Provided extensive customer service training to office staff
One of the most important steps HQMP is taking to enhance the patient experience — as well as improve outcomes and reduce costs — is to introduce a care management system at each of its primary care locations that will create continuity and a single point of contact for patients as they move through different parts of the Health Quest system. Each primary care office will have a care manager who tracks patients while they are in the hospital, speaks with them by phone after they are discharged, and assists with making primary and specialty care appointments, among other duties.
Care management is a key component of the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Primary Care Plus (CPC+) program. CPC+ seeks to help primary care practices improve the way they care for patients by providing financial resources from several partners, including CMS, commercial payers and state Medicaid agencies. The program is the successor to the Comprehensive Primary Care (CPC) initiative, which ended in December 2016; HQMP was one of the first entities in New York to participate in CPC.
“The idea behind CPC was to help primary care practices become more efficient by, for example, gathering information that’s important to ensure patients aren’t readmitted to the hospital and minimizing mistakes in medication reconciliation and documentation,” says William Heffernan, MD, Chief of HQMP’s Primary Care Division and Chair of the EMR and Innovation Committee. “CPC helped practices do things in a standardized way while remaining unique. CPC+ takes the lessons learned in CPC and adds to them.”
Ten of HQMP’s primary care practices are participating in CPC+, the first round of which kicked off in January 2017. The program will continue for five years.
“CPC+ gives us dollars up front to create a care management infrastructure that’s difficult to create with only fee-for-service payments,” Dr. Loomis says. “The program allows us to invest in primary care by hiring care managers and buying IT resources we need to ensure no patient falls through the cracks.”
“As we empower more and more physicians to be in charge, their satisfaction will increase.”
— William Heffernan, MD, Chief of HQMP’s Primary Care Division and Chair of the EMR and Innovation Committee
Dr. Heffernan reviews patient information on HQMP’s EMR with a staff nurse.
Prioritizing Population Health
To Dr. Loomis, caring for the health of populations means paying attention to the small but important details of patient care, as well as bringing more physicians and services to the Mid Hudson Valley so patients do not have to leave the region for care.
“We want to ensure every patient gets the right care every time, and that we close the loop on every encounter, both in the clinic and the hospital,” he says. “If, for example, we can support a patient in taking his low-cost blood pressure medicine, we may be able to prevent him from having a stroke and incurring high-cost care.”
“We’re adding a lot of specialists and services that haven’t been available in our area before. Patients live in the Mid Hudson Valley for a reason. They don’t want to go to the big city. We want to provide as much high-tech, high-touch care as we can close to home.”
Examples of HQMP’s commitment to providing local specialty care include the Neurosurgical Interventional Program, which cares for stroke patients, and the interdisciplinary cancer team.
“In one appointment, patients with cancer who require surgery — including breast, gynecologic and thoracic cancer patients — can meet with a surgical oncologist, a medical oncologist, a radiation oncologist and a case manager,” Dr. Turk says. “They can receive a treatment plan without having to go from physician to physician over multiple days.”
Achieving that sort of streamlined care has spurred HQMP to take another important step to improve population health: placing the divisions of urgent care, primary care and hospitalist care under one umbrella.
“One of the most exciting things we’re doing is creating a division of Population Health that includes urgent, primary and hospitalist care,” Dr. Heffernan says. “We needed all three divisions to share information so patients could get to the next, most appropriate care site in a timely manner. Consolidating the divisions into one body makes that easier.”
“We’ve moved the needle a long way in terms of reducing mortality rates and hospital readmissions, and we continue to work on those things every day,” Dr. Loomis adds.
Reducing Costs by Increasing Access
One way HQMP is controlling the costs of care — the third goal of the Triple Aim — is by providing patients who cannot get in to see their primary care physicians with lower-cost alternatives to seeking treatment in the emergency department (ED).
“Part of our responsibility as a group is to educate patients about when it’s appropriate to go to an urgent care center and when it’s appropriate to visit the ED,” Dr. Turk says. “We have two urgent care locations and plan to open a third by this summer. These centers are open 12 hours a day, seven days a week.”
To reduce hospital readmissions, HQMP is exploring the possibility of sending physicians to visit discharged patients at nursing homes. The practice is also investigating the feasibility of dispatching physicians to see patients in their homes if they are unable to visit an office location.
Glenn Loomis, MD, FAAFP, Chief Medical Operations Officer at Health Quest and President of HQMP
Taking Aim at a Fourth Goal
Dr. Loomis prefers to think in terms of a Quadruple, rather than a Triple, Aim, with the additional goal being provider happiness. HQMP aspires to be the region’s premier destination not only for receiving care, but for giving it, as well. Becoming a physician-led organization — giving physicians the tools and the confidence to shape the future of the practice — is one of the most significant ways HQMP is increasing physician satisfaction. Another is helping physicians refocus on what they do best: interacting with and treating patients.
“I’d much rather have a physician engaged with a patient face-to-face and making top-level decisions than entering information into the EMR or filling out a document to go to an insurance company,” Dr. Loomis says. “We’re working to minimize the number of clicks physicians have to make to get to what they need in the EMR and to off-load certain activities that don’t require a physician’s expertise.”
HQMP helps new physicians start off on the right foot with extensive orientation and mentorship from established colleagues.
Nader Mahmood, MD, left, Dr. Heffernan and Hary Suseelan, MD, right, discuss continuity of care between primary care and the pulmonology specialty.
“When you put physicians in charge of a physician group, you get their best effort.”
— Glenn Loomis, MD, FAAFP, Chief Medical Operations Officer at Health Quest and President of HQMP
A Future Defined by Growth
HQMP plans to double in size in the next five years as it expands in specialties that are underrepresented in the Mid Hudson Valley — such as OB/GYN, general surgery, and colon and rectal surgery — and fill a large gap in primary care. Dr. Loomis estimates the region has a deficit of
nearly 50 primary care physicians.
“Our catchment area is projected to have an increasingly aging population, and we’ll have a greater need for primary care physicians to care for those patients,” Dr. Turk says. “Having an adequate primary care base will drive all aspects of care for our patients in the future.”
Dr. Loomis embraces the challenge of meeting HQMP’s goals.
“We’re going to be a top performer in quality and patient satisfaction,” he says. “We’re going to expand our geographic footprint and physician roster. We will hire top-notch specialists who will rival those in New York City and Albany. Patients will be able to transition seamlessly between hospital and outpatient care. We’re going to work with our independent physician partners to control costs of care in our communities and make the Mid Hudson Valley a great place for employers. If we do all of those things, we will meet the spirit and letter of the Quadruple Aim. That is very aspirational, but it’s what we intend to do.”
For information about HQMP primary and specialty care, as well as a list of practice locations, visit healthquest.org/hqmp.