For many people, doctors and caregivers are there for when something goes wrong. Preventative medicine takes time, money, forethought, and a change in lifestyle. For many patients, the hurdles seem far too high to overcome and they struggle to know where to begin. The face of medical care, however, is changing. At the forefront of changes being made to healthcare on a national scale is the Accountable Care Organization (ACO), a value based contract that has the ability to measure and deliver high quality care at a manageable cost.
In its infant stages of development, the goal of this program is first being applied to Medicare beneficiaries. Summit Pacific Medical Center, thanks primarily to the efforts of Tammy Davis and Ashley Galvin, is one of the first hospitals on the West Coast to take part in this evolving program. “The goal of value-based changes to medicine is population health done through prevention of disease,” describes Davis. “For instance, if we can stop someone from smoking at 25 years old, essentially we are reducing the likelihood that they will develop lung cancer in the future. The ACO program at Summit Pacific Medical Center will promote screenings, immunizations, and focus care on the sickest patients within our Medicare beneficiaries.”
The program’s intent is to simultaneously reduce costs to patients and Medicare and reduce preventable disease and injuries, while rewarding hospitals and medical centers for healthier patients. It’s a reversal of operations, if you will, as traditionally medical centers have earned their keep through treating sick patients. The shared savings is a revolutionary concept in the form of a transition model that is bound to evolve and grow over the upcoming years.
“We began the program in January, so we don’t have any outcomes yet. But so far patients have been very pleased with the way we’ve done things,” reports Davis. The program in these beginning phases is expensive, with many, many hoops to jump through and rules to abide by. Davis explains however that it is, “the cost of tuition for healthcare reform.” Much of this reform begins by improving health literacy in patients by asking questions such as, “How well did you understand your medical visit? Do you understand your prescription? Do you know about home care?” This is where Ashley Galvin fits into the big picture.
Galvin’s task as a Registered Nurse is to implement and run the Care Coordination Program. When a patient schedules a doctor visit, very often they will have less than fifteen minutes of face time. This limited time due to a doctor shortage and crammed schedules very often leaves little opportunity for questions and delving to the root of prevention. Many of the patients with Medicare are 65 years old or older and are discussing serious issues with their doctor.
The Care Coordination Program allows people like Galvin to take the time to delver deeper into discussions about medication and health education to ultimately increase the patient’s understanding of their own health. “My job will be to act as a liaison to make sure everyone gets proper information and act as a social worker of sorts. I’ll be able to directly purchase wheelchairs or walkers if it will help keep someone out of the hospital,” says Galvin. This type of preventative care has been difficult to achieve through traditional insurance methods and Medicare, but could be a key in greatly reducing emergency room visits and Medicare expenses. “I’ll be meeting with patients and talking about everything from home life to medicine. What can we practically change to improve a patient’s health? It’s a holistic view, if you will, of that patient’s care. I will take on the role of a ‘health coach,’” explains Galvin.
Davis, who is the Accountable Care Director at Summit Pacific, is excited for the medical center to be investing in Galvin as a leader in the new program. Galvin seems eager to step into her new role as well. “Working as a nurse, my favorite moments have been helping patients outside the clinic. So often, a patient would come in one week only to return the next for something that was preventable. I couldn’t help but think, ‘if someone had done that one thing for you, you wouldn’t be here.’ The times I was able to check in with a patient and help prevent a return visit made me most excited. Now that’s my job and not only that, I get to be creative in the ways I help patients take preventative care,” smiles Ashley.
The program will not only be improving care for patients, but also tracking the quality of the health care in participating providers, helping them target areas with room to improve and also find more cost effective methods. The three-year contract will be a springboard for learning, ideas, and application to other areas within the hospital. “Things are changing and we want to be ahead of the game,” says Davis, who is also a Nurse Practitioner. “Let’s change the healthcare landscape in a way that will be better for the patient.”
