Practices Mark First Year with State’s Chronic Care Initiative
In May 2008, a group of medical practices became the first in Pennsylvania to redesign their practices to better care for those with chronic diseases—and get paid for it.
These 30 southeastern practices joined a new state initiative that combines the Wagner Chronic Care Model with the Patient-Centered Medical Home (PCMH) to improve care for adult diabetic and pediatric asthma patients.
Now, as the initiative expands to a wider area, physicians at two of these practices look back at their first year with the chronic care initiative's pilot learning collaborative.
Learning from each other
It was a little overwhelming at first, recalls Elizabeth Fabens, MD, of Greenhouse Internists in Philadelphia.
"But as it went, people really did embrace it and came back with more and more ideas," she says.
Dr. Fabens said she enjoyed the camaraderie of the learning collaborative—the chance to work with others "who do in-the-trenches primary care."
Joseph Mambu, MD, of Family Medicine, Geriatrics, and Wellness in Lower Gwynedd agreed, saying, "We were just finishing a two-year PCMH national demonstration project … and it was a wonderful opportunity to continue collective, collaborative learning."
Making the change
Practices in the collaborative got help from each other and from the state implementing the chronic care and PCMH models.
The chronic care model focuses on six principles: improving patient self-management; proactively reaching out to patients; using evidence-based guidelines to make treatment decisions; using simple systems to identify and track patients; identifying or developing community resources to promote healthy lifestyles; and creating a quality-oriented practice culture.
"It's not just waiting for people to show up for an appointment but actively going out and pulling people in," Dr. Fabens explains.
The medical home seeks to provide accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.
Implementing these changes wasn't easy—even for Family Medicine, Geriatrics, and Wellness, which had already become a PCMH through the TransforMed national demonstration project.
"The medical home is very hard to develop. It takes a lot of time, leadership, and commitment. And it takes money," Dr. Mambu says.
To help offset the cost, practices received increased reimbursement. This allowed Greenhouse Internists to hire a health educator, who Dr. Fabens says made all the difference.
"She has a non-doctor perspective. Doctors, historically, don't get taught a lot about nutrition and lifestyle. It's not in the traditional medical model," Dr. Fabens says.
The health educator also was able to take care of the intense monthly reporting requirements and follow-up with patients, which revealed something interesting.
"We now know that not that many people read the letters we send them," Dr. Fabens says.
Though Dr. Mambu says payments were frequently late or inaccurate, he doesn't regret his decision to participate.
"It's a leap of faith right now. You have to believe in it, and I believe in it," he says.
Seeing results
In one year, the practices in the pilot collaborative helped improve care for about 15,000 adults with diabetes and 12,000 children with asthma, Gov. Ed Rendell said at a dinner honoring participants.
The number of diabetics with self management goals increased 195 percent, while the number getting foot exams increased 142 percent and the number getting eye exams increased 71 percent. About twice as many children with asthma have documented asthma action plans.
The patient reaction at both practices has been positive, although Dr. Fabens noted that some patients complained about the increased communication from the practice.
"Patients like the open access, but I don't know whether they understand—or were interested in—what the medical home and chronic care models are," Dr. Mambu says.
"I definitely think that it's really improved the care that we give," Dr. Fabens adds.
Last Updated: 7/29/2009