Aligning Forces Alliances in Maine, Minnesota, and Oregon were recently featured in Health Affairs for their efforts in developing safety-net accountable care organizations (ACO). ACO-focused initiatives have early signs of success in delivering cost-effective, patient-centered care while advancing patient engagement, thus achieving Medicaid’s Triple Aim. Safety-net ACOs are collaborative entities of...
Nathan Wilson, a self-identified “qualitologist,” said that “nothing will agitate a group of physicians more than introducing patient experience surveys into their practice,” despite the benefits of incorporating the patient voice. When patient experience surveys were initially piloted, the results were positive. But, when the program expanded, Wilson found that physicians experienced the “four stages of grieving:” denial, fear, anger, and acceptance. Wilson’s group used the data, and the physicians with the worst patient satisfaction scores...
To get the collaborative approach working, Cleveland’s Alliance had to overcome some history, according to J.B. Silvers. First, the approach was “just trust the doctor”—which, needless to say, did not work well. The second phase was to trust the managers and the free market to fix the system, but that resulted in managed care and subsequent frustration. Finally, a collaborative model emerged in Cleveland, and it has been a success. Cleveland focused on primary care, celebrated victories, and had trusted data because of the uptake of electronic medical systems. The...
If communities can create a focus around information sharing, about patients and with patients, Craig Brammer believes we can radically improve health and the way patients navigate health care. Part of that is getting people in a room to talk about things they don’t agree on. How do you give people a nudge to do this? In Cincinnati, they use data as a “magnet” to pull people together. Part of it is extending a low-risk opportunity to participate. “We learn together and give ourselves an opportunity to improve.” Brammer knows firsthand the importance of...
Ann Kunkel told the story of Betty, an older woman living in a senior community, who, in her day, “was a force to be reckoned with.” She was a social activist for women’s rights and racial equality, but in her later years, she became isolated and developed diabetes and osteoarthritis. Her unresolved grief and growing alcohol dependency compounded her problems. When she did go to her doctor’s office, they would treat whatever flare-up had occurred but didn’t know her aspirations or goals. Care transformation changed Betty’s life for the better.
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Phil Baty is a family doc. His patient, Rick, is a 62-year-old Bible-carrying truck driver with multiple health problems. Baty has been his doctor for 22 years. In the past, his visits have been spent dealing with the latest health problem, rather than managing all his chronic conditions. Now, with new tools like care managers, his practice can be proactive and review cases. His practice now has evidence-based practices and clear targets. Baty is achieving the “quadruple aim”—the triple aim plus the added benefit of doctors feeling a little bit less insane. Baty was able...
As Ann Abdella would bicycle to work, she would pass by small farms and think about the similarities between small farmers and independent primary care practices. Both are the backbone of the community and have a great sense of pride, but they are disappearing at a rapid rate. Primary care is the foundation for transforming our health care system. For almost a century, farmers have had the support of local extension agents. Independent physicians have had to fend for themselves. That is, until trained practice enhancement associates, or PEAs, came to Western New York to help practices...
Quality Field Notes features key lessons learned by regional Alliances of clinicians, patients, and payers in Aligning Forces for Quality communities as they work to transform local health care and provide models for national reform. The latest topic in this series focuses on patient experience. Patient experience surveys, particularly those that use validated questions such as the Consumer Assessment of Healthcare...
