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Managing Care and ED Utilization

October 19, 2010
by Mark Hagland
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Interview: Kenneth Sperber, M.D., Physician Operating Officer, Hillside Avenue Family and Community Medicine

Over the past few years, the physicians at Hillside Avenue Family and Community Medicine, a six-doctor family medicine group in Pawtucket, R.I., with an active patient base of 15,000, have been able to develop a patient-centric medical home model, moving forward with the support of a state-level grant to implement such a model, through a program called the Rhode Island Chronic Care Sustainability Initiative. Hillside Avenue was one of five medical groups given that grant; the five physician organizations have been working collaboratively with all the major health insurers in the state on issues such as reducing readmissions to emergency departments and hospitals.

The work of tracking patient status and managing patients’ disease states and care has led to Hillside Avenue’s receiving the 2010 McKesson Distinguished Achievement Award from the Alpharetta, Ga.-based McKesson Corporation, Hillside Avenue’s vendor partner (the Hillside Avenue physicians use McKesson’s Practice Partner electronic health record (EHR) solution to support their care management work. McKesson selected Hillside Avenue’s physicians for the award partly in recognition of a group of achievements they’ve made to date, including reducing their patients’ emergency department (ED) usage by more than 10 percent over the past year; reducing average blood glucose levels among their diabetic patients by 5 percent; screening more than 50 percent of their adult patients for depression; and providing formal smoking cessation to more than 75 percent of their adult patients who smoke.

HCI Editor-in-Chief Mark Hagland spoke recently with Kenneth Sperber, M.D., physician operating officer at Hillside Avenue Family and Community Medicine, regarding his organization’s work in the patient-centered medical home arena.

Healthcare Informatics: What compelled you forward to begin this initiative?

Kenneth Sperber, M.D.: We’re involved in the Rhode Island Chronic Care Sustainability Initiative, CCSI Rhode Island. The state put it together about two years ago. It started out with five practices and all the major payers in the state, along with the Rhode Island Office of the Health Insurance Commissioner, called OHIC, which oversees the health insurance industry here in Rhode Island.

The role of OHIC in this is that it was necessary for OHIC to be involved in order to create a waiver for a demonstration project around the patient-centered medical home; otherwise, it would have constituted an antitrust violation for the five practices and five payers to sit down and talk together about payment and care management.

HCI: When did OHIC convene the five groups and five insurers?

Sperber: About three years ago. And it took about a year to hammer out what the plans would pay to start those projects, and for a practice to implement EMR adoption, as part of this. One of the practices among the five didn’t even have an EMR at all; most of the others had one, at various stages. We’ve had an EMR since 1992, and have been paperless since 1994.

We weren’t yet doing all the things required to become a certified patient-centered medical home under NCQA [the Washington, D.C.-based National Committee for Quality Assurance]. We now have a nurse case manager to help follow up with patients on things like eating plans.

Patient-centered medical homes are where we think the future of healthcare is going. So we began two years ago. And the project has now expanded beyond in the initial five sites, and now we have nine or ten. NCQA has three levels of certification, with different standards, level three being the most advanced. The initial five sites are now level one certified patient-centered medical homes. We got certified about a year ago. We were all expected to be certified as level one, and we all got that, and we’re working towards level three.

And one piece of this initiative was to try to begin to address ER utilization. And I came into the practice in 2003, and even then, one of the catch-phrases of our practice was, ‘sick today, seen today.’

HCI: Tell me more about your work averting emergency room visits.


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