Alaska clinic restructures care with a focus on patients, efficiency

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Sometimes reimagining a process from the ground up can be more effective than nibbling around the edges, and that’s how a clinic in Alaska, featured in a video on Hospitals & Health Networks, found itself on the cutting edge of quality care provision.

By restructuring his organization’s clinic into an integrated patient-centered medical home (PCMH), the practice took its Physician Quality Reporting System performance metrics from the bottom to the top quartile, says Steve Tierney, M.D., medical director of quality improvement and chief medical informatics officer of Southcentral Foundation in Anchorage, Alaska. Tierney puts the cost of the improvement at a 7 percent rise in healthcare spending between 2004 and 2009.

The clinic focuses on being patient-centric (they refer to their patients as “customer-owners,” according to Tierney), and uses a team-based approach that emphasizes overall health rather than the treatment of a specific disease. Tierney says the clinic has five healthcare teams, composed of a provider and a nurse case manager, as well as clerical and medical assistants. A support team gives patients access to an integrated pharmacist, midwife, a pair of behavioral health consultants, a dietician and a certified diabetic educator.

Tierney says this structure, which he describes as “a little bit more like a lean model” than healthcare practices have traditionally adopted, has helped reduce redundancies, making the clinic more cost-efficient overall. All providers get paid a salary, and the practice ditched any quotas related to productivity or “relative value unit” metrics in favor of an evaluation based on a list of monitored and control chronic conditions, completed screenings and vaccinations, and same-day access to medical home providers.

This streamlined model provides a template that can “accommodate most of the ongoing chronic conditions, preventive health, or screening behaviors that any population would need, and they would have a relationship with specialists, where they would refer out for things that would be unique, or different or changing,” says Tierney.

- watch the video