Partnering with our physicians for population health success

December 06, 2016

PartneringPhysicians_ThumbnailChange has come to the way our care teams, support staff and payors work together to deliver care designed to improve the health of our communities.

The foundation of knowledge and expertise provided by our physicians remains at the core of our patient care. We are forming new bonds with both our employed and affiliated physicians as we address the needs and health patterns of groups of people (populations) and build mutual incentives around both the quality and cost of care.

Our Caregiver ACO

For example, our own Caregiver ACO is growing and now encompasses more than 45,000 caregivers and family members. We are investing in our own health, learning what works, and spreading the word - more than 150 physicians, nurses, care managers, analysts, and administrative leaders completed Model of Care training this year. Our desired quality metrics for the program are intentionally aligned with our system-wide quality goals.

Primary care re-design

Primary care is the front line for ensuring healthier populations, and we are changing how we interact with our patients to provide proactive, connected care. Providence is exploring team-based primary care models, running pilot programs, and putting successful models into place. Care teams are evolving to address social and lifestyle factors. Some care teams have embedded social workers, mental health professionals or pharmacists to broader the depth of integrated care.

Medical assistants look for gaps in care and advise patients during the office visit, and they may also act as “scribe,” taking notes when the doctor is in the room then handling patient check-out with the benefit of first-hand information. With team-based care, patient volume per physician can be increased without compromising clinical practice levels or patient satisfaction.

“Up until now, primary care innovation has been mostly regional and we haven’t had a systemwide channel similar to what our institutes provide to specialty care,” says Jon Younger, M.D., group VP, medical primary care – physician services. “Now, through our Primary Care Steering Group, sponsored by the Employed Provider Network Leadership Council, we’re bringing primary care leaders from across the organization together to share best practices as well as new ideas.”

Knowing our resources, understanding the populations we want to serve, and working with the best processes and tools – this is how we’ll ensure better outcomes and the highest value care.

MACRAPreperation_ThumbnailPreparing for MACRA

The Medicare Access and CHIP Reauthorization Act of 2015 changes how the Centers for Medicare & Medicare Services pays for provider services and is an important part of how we take care of our populations. Read the latest information on MACRA from our Providence population health leaders: