Practice transformation groups: Improve engagement, outcomes
Richard Whittaker, MD, Chief Medical Officer, WellMed
Seeing relationships between clinicians and patients as crucial to wellness, and with a vision for improving health care delivery for seniors, Dr. George Rapier III founded WellMed in 1990.
Using the WellMed Care model, which adopts the philosophies of Accountable Care, WellMed, part of Optum, continuously strives to improve quality and lower costs.
With a strong focus on primary and preventive care while using advanced informatics, WellMed supports the attainment of high-quality outcomes, i.e., healthier patients.
WellMed has recently been recognized by The Joint Commission, the nation’s oldest and largest health care standard-setting and accrediting body, as an accredited Primary Care Medical Home and have been awarded the Gold Seal of Approval for Ambulatory Care.
Conceived in 1990 by founder and current chairman George Rapier, MD, WellMed entered the market with a model of employed physicians highly engaged in evidence-based medicine and providing excellence in patient care.
With clinician engagement at the core of their business, WellMed found success by providing the right care for the right patient in the right setting at the right time.
Growth and opportunity
Aligning itself with Optum Care in 2011, WellMed had the great opportunity to reach more patients with our brand of high-quality care. In addition to our patient population growth spurt, our network of primary care providers (PCPs) diversified.
Our clinician team shifted from near 100% employees to 70% contractors.
Integrating contracted PCPs into the WellMed model, driven by provider engagement, called for a reproducible, evidence-based approach.
The tried and true management approach “4DX,” outlined in the book The 4 Disciplines of Execution by Chris McChesney, Sean Covey and Jim Huling, provided the systematic approach for smooth transitioning to value-based outcomes.
The leadership team focused on the four important concepts of the 4DX method:
- First, focus on the “wildly important goals” (WIGs) you wish to improve upon. These are the small number of critical items that are most important to your organization’s success.
- Second, focus on highly controllable “lead measures” that you must improve to achieve your wildly important goals.
- Third, develop a compelling team scoreboard.
- Fourth, ensure a cadence of accountability — meeting regularly to review the scoreboard, improve accountability for lead metric performance, and recognize improvements and setbacks.
The “wildly important goal (WIG)”
Our strategic WIG was “reducing the readmission rate of high-risk transition patients in our contracted network.” Four rigorously studied, evidence-based clinical interventions would be the vehicles by which we got there.
- Early contact with patients after discharge from hospital, defined as “three-day telephonic contact”
- A “seven-day follow up visit with the patient’s PCP”
- “Medication reconciliation”, a post-hospital review of patient medications
- The creation of a negotiated “individualized contingency plan,” to include identification of the most likely emergent issue that might arise in the next 30 days and what to do should it occur — for example: If my legs swell then I will: (1) weigh myself and (2) call my doctor
Implementation of strategy
Implementation of the strategy began with groups with the potential to show the greatest improvement.
These groups had at least 100 full-risk Medicare Advantage patients, with aberrant utilization metrics at least 25% worse than the market average.
These groups also had clinicians sufficiently engaged to attend a 15-minute weekly meeting with a mentoring medical director to discuss care improvement for transitioning patients.
Winning buy-in from independent physicians to participate in Practice Transformation Groups is rooted within the desire held in common among clinicians: to do the best by their patients.
Appealing to these intrinsic behavioral motivators was a reliable way to create engagement:
- Autonomy (choosing how to accomplish the prescribed goals)
- Mastery (improving their personal performance in lead indicator terms)
- Purpose (fulfilling their duty as providers to deliver the best patient care)
Extrinsic motivators, such as financial rewards for improved performance metrics, are a practical method as well.
Regular scorecards were issued to keep Practice Transformation Groups up-to-date on their progress toward value based measures. Medical directors provided leadership and mentorship, which guided groups through the process. Wins were celebrated.
After two years, Practice Transformation Group metrics showed conclusive evidence that the work was well worth the effort. At the enterprise level stunning numbers were seen.
Across 72,000 patients and 398 primary care providers in Florida and Texas, participating groups were compared to non-participating groups over a 24-month period. Total utilization (observations and admissions) improved by 2.5% compared with worsening by 3.9%.
Re-admission rate improved 14.3% compared with 5.1% and total cost of care reduced by $1.60 per member per month compared with a worsening of $47.30 per member per month over the 24-month period.
WellMed continues to grow, and key to its future success in the contracted world is the work of Practice Transformation Groups that engage physicians to provide optimal patient care.
The efforts that WellMed has put into Practice Transformation Groups have yielded two important conclusions. By choosing a simple, methodical, and step-wise process, the organization can sustain improvements in a rapidly moving environment.
Additionally, by appealing to the best qualities of doctors; their desire to learn, grow and provide superlative care to their patients, engagement in a contract world is more than possible — it is a great success.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.