Frontiers of Health Services Management - Summer 2013 - (Page 40)

can call after hours and speak with a nurse who can identify the caller’s physician and access the caller’s electronic health record. in addition, patients can use My nurse to request prescription refills and schedule an appointment. leaver does not mention whether UnityPoint Health offers extended clinical days or hours to improve access for busy employees and parents. Piedmont Heart’s Patient first program was designed to improve delivery of seamless, high-quality care. its approach to scheduling enables a physician to focus on one or two activities Evidence from highly each week rather than try to manage a variety of unintegrated systems and early adopters indicates coordinated tasks related to a patient’s care. conthat integration improves sidered the most dramatic value and access and element of Piedmont increases patient loyalty. Heart’s integration, Patient first provides dedicated, around-the-clock cardiovascular care and ensures better coordinated care. While better-quality care is, by definition, better for the patient, it is not necessarily patient centered. Molden, Brown, and griffith do not discuss the ways in which patients are better supported but rather concentrate on how consolidating and reconfiguring provider duties and hours has decreased variation and improved handoffs. Diverse Providers/ Interprofessional Teams Poor interprofessional collaboration and communication can undermine care delivery and patient outcomes (reeves et al. 2008, 2010). the demand for primary care services is projected to increase because millions of individuals will gain health insurance coverage by 2016 and the sizable baby boom generation is aging. “economic forces, demographics, the gap between supply and demand, and the promised expansion of care necessitate changes in primary care delivery,” fairman and colleagues (2011) report in the New England Journal of Medicine. Prudent use of mid-level providers has proved to be cost-effective and safe. a systematic review of 26 studies published in Health Affairs found that “health status, treatment practices and prescribing behavior were consistent between nPs [nurse practitioners] and physicians” (cassidy 2012). increasingly, nPs, physician assistants, and clinical pharmacists are treating patients in acute care settings and emergency departments (eDs); caring for individuals with common, easily diagnosable and treatable acute problems in minute clinics; participating in interprofessional teams that care for elderly people with advancing chronic conditions in home-based primary care programs (Weaver et al. 2000); and working in integrated behavioral health programs with social workers, behavioral health professionals, and community health representatives to care for high-risk, high-cost, dual eligible patients (funderburk et al. 2011; Mcguire et al. 2009). the use of teams, information technology (e.g., the targeted telemonitoring with looped intervention programs offered in the veterans Health administration and Kaiser Permanente systems), and shared data and the addition of nonphysician providers have the potential to offset the increased demand for physician services while improving access to care and averting a shortage of primary care providers where shared-risk and capitated reimbursement models are available (green, Savin, and lu 2013). in Piedmont Heart’s Patient first program, 99 physician extenders (teamed with 90 physicians) formed coes that 40 • f ro ntier s o f h ea lth s e rvic e s m a na g e me nt 29 :4

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013