ABSTRACT
Introduction In the last chapter, we introduced and discussed the critical issues of healthcare. In this chapter, we discuss the three directions of improvement within healthcare. Reforming healthcare has been discussed by many for a very long time. However, not too much has happened because government regulations and quality principles of improvement have not really been at the core of the improvement discussion. Fundamentally, three areas of concern should be examined in the journey of improvement:
◾ Primary care ◾ Hospital care ◾ Managed care
Primary Care So far we have indicated that by improving and providing access to primary care, we can de§nitely improve both cost and satisfaction. But what exactly is improvement in primary care? Many states, including Colorado, Pennsylvania, North
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Carolina, Michigan, Washington, Minnesota, and Wisconsin, have started programs to help individual practices incorporate quality tools and methodology in solving some of their problems. ˜e objectives of these programs are to
◾ Improve the patient experience in primary care, including engaging patients in self-management activities
◾ Improve primary care quality and outcomes using collaborative activities, educational resources, and coaching within the practice
◾ Apply evidence-based guidelines consistently in care of patients ◾ Use technology to improve practice processes, with an emphasis on use of
the patient registry ◾ Reduce waste in the medical practice, with the outcome of increasing cli-
nician time with patients ◾ Improve pay-for-performance metrics ◾ Move practices toward the patient-centered medical home concept
In the state of Michigan, for example, a formal program has been developed through the Michigan Partnership for Community Caring (MPCC) and the Automotive Industry Action Group (AIAG) that recruits Michigan-based primary care medical practices to participate in the Michigan improving performance in practice (IPIP)/patient-centered medical home (PCMH) project. ˜is initiative is a state-based quality improvement approach and it is funded in large part by the Robert Wood Johnson Foundation and sponsored by the American Board of Medical Specialties. ˜e program was developed in collaboration with the national primary care specialty societies to help physicians improve chronic disease and preventive care in the oŽce-practice setting. It focuses on the following:
◾ Disease registries ◾ Work ²ow analysis ◾ Chronic care model ◾ Team building and communication ◾ Implementation of systems change ◾ Quality improvement principles ◾ Advanced access scheduling ◾ Population-based care management
A practice participating in this type of a program bene§ts in many ways, including:
◾ Assistance to practices in maximizing their physician group incentive program (PGIP) incentives and pay-for-performance (P4P) requirements
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◾ Increased eŽciency in oŽce processes ◾ Improved care of chronically ill patients, as well as increased patient and
sta› satisfaction ◾ Advance practices toward PCMH designation ◾ Help to physicians in maintenance of certi§cation (MOC) and continuing
medical education (CME) credits and to others on the practice sta› with continuing education credit, o›ering a positive economic impact
Michigan IPIP/PCMH is unique; it involves physicians from multiple-specialty organizations, as well as government stakeholders. It engages improvement teams within the practice that will be coached by quality experts from industrial settings. ˜e coaches receive special training in the healthcare culture and assist the practice to implement quality principles and ultimately improve the physician’s practice. ˜e focus of this training is to identify value-added processes and eliminate waste, therefore streamlining the overall cost of the practice. While the focus is initially on the practice’s chronic diseases, such as diabetes and hypertension, over time it will expand to apply to all patients and will include asthma as well. ˜e training of the quality coach is provided on a volunteer basis and at no cost to the practice.
