March 10, 2011
By C. Todd Staub, MD
Recently, I woke up early to review what had happened with my patients from the prior evening’s after hours clinic. For one patient, an elderly woman who had come in with abdominal pain, I read her progress note, ordered additional testing, and asked the clinical team to contact her and put her on my schedule for follow-up that afternoon – all while sitting in front of my computer, drinking a cup of coffee.
This scenario is playing out in more than 70 practice sites across the state of Connecticut: providers affiliated with my organization, ProHealth Physicians, are flipping open their laptops to provide comprehensive and timely primary care to almost 10% of the state’s population.
A group of dedicated primary care doctors founded ProHealth Physicians fourteen years ago from 80 small primary care practices around the state. Today we have 190 physicians and 70 Nurse Practitioners and Physician Assistants, and we are growing every year. Founding this group practice was not easy. New England physicians have been wedded to the fiercely independent small practice model for more than two centuries. But we came to realize that the group practice model could open up new avenues for improving patient care and professional satisfaction.
We are an integrated group practice that is owned and governed by primary care physicians. In essence, we are trying to create a more effective primary care foundation on which to build a health care system that preserves wellness and is rewarded for it. We want to redesign health care around the basic principles we were all trained to follow: prevention, early detection, optimal intervention, and the effective coordination of care. At the same time, we strive to preserve the personal relationships built on trust and understanding that have been at the core of New England medical practice for generations.
We felt that electronic health records (EHR) were central to this mission, so we installed them in every site. The system includes a data warehouse with disease registries that we can use to improve the quality of our care. For example we have about 15,000 diabetics in the practice, and we know exactly how many office visits they have had, their Hemoglobin A1c levels (a marker of how well diabetes is controlled), their cholesterol levels, and their blood pressures. Patients that are not meeting clinical goals are contacted by the clinical team and automatically scheduled for an appointment. As a result, our performance on hitting targets for these clinical measures and others has been steadily improving over the last five years.
We also thought it was important to bring health care to where it needs to be, so we are building new practice facilities in the neighborhoods in which the people we serve live.
Our goal is to use primary care principles and a sustainable business model of health care delivery to help patients stay well and pursue their own goals with just the right amount of contact with the health care system to allow them to do so. We have negotiated with commercial payers and with our state government to pay us for higher quality, lower cost health care, taking us away from the old volume-driven model.
Next, we plan to develop an integrated township of medical homes that will emerge as our own accountable care organization over time. What we need now is for the next generation of clinicians to take what we have started and bring it to the next level.
C. Todd Staub, MD, FACP is the chair of ProHealth Physicians and of the Primary Care Coalition of Connecticut. He also continues to practice general internal medicine in his practice site in Litchfield, Connecticut.