Virginia Garcia Medical Home Continues to Evolve
In 2007, Virginia Garcia piloted its first medical home at VG Cornelius. The concept of giving patients a place to call “home” for their medical needs is now at the forefront of health care reform at the state and national level. In the medical home model, teams of health care providers that include primary care physicians, nurses, medical assistants and care coordinators work to provide comprehensive care for each patient. Before appointments, the team meets to “scrub the chart,” go over patient history and determine how to address the particular health concerns of that visit. Over the past five years, Virginia Garcia has integrated medical homes into each of its clinics and is preparing to take coordinated patient care to the next level.
“We are beginning to look at ways to manage a patient’s health by determining who on the team would be best to serve that patient’s needs at that time. For example, does the patient need to be seen by a physician, or can that patient’s needs be well served by a nurse to go over lab results, a medical assistant for blood pressure screening or a care coordinator to follow up on a medication regime? We are looking at how to make to best decisions for patient care, while at the same time making best use of our providers’ time,” said Ann Turner, Virginia Garcia co-medical director.
As the focus of health care shifts, many clinics, providers, insurers and government agencies are looking beyond the outcomes of individual office visits to the goal of improving patient and population health overall. The state of Oregon has been studying an alternative payment methodology (see APM article), in which providers will be reimbursed for health outcomes, rather than patient visits. Virginia Garcia, along with two other safety net clinics in Oregon, has been selected to pilot this new approach. “This fits in well with the ‘Triple Aim’ goal in health care reform, to provide a better patient experience, improve overall population health and reduce health care costs,” said Turner.
In preparation for the transition to APM, Virginia Garcia providers met in February to look at where and how they can improve team based care under the new system. “We got input from doctors in each medical home team,” said Laura Byerly, co- medical director, “and came up with areas where we can grow and improve. “
The biggest change will be in how the medical team prepares and plans for appointments. The introduction of APM will allow the teams to schedule time to go over their patients’ charts and to make a treatment plan not only for that day, but for their care going forward. “This gives us more flexibility as a team,” said John Guerrero, M.D., at VG Beaverton. “We’ll be able to look at our schedule and take out inefficiencies in our workflow. It will also give us the ability to build in more patient education. “
Virginia Garcia will conduct trainings for providers and support staff to identify and standardize roles for each member of the medical home team. “We plan to formalize high value trainings,” said Turner. “Everyone on the team, from the provider to the receptionist, needs to understand how important their role is.”
Another area the provider group identified for improvement is the transfer and use of data. Currently, with patients being referred to Virginia Garcia from hospitals or other providers, the electronic medical records for some patients don’t reach Virginia Garcia physicians in ‘real time.’ “We are looking at how to close the loop so the medical home team has complete patient information ahead of their visit,” according to Byerly (see LEAN article). “We will also develop a system to aggregate data so that we can better understand and manage population health.”
Virginia Garcia has the advantage of having put the medical home model in place before it became a national priority. The practice of working as a team has been honed over the course of five years. “I’ve seen a lot of growth and improvement in the quality of care we provide since we adopted the medical home model,” said Guerrero. “We’ve grown to really trust and rely upon the people next to us on our team. Virginia Garcia is a small organization with big ideas. That means we can get things done.”