A multifaceted approach to coordinated care
In the heart of Philadelphia sits Jefferson University Hospitals' Family Medicine Associates, the largest single-site primary care practice in the country. The practice serves patients of all types, from international refugees and the homeless to lawyers and hospital trustees.
While the staff tries to treat everyone equally, the diversity is challenging, said Richard Wender, MD, chairman of the Department of Family and Community Medicine at JUH.
"It poses a huge number of barriers," he said.
"Our culture is about providing an extraordinary experience for everybody," Wender said. "We recognize that healthcare expectations are varied across many people, many factors – not just related to education level and income. We're trying to work at the highest common denominator of patient expectation."
To meet its goals, the practice has become "systematized," based on a team culture. That means a lot of time is spent coordinating among members of the staff, and communication is key. Wender said his staff meet on a weekly basis.
"You can't be naïve. It just takes almost daily thought and attention to create this systematic culture," he said.
Jeffery Lewis, chief operating officer at EHIM, a Southfield, Mich.-based healthcare solutions company, can't agree enough about the importance of communication, and not just within an organization.
How a healthcare facility communicates outside its doors is extremely important, he said, but initially multiple strategies must be created.
"There is no one strategy you can use in a community like (Philadelphia)," he said. "Essentially, what you have to do is build what I refer to as a multifaceted approach."
Organizations have to define their populations and reach out to them one at a time, Lewis said. An incremental approach is important so that what is learned in the first round can be applied to the next round.
When reaching out to targeted populations, Lewis said, every possible resource available, from faith centers to libraries, radio and newspapers, should be used. Get one's resources to adhere to the same message and make sure that message is constantly out there.
"Multicultural care is vital for getting people proper care, and helping them become partners in the process," said Sarah Scholle, assistant vice president of research at the National Center for Quality Assurance, a nonprofit dedicated to improving healthcare quality that has developed a Multicultural Health Care Distinction program. "Otherwise, they may not get needed care or learn how to avoid costly, preventable complications and hospitalizations that drive up costs for everyone."
Wender acknowledges that Jefferson's systematized practice, which is recognized as a NCQA-qualified patient-centered medical home, does provide cost efficiencies, but says coordinating care for such a diverse community is expensive.
Language interpretation services are particularly financially burdensome, he said. His facility can redirect funds to where they're needed and can get money from grants and other programs, but the resources available are not enough.
"We need to be doing much more than we're doing. The need is almost bottomless," he said.
