Physician leadership essential for integrated community health
NASHVILLE, TN - David Rinehart, MD, a primary care physician at CaroMont Health Southpoint in Belmont, N.C., learned the importance of accountable care in just one patient visit. "I was seeing a 55-year-old patient who told me 'I'm doing much better now.' I was shocked to discover that he had recently been hospitalized for a perforated gastric ulcer, but we had no record of that - no fax from the hospital or anything. That's something that's just too important to not get communicated."
Rinehart shared his views at a session titled "Preparing for integrated community health" at the Premier Breakthroughs Conference in Nashville on June 7. He heads the care physician council that's working closely with hospitals and clinics throughout the CaroMont Health system headquartered in nearby Gastonia, N.C. Their aim is to help all stakeholders - including hospital leadership and the system's 135 employed physicians - make a smoother transition to integrated community health.
"The ACO voyage is just beginning, and we're building the ship from scratch," said Jerry Levine, MD, CaroMont Health's executive vice president and chief medical officer. CaroMont is an ideal candidate for the ACO voyage because its quality record is distinguished - and the population it serves struggles with chronic health problems like diabetes, obesity and hypertension.
"Gaston County ranks #76 on the list of healthiest counties in the state," said Levine. "That's one of the reasons why Gaston Memorial Hospital had more than 100,000 emergency department visits last year - the second most in North Carolina."
CaroMont is well-equipped to manage these populations at the community level because all of its primary care clinics have already achieved Level 3 Patient-Centered Medical Home (PCMH) status. "But moving to a new model that emphasizes quality and risk-sharing requires a lot of physician education and leadership training," added Levine. "We've created a Physician Leadership Academy to help doctors develop the skills they need to be knowledgeable and persuasive in front of CEOs and CFOs. We currently have 45 physicians taking part in the academy, and they get CME credit for attending the courses."
CaroMont has also established a number of internal quality councils, plus a population health committee and several patient advisory councils that seek feedback from community members. "When setting up quality councils, it's important to find physicians who are very enthusiastic and involved," said Christina Huitt, RN, CaroMont's interim director of quality management. "Our doctors are eager to be on the councils because they're very committed to improving population health."
"One of the biggest challenges in integrated community health is to engage people who don't use the system - the patients who don't come in for primary care visits as regularly as they should," added Rinehart. "That's why we have nutritional consultants who go out into the community. And we're training providers in motivational interviewing so they can encourage lifestyle changes and deepen that engagement."
As for the 55-year-old patient who fell through the cracks, Rinehart noted that the situation is unlikely to occur again. "Now the hospital automatically sends the surgical note and discharge summary to the primary care physician," he said. "And our office nurse gets a reminder to contact the patient within two days of discharge. Communication has dramatically improved, and that's the key ingredient in collaborative community care."
