This is the first in a three-part series about Baylor Scott & White Quality Alliance, a clinically integrated accountable care organization.
Part I: CLINICAL INTEGRATION
There has been much written about the radical ways in which American health care is changing or will change, especially with health care reform and the introduction of accountable care organizations (ACOs) like the Baylor Scott & White Quality Alliance (BSWQA).
If you’re young and healthy and rarely go to the doctor and never set foot in a hospital, things might not seem all that different right now. But for millions of patients — especially those with chronic conditions — BSWQA intends to transform care by providing a level of continuity and quality that can be life-changing, if not life-saving.
To illustrate, let’s look at the care of a patient, Mr. Jones, under the fragmented system of health care, where physicians, hospitals and other care providers all operate independently. Such a system has been the norm in the United States for decades.
About Mr. Jones: He is a 60-year old smoker with diabetes, diminished kidney function and chronic lung disease. He previously has had a heart attack. He has been admitted to the hospital because his chronic lung disease has flared up and he has pneumonia.
Keep in mind, there are millions of Americans with multiple chronic conditions like Mr. Jones.
The Old Model of Care
Mr. Jones receives care in the hospital until he improved enough to go home. Upon being discharged from the hospital, he is told that he needs to be seen by his physician for follow-up care within the next 72 hours. He also receives a prescription for an antibiotic.
Unfortunately, while Mr. Jones has four specialists managing his various health conditions, he doesn’t have a primary care physician and none of his other physicians can see him on such short notice. In fact, it will be two weeks before anyone can squeeze him in. Furthermore, the medication that he was prescribed was too expensive, so he was unable to get it filled.
A week later, he has a relapse of his pneumonia and has to be readmitted to the hospital.
It didn’t have to be this way.
Mr. Jones may have received fine care while he was in the hospital. He may even be satisfied with the care that each of his specialists typically provides him when he can get in to see them. However, the lack of coordination and the fact that the hospital and each of his specialists operate in silos, only managing certain aspects of his health, led to a poor outcome. Likely, none of his specialists were even aware of his futile attempts to get a timely appointment.
Changing for Good
BSWQA is changing all of this. BSWQA is an integrated network of more than 3,700 physicians, 43 hospitals, 31 surgery centers, 29 skilled nursing facilities, 10 home health agencies, three hospices and additional points of care spread throughout North and Central Texas. Recently, BSWQA also added plans to develop retail clinics in select North Texas Walgreens pharmacies.
So what does all this mean for Mr. Jones? How would his story be different if he was a BSWQA patient?
For starters, although Mr. Jones suffers from several chronic health conditions and has multiple specialists involved in his care in the hospital, he will also have a primary care physician and practice that serves as his “medical home.” The physician and staff within his medical home will know of his hospital admission and know of his discharge. He will leave the hospital with a confirmed, prompt appointment for follow-up care.
And because he’s a BSWQA patient, a registered nurse care coordinator, who is in routine contact with his primary care physician’s office, will call him the day after he gets home from the hospital to make sure he will not have any issues getting to his doctor’s appointment.
The coordinator also can review the record of Mr. Jones’ hospital stay because the hospital and physician practice both have access to his electronic health record and are connected through an electronic health information exchange. The coordinator will make sure he doesn’t have any questions about any of the instructions he was given from any of the specialists who visited him in the hospital.
She will also make sure that he understands the importance of getting the prescription for the antibiotic filled, and she’ll work with him to overcome any financial or other barriers to getting it filled.
As a result, his hospitalization, the transition and post-hospitalization care are successful. Mr. Jones is able to avoid readmission, saving tens of thousands of dollars and improving his clinical outcome. Additionally, due to the ongoing relationship he has with his primary care physician and his nurse care coordinator who work in close collaboration, they are able to finally convince him to take free smoking cessation classes and quit smoking.
This outcome was made possible because all of his specialists, his primary care physician and the hospital are part of BSWQA and are committed to true clinical integration. They all shared information and were able to deliver a positive result not only for Mr. Jones, but for the nation’s overburdened health care system.
Coming soon – Part II: BSWQA and population health