One of the clinic systems in the program, Apple Valley Medical Center, demonstrates how a systematic focus on comprehensive management can improve care. Two years ago they developed a registry of its patients with diabetes to allow the clinic to track them better. The registry provides staff with daily reminders on patient-status so that any issues are addressed promptly. Based on the issue, the provider involved may be a nurse, nurse practitioner, physician or other provider. As a result of this approach, Apple Valley Medical Center was able to improve its community standing on this measure by 110 percent in the first year of the program. Its patients with diabetes at goal for optimal diabetes care, as reported to Minnesota Community Measurement, moved up 23 percentage points in one year.

Our pilot project with Medica has allowed us to better coordinate patient care in order to improve the health outcomes of those with chronic or complex health conditions, said Dr. Peter Frederixon, medical director of quality at Apple Valley Medical Center. Our efforts are helping to prove that better coordination of care will increase a patient ™s compliance and improve outcomes while decreasing cost. Since most health care spending goes to treat a small percentage of chronic conditions, addressing these aggressively is likely to save money. This effort has been truly beneficial for patients, Medica and Apple Valley Medical Clinic.

The clinic-based chronic care management program also changed the way providers get paid by Medica. The participating clinics earn performance-based payments tied to improvements in clinical quality and to managing the total cost of patient care. While the healthcare home is one way to structure primary care practices to be more efficient and provide a higher quality of care, other care model designs and payment strategies will be explored.

Source Medica