Relationships and St. Luke’s Health System support are significant factors in the success Dr. Jon Schott and his team are having when it comes to accountable care.
Dr. Schott and the dozens of highly committed staff members of St. Luke’s Clinic Baker City are receiving well-deserved national attention these days.
Team-based care, convenient access for patients and quality gains that have resulted in dramatic improvements in the use of medical services are among the many reasons Baker City recently was named for inclusion in the Robert Wood Johnson Foundation’s best-practices program: The Primary Care Team: Learning from Effective Ambulatory Practices.
The clinic has been identified as an “exemplar practice” to be included in the foundation’s new national program known as the LEAP Project. Baker City is one of 30 primary care practices, and one of very few rural clinics, selected for participation out of hundreds of practices nominated by national experts and rated by a national advisory committee.
The project is meant to identify the best ways to improve patients’ health care experiences. A LEAP team will visit Baker City in January or February to see how the primary care team does its work. Findings from Baker City and other study sites will be combined to develop training and technical assistance materials that can be used by others.
Dr. Schott, Baker City’s site medical director, credits his staff for their dedication to improving processes on behalf of patients, and St. Luke’s for its support and commitment to the rural clinic. Baker City became part of St. Luke’s Health System two years ago.
Among steps Baker City has taken to improve health care for the community:
And while the recognition is new, the foundation for the clinic’s changes in the direction of accountable care goes back a half-dozen years.
The clinic, Eastern Oregon Medical Associates, was not part of St. Luke’s Health System then but had great relationships with St. Luke’s and several individual doctors and programs, including the Mountain States Tumor Institute, Dr. Stefanie Fry of St. Luke’s Clinic Idaho Cardiology Associates and Dr. Marshall Priest, medical director of St. Luke’s Heart. Dr. Priest, Dr. Fry and other St. Luke’s physicians mentored and advised Dr. Schott and the Baker City staff.
“We wanted to be a part of that,” Dr. Schott said. “They seemed always to be leaders.
“The sense we got was that Baker was important to them, and the patients picked up on that.”
At the same time, the Baker City clinic had relationships with other helpful organizations: Oregon Health & Science University, which many clinic staff members attended and which sent students their way, and Qualis Health and The Commonwealth Fund. The clinic was part of Qualis/Commonwealth’s primary care safety net medical home project.
All of these relationships, and the focus on quality and access concerns, have played their parts in the clinic’s evolution toward accountable care and its recent recognition by the Robert Wood Johnson Foundation.
The clinic has, among other things, shifted its approach to diabetes, first employing a diabetic educator, then expanding that element so that care became team based. About three years ago, the clinic made the deliberate decision to organize as three teams, to ensure coverage and improve patient access. Other changes have fallen into place as the result, including expanded hours (the clinic is open 7 a.m. to 7 p.m. weekdays and has weekend availability as well). The team structure meant leadership dynamics changed; things are more equitable now within the staff.
“It’s changed the clinic, in terms of leadership and how we see patients,” Dr. Schott said.
Culture has shifted, morale has improved and care is dramatically better in very tangible ways.
For example, emergency room use for non-emergent needs has been reduced by half – yes, 50 percent – for urinary tract infections and bronchitis for clinic patients, Dr. Schott said. This is where there is data; it’s likely that other reductions in emergency room use and other patterns of health service delivery improvements could be documented as the result of the clinic’s innovative approach.
Next up for the team to tackle: mental health. Mental health, particularly in St. Luke’s rural areas, is particularly challenging, and is a key contributor to many chronic health conditions. Baker City is going to try to improve the situation in its area by adding a psychiatric nurse practitioner.
The clinic has worked especially closely with Saint Alphonsus Medical Center Baker City on difficult cases involving chronic diseases and/or mental health problems and where patients have complex multiple needs. In such cases, hospital administrators, nursing staff, and discharge planners have worked together to achieve the best possible outcomes. Baker City clinic nurse care manager Mary Stearns, R.N., has been a critical piece of the puzzle, working at times with the state and Medicaid to arrange nursing home care and attending weekly meetings with hospital representatives and other members of the care team to facilitate and coordinate mental health care and other services.
Through continued meetings between all those involved, patients have been surrounded with medical caregivers, including physical and occupational therapists, nutritional support, mental health support, and social services. It’s clear from such efforts that the team approach is significantly improving the quality of life for our patients.
Dr. Schott says becoming part of St. Luke’s Health System has been invaluable for the clinic’s patients for many reasons, but points out two in particular: support of nurse care managers and myStLuke’s, the electronic medical record system now being implemented across the System.
“We couldn’t provide that care without St Luke’s,” Dr. Schott says. “And the idea of a patient having one chart across an entire system is part of the core philosophy of a medical home. The ability for patients to access and communicate within that chart is a tool we have only begun to figure out how to use. It goes without saying we wouldn’t have been able to do that without St. Luke’s.”
For Dr. Schott, the shifts in health care happening now have a parallel … in penicillin. He recalls spending time early in his career with a physician whose career coincided with that exciting discovery.
“It’s one of the most exciting times in health care,” Dr. Schott said. It’s “as dramatic as antibiotics were.”
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.