Family physician David Swieskowski, M.D., has found a way to improve the care of his patients with chronic diseases and increase practice revenue at the same time.
Swieskowski, vice president of Mercy Clinics Inc. in Des Moines, Iowa, is sold on collaborative self-management support, a system of care that promotes patient and provider synergy in the treatment of chronic disease. According to Swieskowski, the system involves goal setting that is patient-directed. Medical staff members then help the patient develop and carry out a plan to meet those goals.
Collaborative Self-Management Support Key to Care
By Sheri Porter
6/13/2007
The concept fits every chronic disease, "but we're focused mostly on diabetes and hypertension right now," said Swieskowski. Mercy Clinics has 140 physicians at 16 primary care sites in the Des Moines area. Nearly all of the 16 sites also employ a full-time nurse, known as a "health coach," who is specially trained in helping patients understand and make health behavior changes.
Appointments for patient coaching sessions are scheduled in addition to regular physician visits and are handled solely by the appointed health coach. "We believe (health coaches) are more effective than physicians in doing (coaching sessions) and can do it for considerably less cost than having physicians spend their time with the activity," said Swieskowski.
Appointments for patient coaching sessions are scheduled in addition to regular physician visits and are handled solely by the appointed health coach. "We believe (health coaches) are more effective than physicians in doing (coaching sessions) and can do it for considerably less cost than having physicians spend their time with the activity," said Swieskowski.
"It's really health behavior change, not disease-specific education," he added. "That's what makes it possible for an office nurse to work with every disease condition, rather than specific (conditions) that a disease educator might work with."
New Health Partnerships Initiative
Bertha Safford, M.D., a family physician in Ferndale, Wash., shares Swieskowski's enthusiasm for collaborative self-management support. Both she and Swieskowski work with a recently launched initiative dubbed New Health Partnerships, or NHP, whose goal is to improve comprehensive care of patients with chronic disease.
Get E-mail Updates
The AAFP has created an e-mail discussion list (Members Only) to help facilitate the flow of information about NHP. Members who sign up to participate in the discussion list, which is titled "IHI New Health Partnerships Initiative," will automatically receive updates about NHP by e-mail. The discussion list features a bulletin board option that allows member to post and read messages from other list members.
Safford, who was recently named the Academy's official representative to NHP, champions the chronic care model and collaborative self-management support in her own practice.
In an AAFP News Now story announcing the NHP initiative, Safford said, "Experience has shown that if you do everything in the planned-care model but don't include self-management, you're only going to get so far. Patient self-management is the critical piece."
In an AAFP News Now story announcing the NHP initiative, Safford said, "Experience has shown that if you do everything in the planned-care model but don't include self-management, you're only going to get so far. Patient self-management is the critical piece."
Financial Benefits
Swieskowski says that the collaborative self-management system of care not only dramatically improves patient outcomes, it also is keeping the Mercy Clinics financially healthy. "We found a way to deliver this service and to do better than break even," said Swieskowski. "We've negotiated a payment with our largest insurer, and we get a direct payment for providing this service."
In addition, Mercy Clinics received more than $1 million in pay-for-performance payments last year. Swieskowski said 85 of the 86 primary care providers participating in Wellmark BlueCross BlueShield's pay-for-performance program hit their targets.
In addition, Mercy Clinics received more than $1 million in pay-for-performance payments last year. Swieskowski said 85 of the 86 primary care providers participating in Wellmark BlueCross BlueShield's pay-for-performance program hit their targets.
Disease Registry
Swieskowski attributed those successes to the new care processes designed around the health coaches, as well as to a robust disease registry. In the Mercy Clinic system, that disease registry does not rely on an electronic health record, or EHR, system.
"We just have a stand-alone registry; we do manual data entry," said Swieskowski, adding that the registry includes data such as blood sugar levels for 9,000 patients with diabetes and blood pressure levels for 5,000 patients with hypertension.
It's the registry that tells staff members when patients are not meeting their outcome goals and need to be scheduled for an appointment with their physician or other health professional or the health coach, he said.
Swieskowski said he's not anti-EHR -- in fact, starting in 2008, EHR implementation will begin at one clinic site and expand across the Mercy Clinic system during a five-year period -- he just believes that improvement in care processes takes priority. "I believe you have to change your care processes first, and then get an electronic medical record that mimics your new care processes, not your old ones," he said.
Swieskowski maintains that under this system a patient with a chronic disease receives just a fraction of the health care he or she needs from professionals in the medical office setting. Instead, the bulk of the treatment plan takes place in the patient's own home. Using a collaborative approach to support "the care that patients give themselves is probably more important than the few minutes we give them while they're in the office," he said.
"We just have a stand-alone registry; we do manual data entry," said Swieskowski, adding that the registry includes data such as blood sugar levels for 9,000 patients with diabetes and blood pressure levels for 5,000 patients with hypertension.
It's the registry that tells staff members when patients are not meeting their outcome goals and need to be scheduled for an appointment with their physician or other health professional or the health coach, he said.
Swieskowski said he's not anti-EHR -- in fact, starting in 2008, EHR implementation will begin at one clinic site and expand across the Mercy Clinic system during a five-year period -- he just believes that improvement in care processes takes priority. "I believe you have to change your care processes first, and then get an electronic medical record that mimics your new care processes, not your old ones," he said.
Swieskowski maintains that under this system a patient with a chronic disease receives just a fraction of the health care he or she needs from professionals in the medical office setting. Instead, the bulk of the treatment plan takes place in the patient's own home. Using a collaborative approach to support "the care that patients give themselves is probably more important than the few minutes we give them while they're in the office," he said.
