Primary Strategy

HealthLeaders Media Council members discuss their organizations' strategies for primary care.

This article first appeared in the June 2016 issue of HealthLeaders magazine.

Will Garand
Vice President of Planning and Managed Care
Community Memorial Health System
Ventura, California

We have 13 outpatient clinics that we administer. Those locations have a mix of primary care and specialty care. Over the years, the main impetus for specialty care has been patient access to providers for Medicaid services. Our offices do not employ the physicians, as we are located in a Corporate Practice of Medicine state, and we also do not have a foundation. The way we engage with physicians is to use a friendly professional corporation that physicians contract with individually, and then we contract with the PC to staff the hospital.

We have plans to grow again substantially in the next four years, including plans to add significantly more primary care physicians during that time. This will be through a combination of physicians who are aligned through their own practices and also by adding sites.

We might be able to establish some new outpatient hospital departments in the community through our critical access hospital. Our existing sites are mostly in competitive markets. As we grapple with new restrictions in establishing outpatient hospital sites, we may need to pursue alternatives, which could include management services organizations in existing physician locations, or eventually establishing a foundation.

Rick Nordahl
CEO
Sanford Sheldon Hospital
Sheldon, Iowa

Our primary care strategy centers around increasing our presence through expanded clinic hours. That doesn't mean, however, that we're going to run an acute care center—in a town of 5,000, we don't have the volume for that.

However, we have expanded our clinic hours to include lunchtimes and evenings, and we are now open from 8 a.m. until 8 p.m. Monday through Thursday, 8 until 5 in the evening on Friday, and from 8 until noon on Saturday. The integration of evening hours between 5 and 8 was the biggest change, followed closely by opening up lunchtime appointments from 11:30 a.m. until 1 p.m., when we had traditionally been closed.

Our intent is to get patients the healthcare access they really need, and to meet the consumer where they need to be met. The next step could be full availability on Saturday, possibly with part-day availability on Sunday. Without that, we really can't grab all of that market that we need to.

There have been changes in hiring as well. As we look to hire new clinicians to cover those extra appointments, we're filling more of these roles with advanced practice professionals, including nurse practitioners and physician assistants, in addition to enhancing the behavioral health portion of our primary care business with more counselors, plus health coaches to coordinate the program and improve care continuity.

Garrett Havican
Vice President of Strategic Planning and Ambulatory Operations
Middlesex Health System
Middletown, Connecticut

On the shift in incentives: The federal government is incentivizing us to keep patients out of the hospital, so the hospital market is shrinking—a fact that drives our decision-making. But keeping patients out of the hospital is the right thing to do—the majority of patients can be treated in the community very effectively, so long as there's someone present to assist in care coordination. I think that incentives—or, better yet, the disincentives—for hospitals to retain patients are in play, and that's a big cause of this shift.

On developing a strategy: Taking inventory of where our 70 doctors and 10 facilities are located in the community is our first step. The second is to make sure we have the appropriate number of providers in each of these geographic areas based on needs. The third is to make sure we have a coordinated approach toward managing patient care. This includes ensuring that our network is consumer-friendly, that we're easily accessible to members of the community, and that we have an electronic medium we can use to communicate internally.

On driving growth: Those are our immediate priorities to ensure that we've spread our primary care base throughout our community. That's really the focus for the future of healthcare, along with population health management, ACOs, and the coordination of care. That is what's really driving that growth. 

Donna Littlepage
Senior Vice President of Accountable Care Strategies
Carilion Clinic
Roanoke, Virginia

Carilion has been very focused on primary care activities since we developed a patient-centered medical home back in 2008, and we're in a market where our hospitals frequently find themselves filled to capacity.

So, for patients who are better treated in an ambulatory setting, their not being admitted has been beneficial for us. The shift has not been as disruptive to our organization as it has for other providers that are still in the fee-for-service world.

Our organization is trying to determine the best way to share savings so everybody gets rewarded for doing the right thing, whether that is preventing disease, managing it properly, or sending a patient to a specialist. We're still determining the best way to incentivize the specialists, but for primary care physicians, we've added quality metrics to their scorecards so they're compensated for how well controlled their diabetic or hypertensive patients are, along with numerous other quality metrics. We realize that sometimes it can take more time to do these things than those quick, easy visits that they might otherwise do quickly and get paid for.

Our internal culture shift around primary care is more a matter of good communications between primary care clinicians and specialists, so that everybody understands what we're trying to do, how we're trying to do it, and how we can work together to be successful.