by Lisa Lewis, DO, practice owner, Sustaina Center for Women
Featured in the March-April 2020 Colorado Medicine Colorado Medicine.
Transforming Clinical Practice Initiative, which worked with close to 200 practices during its four-year time frame, submitted roughly 20 “exemplar practice” stories to the Centers for Medicare and Medicaid Services directory. TCPi is a federally funded, governor’s office initiative that ended Sept. 30, 2019. The following is an edited version of that story that illustrates some of the work Sustaina Center for Women did to earn the “exemplar” designation.
Sustaina Center for Women is a small practice in Lakewood. Our team includes myself, a gynecologist; a women’s health nurse practitioner (NP); two medical assistants; and a part-time behavioral health specialist. Our patients are busy working women who are providing multigenerational care and can’t spend extra time in a doctor’s waiting room. We are focused on our patients’ needs and experience. In the end, our focus on patient experience has improved patient outcomes, saved or avoided unnecessary health care costs and inspired team members to work to the top of their scope.
Our patients can “swing by and get things done by people who care” and we take pride in our work. In addition to our cost reductions, increased patient access and better health outcomes, the team’s efforts have improved team morale, attracted providers from across the country (Elizabeth, our NP, moved from Chicago to work in our environment) and caught the attention of the Centers for Medicare and Medicaid Services, which funded TCPi. Sustaina Center for Women has been featured during several national conferences and I was named to the national TCPi faculty to help replicate the success we’ve seen with our practice transformation efforts.
A few successes:
- Drop-in appointments for existing patients with symptoms of UTI, vaginitis or a sexually transmitted disease “scare.”
- Same-day urgent appointments for more acute needs such as pain, bleeding or Bartholin cyst drainage.
- Improved access to lower cost generic hormone intrauterine contraceptive devices (IUDs) by improving the method of insertion and creating a faster decision-to-placement time; by providing a lower cost yet potentially more effective device, we saved over $72,000 in 2019.
- Treated abnormal bleeding with medication instead of surgery in 90 percent of cases in 2018.
- Transitioned all surgeries to outpatient with length of stay measured in hours, not days, as patients recover better at home.
- Lowered prescriptions for post-op narcotics to six pills with rare refills (none in 2018).
We revamped the office schedule to include daily drop-in availability for low acuity visits; daily “9-1-1” higher acuity open slots; one-week open slots so patients can be seen within the week; and two-week appointment slots for improved availability over time. There is a patient portal and secure text messaging, and patients use a smart phone application to message the team directly.
Our friendly and empathetic environment also helps ensure women feel comfortable asking for the kind of help they need. Empathy and understanding improve access when patients feel comfortable. The team asks every patient if she has a health goal and helps her achieve it. Other patient engagement tools include checklists that help patients determine insurance benefits for procedures and high-cost contraceptive devices.
The team recently embedded a mental health provider in the office. The hope is that convenient, onsite access to mental health services will help women and their families get the care they need when and where they need it. This work was supported by Sustaina’s participation in the Colorado State Innovation Model, another health reform initiative funded by the Centers for Medicare and Medicaid Services.
We engage our patients with checklists to help them navigate their insurance benefits. Our most popular checklist is given to all patients who desire long-acting contraceptive devices. It reminds women to call their insurance companies to confirm benefits before the procedure, which costs $650 to $1,200 per device, is performed. We have nearly 100 percent usage of this checklist.
We have improved our patient surgical experience by creating an atmosphere of comfort and openness in which patients and their families can ask questions to help them reach their goals for surgical outcomes. Patients appreciate the fact that our services help them reduce time away from work, lower copays for outpatient procedures, and minimize opioid use so they feel empowered to return to their usual routines and are home sooner.
The following patient engagement tools help with this process:
- A checklist to prepare for surgery:
- Things to arrange for before surgery – childcare, rides, eldercare.
- Instructions for checking benefits and understanding the financial aspect of surgery.
- A checklist for the day before and day of surgery for patients:
- We have initiated a care coordination agreement with the surgical center that is given to patients so they know what we expect the surgery center to have ready on the day of surgery, what they expect us to have ordered and what the patient will do before surgery.
- An information sheet on “how to recover faster from surgery” for patients and families.
The team’s focus on patient experience generated up to $481,936 in cost savings during 2018 as detailed above.
Our same-day, open appointment slots improve patient access and reduce urgent and emergency room visits. Carefully coordinated, cost-effective services that are focused on patient experience have resulted in significant health care cost savings. The team is building a health neighborhood to provide streamlined health care delivery experiences for patients, and we want to partner with highly efficient primary care physicians.
This is the second of a series of articles that highlights the work practices engaged in TCPi do to earn “exemplar” status with the federal CMS.
Learn more about this federally funded, governor’s office initiative at www.co.gov/healthinnovation/tcpi, a website that will be maintained as an archive through July 2020.