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Relationship-Based Care - Creative Heath Care Management

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Relationship-Based Care: A Model for Transforming Practice, edited by Mary Koloroutis. Minneapolis, Creative Healthcare Management, pages. In May , the department of nursing at the Milstein Hospital at Columbia University Medical Center campus of NewYork-Presbyterian set out. Angie McAllister. Director of Cultural Transformation, Signature HealthCare. Over the past ten years the term “culture change” has become.

March 21, Scaling Relationship-Based Care: Welby was a cheerful family practice physician with a soothing bedside manner who was on a first-name basis with his patients. In turn, patients trusted Welby, embraced his care and got better.

The best, most cost-effective health outcomes occur when providers build long-term, trusting relationships with patients and pro-actively treat disease through real engagement, frequent dialogue and shared decision-making. At its best, primary care helps prevent, mitigate and manage chronic disease and other serious conditions. Unfortunately, American healthcare has largely forgotten the wisdom of patient-centered primary care.

Specialization, technology and activity-based billing practices rob patients of vital time and engagement with their primary care doctors. Personal connection atrophies as patients move through mechanized treatment regimens.

Although their business models vary, these companies share an unshakable belief that relationship-based healthcare generates better outcomes, happier customers and lower all-in costs.

Somewhere, Marcus Welby is nodding in vigorous agreement. They rarely receive the coordinated, holistic primary healthcare services that prevent complicated, burdensome and costly acute interventions. The problem is not a lack of financial resources, but poor distribution of those resources and perverse incentives.

Americans recognize the need for enhanced primary care. Despite its importance, experts predict a shortfall of 14, to 35, primary care physicians by The demand for relationship-based primary care services combined with aligned payment models is catalyzing the growth of care management businesses that offer more coordinated, holistic and concierge-like services. The primary care market divides into the following 4 quadrants based on care duration and intensity: Annual physicals and routine diagnostic procedures with minimal follow-up.

Recognizing the Best in Relationship-Based Care – PR News

Visits for routine care. In both cases, patients schedule appointments with their doctors during normal office hours. In fee-for-service FFS medicine, primary care physicians rarely spend enough time with patients to build deeply-informed relationships. Visits usually last 15 minutes or less. Every hour spent with patients necessitates two hours of administrative work.

This activity pattern degrades the care experience and frustrates both physicians and patients. This approach to primary care is expensive, wasteful and not terribly effective. There is a better way. New primary care businesses models are emerging that provide better, more convenient and lower-cost care. Telemedicine companies such as Zipnosis or Doctor-on-Demand and walk-in clinics such as Minute Clinic offer low-cost primary care services that tackle immediate care needs.

Other companies offer economical concierge-like services that enable primary care physicians to practice relationship-based care with an emphasis on prevention and long-term health. These new models extend the capabilities of primary care physicians and delight customers. In contrast, risk-based contracting e.

Relationship-Based Care - UCLA Department of Nursing - Los Angeles, CA

This is leading to the emergence of enhanced, relationship-based primary care companies. People with multiple co-morbidities, behavioral health problems, addiction issues and significant social deficiencies e. To deliver such comprehensive care, primary care companies must do the following: Address behavioral health and addiction issues.

Ensure adequate food, clothing, transportation and shelter. Build trusted relationships with patients. Engage with patients consistently, intensively and on their terms. To manage this, such companies deploy integrated-care teams that deliver necessary services in community-based centers.

Though approaches vary, they share the following important characteristics: Capitated, value-based or at-risk payment models in distinct market segments that align physicians and care teams with patient needs, better outcomes and lower costs. Team-based care models that engage patients as consumers in convenient settings with comprehensive services.

Supportive infrastructure that reduces administrative burdens and costs while enabling engagement, experience and service.

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Coordinated care services that promote early diagnosis, prevention and appropriate care interventions. Robust data sourcing, analytics and technology to identify risk, improve performance and enhance growth. The following case studies illustrate how leading primary care companies tailor their services to fit the needs of specific primary care market segments.

They illustrate the power of customer-focused business models. Perhaps his social needs were more urgent than his medical needs. He then received necessary care at the appropriate times, virtually eliminating subsequent ER visits.

Recognizing the persistent community need for more extensive services, it expanded its scope in to also offer primary and chronic care services. Its success in new markets fuels its continued growth.

Model of Care

Operating under risk contracts with government and commercial payers, AbsoluteCARE uses claims data and predictive analytics to identify members that are high cost and high risk. It builds attractive medical centers in urban neighborhoods and engages coordinated teams in comprehensive clinical and social care. Engagement starts with the basics, including food, clothing, shelter, addiction treatment and behavioral health services.

From that point on, HEART became the foundation of the journey in redesigning the care delivery system.

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Utilizing resources and literature on bedside reporting best practices, the care delivery team developed a change-of-shift bundle to be used consistently across all practice areas that involved nursing, which meant that nurses in every part of the hospital would be pulling in the same direction to help move the needle.

Called the HEART bundle, it includes a safety huddle led by the charge nurse, standardized bedside report, and patient mutual goal setting. The use of bundles in improvement initiatives has gained traction as a powerful tool to connect several established best practices.

The Institute for Healthcare Improvement developed the method as a structured way of improving care processes and patient outcomes.

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Traditionally, a bundle brings together three to five simple sets of interventions that, when performed together consistently, are proven to improve patient outcomes. While the care delivery team placed equal importance on each element of the bundle, the new bedside reporting and patient-concern processes have had the most profound effect in fostering immediate nurse-patient bonds. Each day, nurses invite their patients to share their concern of the day, which is then written on the whiteboard in the room.

More often than not, this concern is unrelated to getting better. The nurse picked up the present for her so that she had it when her grandchild came to visit, Del Guidice said. In another instance, a long-term patient told his nurse his concern was not being able to see the snow fall from his bed.

Rather than wheel him to the window, Del Guidice explained, his nurse got permission from his doctor to take him outside so that he could feel the snow.

Training on the bundled approach was done in small groups of no more than

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