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Primary Care: Are You Busy Or Effective (or Both)?

May of 2018 we turned on dashboards on the Value of Care for a group of 400 providers. On the dashboard the scale of 0 – 100, a 70 was considered “good value,” below this there were significant opportunity for higher value care. The average score for our providers was 35.

Within hours the phones began to ring – “my care is better than this,” “my dashboard is wrong,” “your data is incomplete” – the general sentiment was “I am making a bigger difference that you are saying I am.”

Let’s look at the facts – they were busy – usually filling their schedule to 80+%, moving through the day giving 100% to each person sitting before them. At the end of the day going home feeling tired but sure of their contribution to their patients. They must be high quality, effective, and their patients are benefiting based on days, months, and years of committed work.

So why the relatively low scores? We set up teams to investigate. The ability to click down to a member level allowed the providers to see what was going on with their patients. Were the patient really theirs or not? An examination revealed YES! Then why weren’t their blood pressure, cholesterol, asthma, blood sugars, immunizations, and screenings not at goal?

Barbara was supposed to come back in but never did, Bob travels all the time, Suzie stopped taking her meds, but never communicated it, John’s son got ill and he missed his appointment and never came back in…. The list of reasons went on and on. But the reality did not change – we were confusing being busy with meeting the needs of our patients. Often, we were not seeing the patients that needed us the most.

This lead to new systems, new ways of proactive (and automated) outreach. Soon the right patients were in the right practice at the right time. Quality took a jump up. Providers knew they were doing the best thing for all of their patients, not just the ones in front of them.

Busy was now productive and we were adding years to the lives and life to the years of those we served!

Is your practice busy, effective, or both?

Exciting Update from GOH Medical-New Clinic Merge!

Important Update from GOH Medical Practice
Dear patients and friends:My dream has been to provide timely, state of the art, proactive, convenient primary care to add years to your life and life to your years by empowering you to take control of your health.  To accomplish this takes significant resources. GOH (Game of Health) Medical has tried to do this as a solo physician practice for the past 4 years with mixed results – and so it is time to evolve.The question was which group do I associate with to bring you outstanding care?  Fortunately, I had access to a huge database to research and find the best medical group.  Working with the team at Compass PHS, we created a Value formula to identify the best primary care doctors in North Texas.  We looked at quality, safety, service and cost – 21 variables in all, to identify The Premier Providers.

A group of practices use team based, outcome-oriented, evidence-based medicine to care for patients.  Some have received the NCQA Patient Centered Medical Home designation.  After this analysis, it was my job to get to know these practices. In doing so, Dr. Chrisette Dharma and Southwest Family Medicine Associates (SFMA) were discovered as the #1 doctors in this analysis. Her new, state of the art office is located halfway between my current office in Dallas and Irving. SFMA has the ability to do online appointments, extended office hours and Saturday appointment availability, all major insurances accepted, and provides extensive imaging, lab, travel medicine and other services.

It is with great excitement to tell you that effective January 1st 2015, I will be moving GOH Medical’s practice to SFMA to join their team and see patients.  Our team includes Nurse Practitioner Angela Kemp, Dr. Asa Hadwell to make sure you get great musculoskeletal care, and our new lifestyle coaching team who will offer you support on weight loss, smoking cessation, and staying with your 2015 health goals.  We will be working with Dr. Dharma and her excellent team of physicians at SFMA to make sure you get the best care possible.

The Park Cities MedSpa, Concierge, Women’s Health & BioTE bio-identical hormone practice will remain at the current GOH Medical location in the Preston Tower. The providing team here includes Celia Dolinta (DNP-Women’s Health), Jill Ethridge, Brandi Padilla (Medical Esthetician) and Cheryl Reinhart (NP). All other medical patients will be seen at SFMA.  To make an appointment at the SWFMA location, please call the direct number below, or you may use our current number and press option #3.

If you have any questions, please contact Lauren Kirschner before Jan 1st atLauren@gohmedical.com.

I look forward to seeing you soon!

Scott Conard, MD

Southwest Family Medicine Associates
8877 Harry Hines Blvd
Dallas, TX 75235
214-393-2940

It’s time to rethink the way we eat

One of the joys of my life is teaching Weight Loss The Jabez Way at local churches. The first line of the Prayer of Jabez is “And Jabez Cried out to the God of Israel” 1 Chronicles verse 4:10. Note, he didn’t ask, request, suggest or inquire – he CRIED OUT! When have you cried out in your life? When you are desperate, frustrated beyond belief, or hopeless? What are you willing to do at this point? To try something new?

With our weight if we knew how to fix it we would.. So the fact we are struggling means we need to be open to a new way, we don’t know what to do, and it is time to change and be a learner (as opposed to a knower).

Here is a must read article that suggests that what we have taught in the past may not work for everyone, and in fact may be harmful. Please take a moment to read it at: http://io9.com/5979523/why-you-should-starve-yourself-a-little-bit-each-day ” Starve Yourself!>

The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1

Working with corporations and providers to create Value Based Care. Read more at the Open Health Market Blog: The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1.

Special Medical Provider(s) Wanted

GOH Medical is growing.  Over the next several months we will need to add a new medical provider: a doctor, nurse practitioner, or a physician’s assistant.  Do you know the right person for this job?  Here are some thoughts to consider;

  1. “Not on our watch”  The Institute of Medicine has boldly declared that we “know what to do, but are not doing what we know” and this must stop.  What would a clinic look like if the commitment was to proactive, preventive health care first; illness management and reactive care second?  We are looking for a provider that wants to review each patient for possible future issues to address them before they develop symptoms.
  2. “Committed to curing the ‘I Feel Fine’ Syndrome”  There is a big difference between “I feel fine” and “I am healthy.”  Patient engagement before symptoms occur is vital to preventing diabetes and heart disease, and diagnosing cancer in stage 1.  Using The Seven Numbers as a teaching tool and foundation we empower each patient to learn and live the Seven Numbers that Can Save their Life,
  3. “Only the best” When problems do appear what does it take to find the best solution? A large part of GOH Clinic is making sure that each person gets what they need when they need it at the right place for the right price – whatever it takes.  Coordination of care, transitions of care, communicating and getting records sent out, and following up are vital commitments,
  4. “Technology leverage” Text, email, blogs, electronic health and medical records, the latest equipment.  We are looking for a technology geek/nerd with a personality,
  5. “Part of a team”  Each teammate at GOH Medical is a link on a chain that includes everyone from the maintenance crew to the super-specialist at the hospital.  All important for a successful healthcare, over-communication and a commitment to six sigma/lean processes ensure success,
  6. “A teacher committed to delegation and empowerment”  Medical knowledge doubles every 18 months.  The best we can do for patients is to understand their challenge, educate them, suggest a course, and encourage them to learn as much as they can to play an active, vital role in their health; GOH Medical understands that there is more that we know that we do not know, than there is that we know, about any particular topic.  Even if we read 24/7/365 we will fall hopelessly behind.  There is no place for arrogance, coercion or convincing; only sharing what we know, sharing what we expect to occur, and then closely communicating if this does not occur over time.  We are a member of a team, we empower, encourage and give 110% effort.
  7. “Focusing first on lifestyle” Food is the strongest drug we put in our bodies every day, exercise the best medicine; but that is not all, there are The Seven Healers we need to pull into our lives each day.  It is from this foundation that we encourage our patients to win the Game of Health.
  8. “An open minded healer” Allopathic medicine has changed the worldEvidence based, informed, outcomes oriented… and it is incomplete and often fails to provide complete healing.  Weak in mind:body medicine, lifestyle intervention, natural healing, myofascial manipulation, meridian management/acupuncture, supplements and other disciplines that may be less rigorous or researched in their body of knowledge, these other disciplines  must be recruited for whole person, successful healing.  Focusing on the patient, not the dogma of one discipline, is required,
  9. “Courageous” we do not believe in codependency or enabling – this means supporting patients to support themselves through The Empowerment Dynamic – TED, not rushing in to “save” or “cure” our patients.  Our patients are not powerless victims of situations; they are powerful creators of a great life and we are a vital member of their team.  Healthcare workers want to help, but this can digress into a one up: one down dependency – one we are committed to avoid.  Sometimes it takes more time and effort to promote, but ultimately it is the road to health,
  10. “Serving all”  With our innovative GOH4Health, GOH4Wellness, and GOH4Breakthroughs we serve people with and without insurance, insured patients and corporations.  Our population based, proactive approach minimizes the waste and redundancy creating very high Value {= (quality + safety)/cost} care.
  11. “Loving” we are followers of Jesus Christ.  This is not to say we discriminate, convince, coerce or force our beliefs on others – quite the opposite.  We see each patient as a gift, tremendous potential, and our commitment is to make sure they know we are Christians by our actions; the loving, non-judgemental care they receive from us.  At GOH Medical, all are welcome, all are served.

Our systems are in place, our team is becoming more competent and proactive.  By this fall we will be running smoothly and ready to serve a larger group of patients with a population based, whole person orientation.  We are looking for a provider(s) who shares our beliefs and philosophy to add years to the life and life to the years by empowering breakthroughs in the lives of those we serve.

Please contact us if you are interested or if you know someone who is.

Did you get the phone call?

Click here to listen to the message (if you have not heard it): Welcome Call.  Practice phone number: (972)292-2247.  Address 2706 Fairmount Street Dallas TX 75201.

Alright so guess how many cups of coffee I had before I recorded the message many of you have received?   I had no idea that I was as wound up as I was but when I got the call (yes I was listed as a patient so I could hear what you heard) I thought “wow, I need to hold off the Starbucks a little!”

All joking aside I am excited to be back in practice.  Randy Brown, a long time patient was the first to be seen at the new practice.  His parents and children will someday be there too as I have had the pleasure of caring for them for two decades.

The First Patient at the new office at 2706 Fairmount Street Dallas Texas

To be honest it is very strange to not be at TienaHealth, and I purposely moved to an office that is far enough away that I will not have an adverse effect on the providers there – all of whom I gave my word to when I recruited them that I would support and help them be successful in their practice.  I miss the staff and the providers very much so if any of you see them then give them a big hug for me!

That said I also appreciate that it is a hardship for those of you that wish to remain with me to drive downtown.  Frankly when you think about health care being divided into 1) prevention and early diagnosis of cancer, 2)management of chronic problems, and 3) acute problems really the only one that requires a sudden visit to the doctor ins the acute problem, and often this can be handled on the phone or web just as effectively.

So the vision is to have a very limited number of patients in the practice (say 400 – 500) as compared with a full practice which often has over 3000 people in the practice.  LET ME KNOW IF YOU ARE INTERESTED IN BEING ONE OF THEM (send email – above right) Over the next several days we will share the vision of what we are going to create.  I think you will be very excited!!  Scott Conard, MD

A Tribute to Those Who Focused on Quality at Medical Edge Healthcare Group, PA

Recently I left my position as Chief Medical and Strategy officer for Medical Edge, PA (now part of the Texas Health Physician Group).  It was stupendous.  My job description was to create a medically integrated group, to empower and support 510 doctors achieving every greater levels of clinical excellence.  Little did I realize when I began the amazing group with whom I would get to work.

My first month on the job I attended a conference at which I saw several primary care physicians.  I was asking everyone “are you in Medical Edge?”  It was not long until I found a few who were.  At one point when I asked one doctor who said “yes,” a second doctor standing near by said “your kidding, I am too!”  Their offices were 5 miles away and they both had been in the group for over 4 years…..

It was at that moment that I knew that the “clinically integrated” part of my job was going to be a challenge.  Two years later I can excitedly report that it had occurred.  Honestly, not due to me, but to a lot of work by Lori Clay, Cora Bennett, Tim Wilson and many other directors of operations and staff.  They divided the company into 11 Areas, then into 3 Regions (Lori’s idea).  Soon meetings of the 100 primary care doctors in each region were occurring regularly, specialists and ancillary services shared best practices in ongoing support for the primary care doctors, and the quality of patient care spiraled higher every day.

Within two more years by focusing on the care process doctors, nurse practitioners, and physician assistants received over 160 Certificates of Recognition by the Bridges to Excellent  based on nationally established criteria on diabetes and heart disease risk.  Shawn Parsley, Donald Fowler, Don Holt, and Paul Anthony were the Regional Medical Directors who empowered and worked with Area Directors like Eric Futscher, Randy Perkins, Paul Kim, Roger Tolar, John Wood, Odi Alvarado, Carlos Mijares, Al Hulse, Elizar Alvarez, and Tim McGuire.  Lisa Oleson, the staff of Care Innovations (a part of Medical Edge), Lynn Myers and the electronic medical records staff provided ongoing leadership to re-define the process and consistency of care patients coming to our offices received.

It was both magical and thrilling to stand on the shoulders of such committed, outstanding individuals.  Working with these leaders and with the office staffs of all 183 Medical Edge offices, who had to change the way the did things every day, all the time, was a blessing I will never forget and for which I will always be grateful.

There are people alive today that would not be celebrating Memorial Day in 2011 if these leaders had not created and shared their vision with others.

So in leaving my post with Medical Edge (now THPG) I post this blog to honor and to publicly share the work of many, and the names of a few that came together from 2006 – 2010 to improve the lives of those we served, and save the lives of many.  Most of the patients you influenced will never know your name, but I will never forget you, your spirit and your commitment.

I pray that you will always be blessed, and I know that God knows who you are and blesses you every day for what you do for so many.

Dr Scott

The 15 Minute Train Wreck – AKA the Office Visit

The 15 minute train wreck – running room to room is dead.  It has been shown to be ineffective and expensive.   With just enough time to get a little information the provider (doctor or PA/NP) makes a quick assessment and launches out the door for the next patient.  Frequently proper follow up and ongoing support is completely lost and the patient is left to wander in the wilderness called “modern” healthcare.

The new model is about continuity, transitions from one care environment (say, the hospital) to another (home), and personalized care.  Outreach and follow up calls with problem solving and support, and team meetings to insure that what patients don’t know is not a reason to have unintended disease and death.

Do you know someone who wants to be a part of providing this care?

Let me know.  It is time to build the team.

Dr Scott

 

Free at Last, Free At Last, Thank God I am Free At Last. Time to head home (the Medical Home)

I am overjoyed (and greatly relieved) that I can now report that I am a “free agent.” I met with Dr Stoltz last Thursday and, at this point, I am no longer associated with Medical Edge or Texas Health Physician Group and will not be opening an office with them.

So it is time to get down to brass tacks and figure out what we are going to do.  As all of you who know me well appreciate I am absolutely committed to

“Adding years to the life and life to the years of individuals, corporations, systems and nations to empower intuitive wellness.”

There will be two aspects of this pursuit for me – clinical practice and creating an Accountable Care System that empowers the Accountable (or Activated) Patient.

In the clinical practice I am committed to finding and growing old with a group of patients who too are committed to living a great life – reaching 100 years of age with vitality and joy.

What does not work for me in the practice is running in and out of rooms 15 minutes at a time until I am exhausted.  This model does not work – the American Healthcare System has proven this without a doubt.  So here are some basic to consider;

  1. One on one, face to face visits will be necessary for part of the time.  But guiding, directing, supporting, and coordinating the effort is as or more important to the process of attaining intuitive wellness.
  2. Creating a medical home with opportunities like group visits, on line visits, telephonic care, and having other members of the team like dietitians, exercise specialists, social workers, pharmacists available to us are also vital.
  3. Working with a great physicians assistant and/or nurse practitioner (and at some point additional doctors) as a part of the team will add tremendous value to the practice.
  4. Finally, the freedom to speak with the specialist or go to the visit when it could/would contribute greatly to your health cannot happen when I am running room to room but may be vital at times to your health.

So now we start building a new model.  The first thing is building the team to get the logistics of starting a practice accomplished.  Not glamorous but necessary.  let’s start with one foundational person; an organized, capable, motivated individual with some healthcare background (possibly an MA or nurse) who would like to run with the ball and create this enterprise.   Do you know this person?  If so, asap please send me their contact information to drscott@scottconard.com

Secondly, this individual will need some help.  Would anyone be willing to volunteer to help with basic tasks ranging from filling out forms to running errands?  It will take a village to create the ideal medical practice for our community, but and now we have the green light for go and we can proceed!

I miss you and look forward to seeing you soon in our new facility.

Dr Scott

A Select Group

Would you be interested in joining a small group, say 200 – 500 people that focus on living life in a positive proactive way to insure their well being?  The more feedback and input received the more it feels like having a team looking out for you, using insurance but not shy about recommending additional resources, activities and events might be the ticket.  Let me know what you think.

 

Dr Scott