Activated Patient

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?

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.

Understanding Intuitive Well-Being™

Imagine a life that just flows with spontaneous energy and joy.  Leaving the “should, would, could” world behind.  Existing as unrestrained creativity and energy;

  • surrounded by people you enjoy,
  • experiencing you occupational pursuits as an expression of your life’s meaning,
  • navigating the challenges of life, recognizing that the process of overcoming them provides your guidance in reaching higher levels of joy and influence.

That is Intuitive Well-Being.  Living a life where physical, social, emotional, financial, and spiritual success flows as an expression of your life.  The state of being whole and complete in all areas without the distraction of that “inner conversation” wearing you out and holding you down.

Once you have achieved a spontaneous, ongoing success you have achieved tiena, a term derived from an Eritrean word meaning “whole and complete physically, emotionally, socially, financially and spiritually.”

How do you get there?  The path is as individual as you are, but often it includes;

  1. Unconscious incompetence (I didn’t even know it was possible), through
  2. Conscious incompetence (I know it is possible, but I don’t know how to get there yet), to
  3. Conscious competence (Success occurs with significant effort, to be lost if not contemplated upon), to
  4. Unconscious competence or intuitive well-being (the state of Tiena) – I am competent and no longer have to think, it just flows in my life).

Would you consider working towards higher levels of mastery of intuitive well-being in your life?

If the answer is yes then post on this blog and consider reading The Seven Healers. Being committed and aware – contemplative in the effort will result in continual joy and tiena in your life.   I look forward to the journey together.

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