The WeCare Physician-Led Primary Care Medical Home
On-site clinics come in a variety of shapes and sizes. Most frequently, nurse practitioners or physician assistants lead them. Some are led by physicians or registered nurses. Nearly all employer-based clinics offer urgent care – such as immediate care for upper respiratory or urinary tract infections, a recent survey found. Most offer blood draws and routine preventive care, such as vaccinations. Four out of five clinics offer wellness services and two-thirds offer health coaching; between one-third and one-half of clinics also offer pharmacy.v
The founders of WeCare TLC believe that to truly manage health plan costs, on-site clinics must become the primary point of contact for all employees’ health care needs. Only then can providers build long-lasting, trusted patient relationships that lead to better health. That’s why WeCare TLC clinics are organized as patient-centered medical homes (PCMH), an evidence-based model that lowers costs and improves quality.
What is a Patient-Centered Medical Home?
According to the American Academy of Family Physicians,iv a PCMH is:
- Physician-led: Each patient has an ongoing relationship with a personal physician who provides continuous and comprehensive care.
- Oriented to the whole person: The care team provides comprehensive care, including acute care and chronic care at all stages of life.
- Integrated and coordinated: Care managers take steps to ensure that patients receive all the care they need within the clinic and community.
- Focused on quality and safety: It uses continuous quality improvement and evidence-based medicine to monitor and improve outcomes.
- Accessible: Clinics commit to enhancing patients’ access to care.
A growing body of research is providing evidence that PCMHs curtail overall health care costs by reducing inpatient visits, emergency department use and hospital readmissions.
For more information about the PCMH model, read the National Committee for Quality Assurance’s Latest Evidence: Benefits of the Patient-Centered Medical Home or the National Committee for Quality Assurance’s Patient-Centered Primary Care Collaborative’s The Patient-Centered Medical Home’s Impact on Cost and Quality: An Annual Update of the Evidence 2012/2013.
Study Proves the Value of Employer-Based Medical Homes
SAS Institute Inc., headquartered in Cary, NC, has operated an on-site health center for more than 30 years. A new study by SAS and Duke University, published in the July 2015 edition of The American Journal of Managed Care, makes a strong case for encouraging employees to make the health center their medical home.
The study divided SAS employees and their dependents into three categories:
- Major users – those who designated the SAS on-site clinic as their medical home.
- Casual users – those who identified community medical providers as their medical home, but used some on-site clinic services at least once.
Casual users had the highest health plan costs of the three groups. Major users who made the clinic their medical home saved SAS $482 per year in health care costs when compared to casual users. Most of the difference ($283) was for pharmaceutical costs. future health care costs.
As for dependents, the difference was even more dramatic. Dependents who were casual users had the highest claims costs, followed by nonusers. Major users saved SAS $600 per year in health care costs when compared to casual users, and saved $330 a year in claims costs when compared to nonusers.ix
The Value of Team-Based Care
The WeCare TLC PCMH relies on a team to deliver care. Instead of a physician trying to accomplish everything in a 20-minute visit, a clinical team – a physician, registered nurses, medical assistants and licensed practical nurses – cares for the patient.
For example, the medical assistant checks in the patient, draw blood, performs eye exams and other screenings. The physician designs and supervises the treatment plan. The registered nurse educates the patient in self-care and oversees care plan implementation. The licensed practical nurse dispenses medication. All these interactions are recorded in patients’ electronic health record, furthering care coordination.
From a patient’s perspective, this means more time with the physician. Freed up from routine tasks, WeCare TLC physicians spent at least 20 minutes with each patient; 40 minutes spent on the first visit. Patients also enjoy the convenience of one-stop shopping. In one visit, patients can receive a flu shot, get a test done, see their doctor and receive needed medications.
Research shows that team-based care improves patient satisfaction and confidence in their health providers.vii One study of a patient-centered medical home compared medical home patients with those who visited a traditional clinic. PCHM patients reported higher degrees of satisfaction across the board, including measures such as the quality of their doctor-patient interactions; the degree of shared decision-making; the coordination of care; their access to care and the helpfulness of office staff.viii
Research also shows team-based care improves quality. First, everyone from the physician to the medical assistant to the nurse brings his or her unique clinical preparation to the patient. In addition, because all providers work together, gaps in care are fewer.
The Staffing Model
Physician: Sets the care plan; evaluates all the data and information to make modifications to the care plan; performs minor surgeries and refers patients to specialists if needed.
Nurse practitioner: Cares for lower-risk patients and provides urgent care.
Registered nurse: Talks to patients who have symptoms; follows up on complicated test results; coordinates pre- and post-surgical care; educate patients on their conditions and coaches patients in self-management. RNs also serve as health coaches, manage the care for individuals with complex conditions and implement disease management programs.
Licensed practical nurse: Renews prescriptions and follows up on abnormal (but not complicated) test results.
Medical assistant: Schedules patients and performs blood draws and simple examinations.
WeCare tlc Financial Impact (**all savings are net of clinic costs)
WeCare TLC Financial Impact
**all savings are net of clinic costs
Making Care Convenient and Accessible
Typically, going to the doctor is inconvenient, stressful and expensive. WeCare TLC strives to make it as easy as possible for employees to get care by offering:
- A physician-led model. Although many patients will see a registered nurse or nurse practitioner for some care, many want to have an ongoing relationship with a personal physician.
- No co-pays. Even a small co-pay acts as a deterrent to care.
- Open appointments for walk-in visits. WeCare TLC purposefully schedules
open appointments each day to handle urgent and emergent care. A dispensary. The top reason patients first come to a clinic is to get their
- Convenient and flexible hours: Clinics are open late or on weekends,
and are designed to meet employee needs.
As a result of this approach, WeCare TLC has some of the highest employee participation rates in the industry.
Percentage of Employees Who Use On-site Clinics
Measuring Metrics to Ensure Success
One of the hallmarks of a patient-centered medical home is an ongoing commitment to quality improvement. WeCare TLC analyzes important performance metrics such as:
- Patient satisfaction: Patients are surveyed on every visit.
- Generic utilization: Frequency of patients’ use of generic medications.
- Provider utilization: How often employees use providers at various licen- sure levels: RN, NP or physician. It also assesses the types of clinical services being used.
- Evidence-based practices: Providers’ charts are audited continuously to ensure care is complete and follows evidence-based protocols.
- Referrals: Referrals to specialists must be timely and appropriate; none should occur for routine office care.
- Follow-up care: Frequency that patients receive timely follow-up care.
Study Proves the Value of Employer-Based Medical Homes
On-site clinics tame health care cost trends in two ways: one, by providing similar services at much a lower cost and two, by disrupting the existing model of health care delivery.
When it comes to medications, tests and treatments, WeCare TLC clinics offer these services at a fraction of the market cost. Its providers are salaried and have no incentive to refer patients to specialists or order unnecessary tests. In fact, WeCare TLC clinics have reduced referrals to specialists by 50 percent by providing needed care within its primary care clinics.
Longer-term, the WeCare TLC model improves employee health as many workers who use the clinics previously had no primary care provider. Through care management, nurses also follow employees when they receive care outside the clinic to ensure high- quality, coordinated and cost-effective treatment. Through health coaching programs, healthy employees stay well; those with chronic conditions learn to better take care of themselves, which lowers future health care costs.
WeCare TLC ’s results since inception are promising: