The Special Care Center operated by Egg Harbor Township, N.J.-based AtlantiCare has improved clinical outcomes and significantly lowered treatment costs for patients with chronic illnesses, such as heart disease, diabetes, hypertension, obesity, asthma and emphysema. While it costs more to care for patients in the center, the extra costs are more than made up in savings from fewer hospital admissions and ED visits.
Encouraged by the success of the 2½-year-old center, AtlantiCare is opening a second center this month. Ines Digenio, MD, medical director of the center, points to 10 factors behind the model's success.
1. Use of a care team. The care team at the SCC includes physicians, nurse practitioners, pharmacists, health coaches and clerical and administrative staff. It also relies on behavioral healthcare to address stress and other barriers affecting chronic conditions.
2. Personal health coaches. Each health coach is assigned to a panel of patients and works one-on-one with each patient on health issues. Health coaches assist patients in proactively managing care and navigating the health system. "The health coach is an advocate for the patient," Dr. Digenio says. "They are very matched with one another."
3. Longer visits. Physicians reserve a one-hour appointment for new patients and a half-hour appointment for existing patients, longer than at many other practices. "This gives us a chance to listen to the patient," Dr. Digenio says. Because these patients have serious chronic conditions, "even a sore throat could turn into a big problem."
4. Constant contact with caregivers. The care team shares 24/7 call so that patients can contact them at any time if they are having health problems. The caregiver can call up the patient's chart from home and admit the patient to the ED if necessary.
5. Pharmacy monitors utilization. Patients can go to any pharmacy they choose to fill a prescription but most of them choose the clinic's on-site pharmacy. If the patient fills a prescription too soon or not soon enough, the pharmacist will call the clinic. "We'll call the patient and ask why," Dr. Digenio says. This is important because patients are on as many as 10 medications a day.
6. Use of clinical IT. All clinical notes are in the IT system. When the care team meets each morning to discuss patients, each of them can call up the patient's chart on their laptops. The system provides information on evidence-based care.
7. Guaranteed same-day sick visits. When sick patients call in, physician offices can guarantee a same-day visit. The practice has left slots open for these patients. A nurse practitioner helps triage these patients before the physician sees them. "This is our preventive emergency department," Dr. Digenio says. Patients who can immediately see their physician do not have to go to the ED.
8. Free educational classes. Patients have access to group education on issues such as diet, lifestyle, types of condition, and by language. There is also a weekly yoga class.
9. Waiver of copayments. To reduce barriers to getting necessary care, AtlantiCare waives copayments for both physician visits and prescriptions filled at its on-site pharmacy.
10. Reduces cultural disparities. Cultural barriers make it more difficult to reach out to patients and improve care. Staff can speak to patients in seven languages: Spanish, Chinese, Cantonese, French Creole, Gujarati, Hindu and Vietnamese.
Find out more about AtlantiCare.
Encouraged by the success of the 2½-year-old center, AtlantiCare is opening a second center this month. Ines Digenio, MD, medical director of the center, points to 10 factors behind the model's success.
1. Use of a care team. The care team at the SCC includes physicians, nurse practitioners, pharmacists, health coaches and clerical and administrative staff. It also relies on behavioral healthcare to address stress and other barriers affecting chronic conditions.
2. Personal health coaches. Each health coach is assigned to a panel of patients and works one-on-one with each patient on health issues. Health coaches assist patients in proactively managing care and navigating the health system. "The health coach is an advocate for the patient," Dr. Digenio says. "They are very matched with one another."
3. Longer visits. Physicians reserve a one-hour appointment for new patients and a half-hour appointment for existing patients, longer than at many other practices. "This gives us a chance to listen to the patient," Dr. Digenio says. Because these patients have serious chronic conditions, "even a sore throat could turn into a big problem."
4. Constant contact with caregivers. The care team shares 24/7 call so that patients can contact them at any time if they are having health problems. The caregiver can call up the patient's chart from home and admit the patient to the ED if necessary.
5. Pharmacy monitors utilization. Patients can go to any pharmacy they choose to fill a prescription but most of them choose the clinic's on-site pharmacy. If the patient fills a prescription too soon or not soon enough, the pharmacist will call the clinic. "We'll call the patient and ask why," Dr. Digenio says. This is important because patients are on as many as 10 medications a day.
6. Use of clinical IT. All clinical notes are in the IT system. When the care team meets each morning to discuss patients, each of them can call up the patient's chart on their laptops. The system provides information on evidence-based care.
7. Guaranteed same-day sick visits. When sick patients call in, physician offices can guarantee a same-day visit. The practice has left slots open for these patients. A nurse practitioner helps triage these patients before the physician sees them. "This is our preventive emergency department," Dr. Digenio says. Patients who can immediately see their physician do not have to go to the ED.
8. Free educational classes. Patients have access to group education on issues such as diet, lifestyle, types of condition, and by language. There is also a weekly yoga class.
9. Waiver of copayments. To reduce barriers to getting necessary care, AtlantiCare waives copayments for both physician visits and prescriptions filled at its on-site pharmacy.
10. Reduces cultural disparities. Cultural barriers make it more difficult to reach out to patients and improve care. Staff can speak to patients in seven languages: Spanish, Chinese, Cantonese, French Creole, Gujarati, Hindu and Vietnamese.
Find out more about AtlantiCare.