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New health care model centers on the patient

Lovelace and Atrinea Health have partnered to bring a new model for health care to Rio Rancho.

That’s according to Dr. John Cruickshank, the chief medical officer for Lovelace Health System. The model is called patient-centered medical home.

The Rio Rancho primary care clinic is owned and operated by Atrinea, which employs all the clinic’s health care providers — including four primary care doctors who coordinate patient care — and is exclusively for Lovelace Health Plan members.

What is different about the medical home model is that the physicians’ goal is simply to identify and treat common illnesses before illness can progress — and before those illnesses get really, really expensive.


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It seems simple enough, but it’s easier said than done.

The Rio Rancho clinic recently held a ribbon cutting, where Cruickshank and several others who are involved in the clinic spoke about the virtues of the new health care model. Cruickshank said the medical home model isn’t really new, but it is new to New Mexico.

“There have been many places around the country where this concept has taken hold and physicians and organizations have embraced the model,” he said.

To help prevent or limit the severity of illnesses, physicians test for common illnesses according to the patients’ age, sex, weight and an assortment of other health indicators. Knowing about potential illnesses before they get too severe is key, Cruickshank said. But connecting patients to the appropriate tests and treatments that will keep them healthy takes a lot of work, he said.

As part of the partnership, Lovelace works with clinics like the one in Rio Rancho to keep tabs on patients and make sure they are making their appointments, according to Dr. John Iacuone, chief medical officer for the Lovelace Health Plan.

He said Lovelace has invested “significant dollars” in software that help the clinic keep track of what patients are billed for and shares that information with the clinic.

“We know if they’re filling prescriptions or if they got their lab tests or MRI,” he said. “We’re dropping our data into an electronic health record to see it in real time.”

A hospital can’t just send an email alert saying that Jane Smith missed her MRI, though. The software must be encrypted and secure so it does not violate the confidentiality rules outlined in the Health Insurance Portability and Accountability Act, or HIPAA.


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Another cost to operate the clinic is a row of small but expensive machines that cut out the need for some appointments all together. The machines run tests that help diagnose common health problems, such as diabetes or high cholesterol.

And all that attention to preventative medicine makes the medical home model more expensive on the front end, Iacuone said. Even though the medical home model comes at a higher price to start with, and it even cost more overall for the first year or two it is in operation, he expects to see savings over the long haul. While all that effort and expense to save a patient a trip or two may not sound all that important, in the grand scheme it could make everyone healthier and save a lot in health care costs, he said.

Cruickshank agreed, saying that being able to, for example, do an A1C test — which measures how well a diabetic patient is managing his or her care — in the clinic is actually a huge advantage.

“It gives us a good indication of what we need to tell you before you leave the clinic,” Cruickshank said. “If you are taking diabetes medications, we can tell you to adjust your medications before you leave. … Or the exam is normal and you can go on about your merry way.”

The reality is that, if the patient is tested off-site, the patient may miss the appointment, Cruickshank said.

“That they may even blow it off entirely is a concern,” he said. “For most of what I’m talking about (diabetes, high blood pressure and high cholesterol), it would have to be really out of whack to have symptoms.”

Doing the tests on the spot may also help reduce the incident of issues on the clinical side as well.

According to a 2007 survey by the Commonwealth Fund, nearly a third of adults with chronic illnesses in the U.S. reported a medical, medication or lab test error in the past two years.

The survey of 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the U.S. reported a variety of other mistakes are made as well. It reported that 23 percent of American adults also had issues with test results not being available at the time of an appointment or that doctors ordered duplicate tests.

Having those tests done properly with the appropriate treatment will help decrease the incident of complications that lead to a visit to the emergency room, Iacoune said. And it’s the emergency care that is causing the cost of health care to spiral out of control.

Treatment for common chronic diseases like diabetes, chronic obstructive pulmonary disease and congestive heart failure accounts for 70 percent of the health care costs in the country, he said. With preventative medicine, those costs drop significantly, he said.

“Anything we can do to delay or prevent complications has a significant impact to the cost to payers,” he said, leaving no doubt on his views about the subject. “Chronic disease drives health care expenditures.”

It’s a great theory, but to actually keep those costs down and ensure that clinics are effectively delivering preventative care isn’t as easy. That’s where the National Committee for Quality Assurance (NCQA) — a company that audits and accredits the clinic based on patient results — comes in.

NCQA has standardized performance measurements for care and offers a certification in disease management.

“It’s like a stamp of approval,” Iacoune said.

There are benchmarks for the patient results and accreditation is based on meeting those benchmarks.

That’s a central difference between how the medical home model works compared to the traditional model, according to Cruickshank. The pressure is on the clinic to improve a patient’s overall health, rather than simply to treat the symptoms of an illness.

Spending time to explain an illness, discuss healthy lifestyle choices and making phone calls when the patient misses an appointment are all part of that, he said.

“(In a traditional hospital and clinic) if you don’t get it right the first time, you get paid to do it over again,” he said. “We can call and reach out to our patients and ask them to follow up and get preventative services. … A traditional office doesn’t have that ability. Many (physicians) are only now discovering that they have a responsibility to chase patients down.”

There is only a handful of clinics in New Mexico where the medical home model is being used and only three Atrinea and Lovelace clinics that operate this way. One is in Albuquerque, one is in Los Lunas, and Rio Rancho opened its new, 2,700 square foot clinic at 111 NM 528 in December 2012. (Call 892-8117 for more information.)