Northern Colorado health care providers shift focus to quality over quantity of care
February 19, 2017
Daniel Zenk, a physician at UCHealth Internal Medicine, remembers when medicine focused on treating patients who only came in when they were sick.
"We tried to prescribe things and make recommendations to make things better," Zenk said. "Then they'd come in again when they were sick."
They still treat sick patients as they come in, but providers are shifting focus.
"We're trying to focus on wellness and health instead of just trying to fix problems when they've occurred," Zenk said.
Often, people will wait to seek treatment on a nagging cough or pain. During that period of waiting, the problem could be getting worse, Zenk said. Or older folks who historically need more medical care have problems that could have been prevented or managed earlier on, Zenk said.
That's particularly important as baby boomers age and as millennials form their own health care plans, Zenk said.
Joseph Gregory, now a physician executive with Banner Medical Group, practiced at the Banner Health Clinic in Johnstown for 18 years.
With a whole network collaborating to make sure patients don't slip through the cracks, patients get better care, Gregory said.
Zenk likes the shift Medicare and Medicaid are making toward value of care.
"Medicare has been a little slow, we've thought in the past, not paying for preventative care options," Zenk said. "They've been much better the last couple years."
Family physicians have changed their hours over the years to be more accessible. In the past, doctors' offices were typically open 8 a.m.-5 p.m. when everyone was at work, Gregory said. Many clinics are expanding their evening hours and are open on Saturdays.
Gregory said evening hours are popular in Johnstown.
"A lot of people living there commute to work," Gregory said. "To be able to get into my office at 6 p.m. or 6:30 p.m. is so much more convenient to them."
Saturdays have always been popular, Gregory said, but it used to be for more urgent issues. They've started using Saturdays for physicals and routine checkups too. Doctors also communicate more with their patients electronically.
Manny Rodriguez, chief marketing and experience officer at UCHealth, said patients want the conveniences other industries afford them in a health care setting.
"Patients have asked for a lot of things that are similar in other industries," Rodriguez said. "Like Netflix — people can watch what they want when they want."
People want to see their doctors and make appointments when it's convenient to them, not the providers, Rodriguez said.
UCHealth's new website and new app and Banner's website serve up physicians close by.
Rodriguez said that way, if someone's regular doctor isn't available at a convenient time for the patient, other doctors will pop up.
Additionally, websites and apps increasingly allow patients to access their medical records.
If patients want to see their lab work, they can access the results an hour or two after blood is drawn, Zenk said.
"When we do the notes, we have something called OpenNotes and (patients) have access to that information," Zenk said. "They can pull it up online. If they have questions, they can email or call about them."
That information helps patients get involved with their own heath care. Zenk hopes collaboration between patients and doctors will help patients work toward health and wellness with less reliance on procedures and medication.
Sometimes, patient access to doctors means not going to the doctor's office in the first place.
Telehealth uses video calls to connect doctors and patients. It's helpful when doctors need to check in on their patients but don't necessarily need to see them in person.
"Maybe there's a patient I saw last month for depression and I just need to touch base with them and ask them about their medication," Gregory said. "I can ask if there are side effects or if they need adjustments. They don't have to spend the time and energy to get into my office."
Zenk thinks if patients get comfortable with using email, telehealth and maybe text messages someday to access their doctors, they will seek care earlier.
"If we're a little more proactive and embrace electronic care, we can tap into young people and get involved with preventative care that might make an impact on treating as they get older," Zenk said.
Paul Kellogg, executive director of Banner Network Colorado, said Medicare reform changes will help health care providers better collaborate on patient health.
Ten years ago, the burden was on the patient to figure out where to go for care, Kellogg said.
"There was no coordination," Kellogg said. "Given the complexity of medicine, it's important that patients get these resources to get in at the right time and place at the right venue."
Though primary care doctors play a big role, there's only so much one person can do, Kellogg said. It's better for nurses, primary care physicians, dietitians, specialists and other providers to work together.
That kind of network, Kellogg said, should make the health care system stronger and more efficient.
"It's what family medicine is all about," Gregory said. "We want to make sure patients get that whole continuum of care."
Before, if a patient had diabetes, a successful treatment depended on if that patient's physician was on their game, Gregory said. Would that physician remember to check up on you in six months? Would they notice if their patient didn't come in for a checkup?
Gregory said in the past, physicians may not have realized when some patients slipped through the cracks and weren't getting the care they needed.
"What we put in place is a team to monitor what I might not be able to do myself," Gregory said. "Someone on my team can call and say 'Oh, it looks like this patient hasn't been in.' "
It's better for long-term condition management and preventative care. Reaching out to high-risk patients and making sure they don't slip through the cracks can prevent hospitalizations and ensure diseases such as cancer are recognized early. That cuts down on overall cost of care.
"Patients who are higher risk or who have had recent hospital stays will notice their doctors checking up on them more," Gregory said.
Payers like Medicare and Medicaid are helping to facilitate and encourage those changes.
Traditionally, Medicare and Medicaid paid doctors per patient visit. Comprehensive Primary Care Plus changes how Medicare and Medicaid pay providers to emphasize quality verses quantity of care.
The plan pays a flat rate instead of per visit. The amount is adjusted for the intensity of care patients need.
Medicare and Medicaid can't continue the traditional model with the rising cost of care and an aging population. By changing how health care providers get paid, they hope to save money.
A flat rate system encourages providers to follow up afterward and address any complications quickly, Gregory said.
There's a performance-based incentive for providers, too. Doctors doing better work and getting patients to where they need to be are paid more, Gregory said. There are measures in place to account for doctors working with extremely sick patients and doctors working with healthy ones.
Patients are also surveyed about the care they get.
The Shared Savings Program is what lets doctors, hospitals and other health care providers collaborate by sharing information, according to the Centers for Medicare and Medicaid Services website.
The Affordable Care Act launched both programs. Kellogg said even if the Affordable Care Act is repealed, the culture of preventative care, accessibility and collaboration will remain intact.
Why it matters
Proactive measures won't make health issues go away, Gregory said. There are going to be problems physicians can't fix, no matter how attentive they are. But studies are clear on the value of comprehensive, preventative care.
"Someone might have a stroke despite my best efforts, but overall I know I'm saving lives," Gregory said.
— Kelly Ragan covers features and health for The Greeley Tribune. Have a tip? Call (970) 392-4424 or email email@example.com.