How a rural clinic in Colorado might just be the model for health care reform
In the early 2000s, High Plains Community Health Center in Lamar, Colo., was struggling to stay in business. With just three doctors on staff, the clinic was having trouble keeping pace with high patient volume - its patient base was more than half of Prowers County's 14,000 residents. Many of High Plains' patients were elderly and/or battling costly, chronic conditions like diabetes and hypertension. Like many rural clinics, High Plains had difficulty recruiting doctors and nurses, and those they had were only able to see an average of 1.82 patients per hour. This resulted in lengthy wait times and frustration on the part of both patients and providers.
High Plains needed to change the way it operated -- or risk shutting down. According to executive director Jay Brooke, who oversaw High Plain's transformation every step of the way, "We're not located in a place where it's easy to hire doctors or nurses. So we couldn't solve our problems just through recruiting -- we had to come up with a different approach. And I think many rural health centers find themselves in a similar position today."
High Plains took several steps to address their shortcomings. Starting with a federal HRSA grant in 2002, they redesigned their patient flow to increase productivity. This required cross-training all of their front and back end office staff as medical assistants (or as High Plains calls them, patient facilitators). Each provider was then assigned a team of three patient facilitators, who were charged with managing almost every aspect of patient flow, as well as providing clinical services under physician supervision. The clinic also began using electronic health records and went wireless, with all patient facilitators equipped with a laptop and phone to take calls and schedule appointments at any time.
By shifting to this team-based approach and enhancing the role of medical assistants, High Plains was able to increase productivity to 3.0 patients per provider hour in just two years, and has sustained it to close to that level for the past decade. This increase translated to almost $500,000 in annual savings -- about 10 percent of High Plains' overall budget -- despite the additional costs of new equipment and higher staff compensation.
Better yet, patient outcomes have significantly improved at High Plains, particularly in the management of cardiovascular disease and diabetes. For example, since 2001, the average HbA1c for diabetes patients has decreased from 8.7 to 7.7. And since 2006, the percentage of cardiovascular patients with controlled blood pressure has increased from 46.3 to 67.9 percent. High Plains' success in the past decade has earned it many accolades, including recognition as a Pioneer Employer by The Hitachi Foundation.
Front-line workers such as medical assistants are essential to a smoothly operating health care practice, but their roles are rarely discussed. As C-Suite health care leaders across the nation anticipate changes to the way that they do business -- the role of medical assistants and other front-line workers should be reimagined.
With the impending changes to payment and delivery systems, hospitals and clinics are incentivized to become Accountable Care Organizations (ACOs), health care providers that share in the savings when they are able to successfully reduce costs while improving the quality of care. Payments to ACOs will be dependent on patient outcomes and a reduction in costs. In the case of High Plains, they were able to achieve both through a team-based approach and more efficient staffing.
If High Plains can improve patient outcomes and reduce costs through innovative workforce solutions, any health care organization can. The High Plains Clinic is an extreme example of workflow and productivity challenges faced by clinics and hospitals across the country. With the recent opening of the health insurance exchanges established by the Patient Protection and Affordable Care, and the coming Medicaid expansion in many states, an additional 30 to 40 million new patients could enter the health care system over the next few years. To meet that surge in demand, health care providers are going to need to improve their productivity and quality of care -- and to do that, they may want to learn more about a rural community health center in southeastern Colorado.
For more details about High Plains Community Health Center, see the case study by Lisel Blash, Susan Chapman and Catherine Dower at the Center for the Health Professions at the University of California - San Francisco.
Blog posts are authored by Hitachi Foundation staff and do not reflect the views or opinions of the Foundation Board, Hitachi, Ltd., Hitachi America, Ltd., or any Hitachi company affiliate.
This post originally appeared in The Hitachi Foundation's Good Work Blog.