Case Studies in Primary Care Innovation

Dr. Lonny Reisman, Chief Medical Officer, for Aetna described how Aetna is leveraging HIT solutions to facilitate improved care delivery. Their acquisition of Medicity has allowed them to create an health information exchange to power functionality needed to create ACOs, specifically via personalized health records, clinical analysis, care management, population management, and risk management. While their health IT solutions have helped them achieve a reduction in acute admissions and hospital bed days, he cautioned the audience to recognize the limits of health IT. In a recent study publish in NEJM, providing access to post-heart attack drugs at zero copy increased compliance to only 49%, highlighting the importance of taking a broad view of patient support.

Frank Ingari, President and Chief Executive Officer, Essence Healthcare, described how a collaborative payer models and integrated provider associations have achieved decreased hospital bed use and readmission rates. Data (and pay for performance) have reduced information asymmetry, adverse selection and denial of care rates. By providing technology and data to providers, Essence is allowing physicians to engage in continuous learning and identify actionable information based on their performance.

Dr. Chris Chen, founder of ChenMed, showcased how his organization turned its head to the sub-optimal care resulting from fee-for-service and instead pursued a model of full global risk. By focusing on improved physician culture (small panel size, frequently panel review, open discussion of practice patterns and outcomes among all physicians) and facilitating rapid cycles for technology innovation (such as the creation of a pharmacy robot delivering prepared prescriptions directly to the exam room door) ChenMed has achieved admirable outcomes and satisfaction scores among its enrollees.

Dr. Brian Prestwich, Assistant Professor of Family Medicine at the University of Southern California, highlighted the four pillars of primary care – relationship over time, access, comprehensive care and coordinated care. He provided examples how his clinic has drawn on models piloted by GroupHealth to improve care. A new worksheet for well child checks has increased his clinic’s structured developmental screening rate from 10 to 90%. Use of occupational therapists has allowed him to embed wellness coaching into his clinic. His call to action? “As a doctor in the trenches please get out there to agitate for better health information technology, and develop integrated health systems that will help us get the job done.”

David Krichhoff, CEO of Weight Watchers, described the R&D Weight Watchers has invested into developing and validating consumer-facing wellness technologies. He called on the integration and use of wellness services in achieving behavioral change among patients. As an example, the NHS in the United Kingdom purchases vouchers for Weight Watchers, which it then provides to doctors so doctors can prescribe and refer patients to Weight Watchers.

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