WellMed Medical Management
Edition: July 2011 - Vol 19 Number 07
For San Antonio, Texas-based WellMed Medical Management, less is more. Its physicians are seeing fewer patients each day – yet increasing productivity. Their priorities are no longer to generate traffic, but to drive it down – yet their opportunity for revenue sharing has increased. WellMed has in effect created a primary care based, and driven, accountable care organization, without the need of a hospital or larger health system.
How did they do it? And what does a primary care-driven ACO look like? Repertoire interviewed Gary Piefer, MD, MsMM, FACPE, FAAFP Chief Medical Officer – WellMed Medical Management Inc., to find out.
Repertoire: For your physicians, what is the average number of patients they will see in a day? How is this compared to the typical number for physicians?
Gary Piefer: WellMed physicians typically see 15 or 16 patients a day. That’s about half the number normally seen in a fee-for-service primary care practice.
Repertoire: How does this model of care help your physicians?
Piefer: Our physicians are afforded the time and resources to provide the comprehensive care required for patients with multiple chronic conditions. Physicians also have control of their lifestyle, more time to spend with their families and don’t have extended hours that cause so much burnout among medical professionals.
Repertoire: Please describe the care coordination teams; what each member does and its effectiveness.
Piefer: The physician, nurse, medical assistants, health coach, case manager, complex care nurse and social workers all are members of the care coordination team.
The physician leads the team and evaluates, manages, coordinates and validates the patient’s care plan. The case manager / complex care nurse / health coach / medical assistant prepares information to assist in the management of the patient, both during the visit and during case conferences.
Social workers evaluate social needs and provide interventions as necessary. For example, if a patient has unreliable transportation or problems accessing basic needs such as food or heat, the social worker can help bridge gaps with contact and coordination of needed services that meet the patient’s basic needs.
The health coach also works independently with the patient to develop self-management goals and coach them to improved outcomes. Health coaches work with patients to come up with mutual goals for helping them achieve better health outcomes, perhaps losing weight, for example. It’s more behavior-based than outcome-based.
The effectiveness of our model can be measured in real terms. We have fewer admissions per 1,000 members for ambulatory-care sensitive conditions. We have better clinical outcomes related to quality measures for ischemic heart disease, diabetes and other chronic disease states.
Repertoire: Please describe your disease management program.
Piefer: Our disease management program is embedded in the clinical practice. It focuses on the major chronic diseases – diabetes, ischemic heart disease, congestive heart failure and COPD – and all combinations thereof to assure patients are following an evidence-based protocol for their treatment.
Part of the task of the team is to make sure patients have access to their medications and that they are taking them appropriately. The program works as an element of the WellMed Care Model to assure that patient visits are supported by information technology of a decision-support tool, protocol tool to make sure elements of care are addressed at their visits.
Repertoire: In your model, physicians have a salary but can qualify for extra income by meeting certain metrics. What are some of the metrics, and how has this model been received by your physicians?
Piefer: Some benchmarks we look at include:
• Effective management of lipids for ischemic heart disease and diabetic patients
• Measurement of LDLs
• Management of COPD by adherence to
protocols and by appropriate prescribing of ACES and ARB inhibitors
• Management of a patient’s blood pressure, etc.
• Measurements of all patients being seen annually.
New patients seen within 90 days.
• Post-hospital discharge patients seen within 7 days.
It’s been received well by physicians, primarily because reaching these targets allows them to receive significant compensation bonuses that can be equal to 50 to 100 percent of their base salary.
Repertoire: What is WellMed’s opinion on the role of the primary care physician in the formation of an accountable care organization?
Piefer: We feel like the PCP and primary care is the foundation of healthcare delivery for an effective patient-centered medical home and accountable care organization. It’s consistent with the tenets of the AAFP TransforMED project and patient-centered medical home guidelines that highlights the PCP as leader of the team that coordinates and manages the care for the patients.
Repertoire: How do your patients’ hospital admission rates compare to the average rates?
Piefer: Frequency of admission and length of stay are both lower than national averages. As measured by admits per 1,000, our hospital admission rates are close to half the national average. Hospital bed days per 1,000 are less than half the national average for bed days for our patients.
Repertoire: What have the cost savings created with this model meant for your group?
Piefer: Cost savings have allowed WellMed to develop programs and implement services to continue to produce improved quality outcomes that are being requested from an Accountable Care Organization. The development of information systems, care coordination teams to include health coaches and social workers and care teams to support the patient are all financed by savings generated by the model.
The expansion of benefits to the patients will be maintained or grow based on the ability of the model to generate savings. These include access to no-cost friction-reducing diabetic shoes and no-cost transportation to and from doctor’s appointments.
It’s allowed us to reinvest in all the systems and processes which generate better clinical outcomes. We can also create an environment for better provider and employee satisfaction by having competitive salaries and benefits.
WellMed Medical Management is a diversified healthcare company and health plan provider serving more than 87,000 patients and plan members, mostly Medicare-eligible seniors in Texas and Florida. The physician-owned practice management company is based in San Antonio, Texas. Founded in 1990 by Chairman and CEO Dr. George M. Rapier III, WellMed provides an innovative healthcare delivery system for Medicare-eligible patients. WellMed is recognized as an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services, and more. WellMed Clinics have over 60 Board Certified Family Practice & Internal Medicine physicians and over 20 Certified Physician Assistants and Nurse Practitioners in over 25 clinics in San Antonio and its surrounding counties, Austin, Texas and the Treasure Coast of Florida. WellMed Medical Management affiliates with over 150 Board Certified Family Practice and Internal Medicine physicians in more than 100 physician group locations in San Antonio, its surrounding cities, as well as Orlando and the Treasure Coast of Florida.
WellMed’s mission is to change the face of healthcare delivery for seniors by providing quality, proactive patient care with a focus on prevention. WellMed believes that patients are entitled to receive a concierge level of medical care and service delivered by physicians and clinic staff who understand and care about their health.