Currently, there are four medical practices in the state of Wyoming that are Patient Centered Medical Homes (PCMH). Thanks to the Corbett Medical Foundation, the Platte Valley Medical Clinic is one of them.
The staff at the Platte Valley Medical Clinic has taken advantage of a pilot program that was offered to them in 2012 and funded by the Centers for Medicare and Medicaid through a grant awarded to the Wyoming Institute of Population Health. In three short years the Platte Valley Medical Clinic has propelled the clinic to the highest level possible, a Level 3, in the program.
It has taken a lot of time, dedication and work according to Dr. Dean Bartholomew. It is a level that only one other clinic in the state has reached so far.
The clinic went through an 18 to 24-month process of transformations to meet the requirements for the model of care as a PCMH.
Work on Tonya Bartholomew's part to prove they were following protocol was a large part of the process, Dean said.
"They don't send someone in to do an on-site evaluation," Tonya said. She was required to upload hundreds of documents and screenshots to show they were following the required procedure or that they had a policy in place to meet the standard of care to become a PCMH. Tonya also had to explain the outcomes.
"This model of care we did do beforehand, but now we have documentation and proof," Dean said.
The model goes back to the basics in preventive care including following up with patients to ensure they are following the advice of the physician and keeping appointments with specialists.
The focus is to improve the patient's health through preventative care and to help manage chronic conditions, like diabetes or high blood pressure, Dean said.
"We adhere to very high national standards. Sometimes that means reaching out to patients, rather than waiting for the patient to come through the door," Dean explained.
A significant part of the program is the care coordinator, a position that was created by the clinic to meet the standards and funded by Corbett Medical Foundation.
Conna McGuire was hired to fill that position three years ago. "Having someone who can focus on care coordination – meaning if someone needs an appointment with a specialist, we help them get set up," Dean said.
Conna also makes sure the proper documentation is sent to the specialist and then follows up, Dean said. "We keep a log on every appointment," Dean said.
Conna ensures the clinic gets notes back from the specialist. This includes x-rays and laboratory results. This follow up ensures the clinic has all the patient's results in one common location and the patient is cared for in a comprehensive manner.
Conna also works with the programs offered in the area, such as Meals on Wheels, Wyoming Independent Living, etc ., and keeps patients informed of what is available and what they qualify for.
"We're trying to close the loop to improve coordination of care, which is at the heart of the patient's medical care," Dean said.
"The Corbett Foundation very quickly identified the need for a care coordinator position to make the (PCMH) successful," Dean said.
It is difficult for a small clinic like the Platte Valley Medical Clinic to create a position that does not provide income generation, and they were appreciative that the Corbett Foundation funded the position.
With the new model in place, Tonya said the clinic has a better way to track their accountability and follow through with the patient's care.
"It used to be, we just did it," Tonya said. "Now we have a tracking process, a more formal process. For instance Conna knows she is responsible for this task and Lana is responsible for that task."
It is advantageous because nothing get miscommunicated or dropped.
"The other piece of that is we are able to do some true population health – meaning we can run a list of all our patients and see who is due for a colonoscopy or who is due for a mammogram," Dean said.
"I think this is the biggest change in how we have shifted – it is more of the preventative care," Tonya said.
"We have the information now ... how do we use it, and does that work in a small community," said Dean of how to get the buy-in from the patient on preventive care.
When facing a patient who does not follow through on their own health care, ultimately it is the patient's responsibility to take care of their own health, Dean said. The clinic can educate the patient and has the tools they can use to help the patient take a look at his or her lifestyle and make the necessary changes to improve his or her health, Tonya said.
The provider discusses with the patient what his or her goal is and how he or she can make the changes needed to reach that goal.
"It's a team effort between the patient and the provider on what is a realistic goal," Tonya said.
Some patients have been resistant because they think the doctor is just trying to make money, but that is not the case, Dean said.
The national guidelines are very extensive and can be found online at http://www.guideline.gov. The website not only shows the guidelines in place, put the guidelines in progress, a guideline index and guideline archive.
"These guidelines are here because we know this helps improve health have better health outcomes," Dean said.
Another component in the PCMH is a 24-hour, seven-day-a-week availability of health care.
Again, it is something that Dean, Jennifer Oiler and Ed Shiels were already doing.
In this model of care, the 24/7 access includes the patients having the access to their information or their provider.
If a patient goes to the emergency room (ER), the ER doctor can get access to the patient's information – more importantly, if the patient needs to have a finger sewn up at 8 p.m ., it can be done at Platte Valley Medical Clinic, rather than going to the ER several miles away.
"Very few small clinics are able to provide that service," Dean said.
The Corbett Medical Foundation has been instrumental in subsidizing the 24/7 access.
Since the implementation of this model of care and the care coordination, Dean and Tonya have seen and been able to report an increase in preventive health care.
For instance, in the past 51 percent of the female patient population were getting a pap smear, now it is at 57 percent – a 6 percent increase in just one month, Tonya said.
"That is the result of Conna picking up the phone and reminding the patient it is time for a pap smear," Tonya said. "Even if it is not at our clinic, we can get it logged,"
Those preventive measures and cancer screenings are important.
Patients of the Platte Valley Medical Clinic can ask their specialist to send their records to the Platte Valley Medical Clinic.
In January 2015, the Platte Valley Medical Clinic was recognized for their accomplishment of becoming a Level 3 in PCMH.
Because of their involvement with the PCMH, Tonya was a contributing writer of the payment model for the state or Wyoming's Medicaid program.
In April, Dean and Tonya have been invited to speak in Casper at the Wyoming's Innovation Award Wrap up Event – Stronger Together about the PCMH program.