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Melinda Muller: Legacy to adopt new model of care

The Columbian
Published: January 23, 2011, 12:00am
2 Photos
In addition to Legacy Salmon Creek Hospital, Legacy has four clinics in Clark County.
In addition to Legacy Salmon Creek Hospital, Legacy has four clinics in Clark County. As health care reform rolls out, these sites will adopt the Medical Home model of care. Photo Gallery

o Legacy clinics will participate in pilot programs that will roll out the Medical Home approach to health care.

o Primary care physicians will play a larger role in coordinating treatment among specialists.

o The roll-out of this new approach to care will take several years, and there could be peaks and valleys along the way.

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In terms of visibility in Clark County, Legacy Salmon Creek Medical Center is our flagship. But woven into the community — at Salmon Creek, in Fisher’s Landing and Battle Ground — are several of our Legacy Medical Group clinics, and these will be the sites of some significant changes associated with health care reform.

o Legacy clinics will participate in pilot programs that will roll out the Medical Home approach to health care.

o Primary care physicians will play a larger role in coordinating treatment among specialists.

o The roll-out of this new approach to care will take several years, and there could be peaks and valleys along the way.

Legacy Health has 18 primary care clinics in the Vancouver-Portland metropolitan area, four of them in Clark County. As health care reform rolls out, these clinics will be associated with a term we all will come to know: Medical Home.

The Medical Home model places the primary care physician at the center of patient care. Considering the health of the whole person, the primary care physician is the gateway to integrated care for each patient, coordinating care that specialists provide and looking out for the big picture.

The goal of the Medical Home model is threefold:

o Shift currently disjointed medical care to a more coordinated model.

o Move from a model in which patients see multiple physicians — where no one is “running the show” — to a model where one person is in charge.

o Aim for a system where physicians function in a team.

Legacy is launching the Medical Home model at five pilot clinics. Soon, over the next few years, the model will be in place at all of our primary care clinics.

The level of care in the Medical Home model is guided by patient need.

o A young, healthy person would receive reminders about preventative care.

o Someone with a chronic disease — say diabetes or hypertension — would receive reminders about prevention, as well as care specifically focused on the disease.

o High-needs patients would receive extra assistance from a health coach or nurse case manager, coordinating not just clinical health care, but also connecting with outside organizations and agencies that may provide additional care.

Patients will have a consistent provider with whom they can communicate.

Same-day access to the clinic is part of the model, and phone or e-mail connections also are available.

What happens in terms of patient outcomes when these things occur? Based on 18 months of tracking within Legacy, we have seen the following:

o Averages of Hemoglobin A1c test, used as a standard tool to determine blood sugar control for patients with diabetes, have improved 11 percent.

o The number of female patients who have had a pap smear within the past three years increased 25 percent.

o The number of female patients who have had a mammogram in the past two years increased 18 percent.

The numbers are encouraging, but this is not a quick fix. Studies show that the Medical Home model requires five years or more to achieve a full transformation in health care, with peaks and valleys occurring along the way.

Given the volatile political climate that has engulfed our country, this may me the most important message we can deliver: Give the Medical Home model a chance to work. We at Legacy believe it is a key part of the future of health care.

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