SUPERCLINIC
THE FUTURE OF HEALTHCARE
Primary care is the logical basis to create a disruptive, value-based network for patients and employer/payers to drive more effective care solutions in the most costly areas of medicine. In its current state, however, primary care is limited in its ability to shift quality and cost due to critical gaps in medical school training, a lack of standardization around best practices, and limited transparency towards the economic and clinical outcomes produced by providers managing patient populations.
For the past 25 years, Elevare Healthcare has embedded “best practice” modules into Primary Care platforms and measured the impact these practices have on clinical quality, referrals to specialty care and the total cost of care. Through the rigorous analysis of these data, Elevare Healthcare has developed proprietary training programs and protocols for primary care. These training programs allow for the optimization of primary care providers and enhance their clinical capabilities creating the SuperClinic model.
The Elevare SuperClinic has the ability to far outperform conventional patient-centered medical home models and advanced primary care models by standardizing around best practices, embedding quality management principles into primary care and continually improving clinical outcomes by sharing clinical outcomes and cost data on every patient passing through the SuperClinic program.
WHY PRIMARY CARE
FOLLOWING THE DIAGNOSIS
Patient care begins inside the physician's office. In 2011, more than 75% of the 1.3 billion medical diagnoses treated originated care at the primary care level, and musculoskeletal and cardiometabolic diagnoses accounted for 45% percent. These facts coupled with the knowledge 75% of all specialty referrals outside of the primary care practice are for musculoskeletal or cardiometabolic conditions make primary care the only logical place to implement an effective care solution.
HOW TO INNOVATE PRIMARY CARE
THE CMS PRIMARY CARE INITIATIVE
These initiatives were overwhelmingly unsuccessful because CMS did not focus on the priority musculoskeletal and cardiometabolic chronic conditions or modifying care processes. CMS also failed to institute clinical best practice guidelines and did not re-train providers in the core areas of medicine using appropriate protocols.
These initiatives were overwhelmingly unsuccessful because CMS did not focus on the priority musculoskeletal and cardiometabolic chronic conditions or modifying care processes. CMS also failed to institute clinical best practice guidelines and did not re-train providers in the core areas of medicine using appropriate protocols.
CREATING BEST PRACTICE
BEYOND EVIDENCE-BASED GUIDELINES
Demonstrate the correlation between improved health outcomes under best practices and a lower total cost of care
Create a foundation on best evidence in peer review the literature and test in the real world (is it generalizable).
Deploy in the real world and use quality management principles to train, measure results/outcomes and continually improve the process.
THE FIVE ESSENTIAL ATTRIBUTES
THE PRIMARY CARE SUPERCLINIC
Practice at the top of their license
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PCP teams have upgraded training and protocols optimizing their care pathways in the core domains of medicine (use true best practices based on the three pillars).
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Follow quality management principles to monitor practice activity, track patient outcomes and react to outlier events
#2
Provide Care Beyond their license
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Integrate/Connect PCP teams to advanced specialists through telemedicine consults
#3
Remove the handoff incentive
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Work with PCP organizations that are independent and willing to be transparent around results (not beholden to other stakeholders)
#4
Appropriate referrals into a curated network
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Use the most advanced analytics to look at patient outcomes, guideline adherence, and procedure volume
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Select a specialty physician for referral of cases outside PCP scope
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Specialty providers ranked and tiered in each region by:
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Clinical guideline adherence
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Quality of care (infection/complication, readmits, mortality, etc)
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Episodic cost or total cost of care
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#5
Incentivized to improve performance and reduce volume
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Lengthen consult times and enhance payment to increase income per patient
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Create clear expectations around process compliance with clinical protocols, improved patient outcomes, and patient satisfaction then link payment to meeting standards of care.