Our journey, which culminated in receiving the 2015 Acclaim Award, began in 1994. New West Physicians (NWP) was formed at a time when the healthcare landscape was in turmoil from the managed care backlash of the gatekeeper HMO model. Although it was impossible to predict the future landscape, through the collapse of this model a singular vision emerged. The vision was simple. Irrespective of future changes in the healthcare delivery system, a physician organization that defi ned itself based on both the quality and the effi ciency of care delivery would be well poised to serve its patients. Although high-quality care and patient service were known to be critical to the success of the model, it was care effi ciency that would differentiate us. The great challenge was to build a sophisticated, high-performing organization within the constraints of the fi nances of primary care medicine. What follows is our vision then and today, for both the quality and the effi ciency of our organization. From our inception, we have viewed high-quality care as the “price of entry” into the world of high-effi – ciency care. Attempts at improving care effi ciency had often been met with skepticism around compromised care. We therefore determined that it was paramount to measure and report quality outcomes from the outset. Moreover, we also determined that a portion of compensation would always be linked to individual provider performance on these quality outcomes studies. Lastly, the vision included transparent reporting of all outcomes with all providers in the organization, and sharing of the data with our health plans—radical concepts at that time. In 1997, the NWP quality outcomes program was launched and from that point forward, three times yearly, sophisticated quality outcomes studies were conducted on a wide variety of disease entities. The results were compared with best practices in the literature and formed the foundation for a program of continuous quality improvement which continues today. Numerous peer-reviewed publications and grant-funded studies have arisen from this program. As health information technology advanced to catch up with this vision, we embraced the tools necessary for population health management. This began over a decade ago with rudimentary, home-grown registries and has evolved to sophisticated tools permitting the ability to predict and manage the health of our population. Inherent in our model was the recognition that high-quality care afforded only small improvements in effi ciency. We recognized that cost of care was not linked to quality of care and that excessive care was both costly and dangerous to patients. We also modeled ourselves based on the observation that high-functioning healthcare systems around the globe invariably had a primary-care-centricity that allowed for effective care coordination. Additionally, the vision included that we were a cost center and not a profit center. This resulted in a conscious decision to not own ancillary facilities for imaging, laboratory services, etc. This model allowed us to critically select our entire network of specialty physicians, hospitals, and ancillaries based solely upon their quality and efficiency. Historically, changes in practice patterns have evolved slowly in response to new developments in evidence-based medicine. Evidence-based research often takes as long as five years to reach clinical practice. Part of this is due to the well-recognized phenomenon of clinical inertia. More importantly, however, much of this is due to the fact that the elimination of wasted care can have important negative financial implications for physicians. It has been well established that new, high-quality literature is not adopted into clinical practice if it is in conflict with established practice patterns. Take, for example, the continuing practice of performing routine nuclear stress tests on patients with stable coronary disease who are asymptomatic, despite clear and accurate literature evidence that this is wasted and potentially harmful care. Our primary care centricity has allowed us to work closely with our narrow specialty network to eliminate much of the wasted care in our healthcare system. This necessitated the development of our “Bench to Bedside” program. The goal of the program is to study the literature for high-quality, evidenced-based research that fundamentally changes daily practice patterns. This is then fast-tracked into clinical practice over a 6- to 12-week timeframe. The process involves meetings with primary care and specialty physicians to agree on practice consensus. Next, clinical algorithms are built to be utilized by the referral department. Compliance is then monitored by the referral nurses and Chief Medical Officer. This strategy is usually collaborative, occasionally contentious, but always based on accurate science and the best evidence-based medicine. Over time, referral streams have been truncated to support a limited network of high-quality and high-efficiency specialist colleagues. This philosophy has been replicated to extend our network to include our hospital partners, imaging centers, laboratory services, urgent care centers, skilled nursing facilities and other ancillary providers. Finally and perhaps most importantly, the sustaining force of our organization is a strong culture of accountability. With no competing priorities other than the cost-effective delivery of high-quality medical care, our decision making has been clear and focused. We are transparent in all that we do. The ultimate vision was to create a primary care organization where providers would spend the majority of their time caring for patients and are supported by an infrastructure that provided a high level of provider satisfaction. Provider satisfaction translates into engaged and motivated individuals who constantly strive to raise the bar of their chosen art—the practice of primary care medicine.
Tags: AMGA, denver, newwestphysicians