Minnesota Physician April 2018

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Improving one practice at a time Small changes produce big results BY LARA LUNDE, MD, AND JULIA MURPHY, MSC


t just five years old, Liam never knows when his reactive airway disease will flare, causing him to cough and wheeze. His mom, Erica, used to bring him to urgent care for immediate treatment, but thanks to changes at Essentia Health–Moorhead Clinic, she now relies on her primary care practice to manage his condition. “It was like an act of Congress—I called today and was able to see you today,” she said during one visit. In addition to scheduling same-day appointments for patients like Liam, the care team can now quickly reference his clinical records, rather than taking down a new patient history every time he comes in. Such seemingly small changes are adding up to a better experience and higher quality care—not just for Erica and Liam, but also for all of the practice’s patients and caregivers throughout the Fargo-Moorhead metropolitan area. Applied nationally, this model could enhance care, reduce costs, and help all providers perform at the top of their practice.

The urgency of better primary care In 2017, Americans made an estimated 461.8 million visits to a primary

care provider, reflecting the fact that, for most people, primary care is the gateway to accessing health care. As a result, transforming primary care delivery is essential to improve the entire health care system. The opportunity for improvement is substantial. Americans spent $3.4 trillion on health care in 2017, accounting for almost 18 percent of Gross Domestic Product. Despite this level of spending, outcomes in the United States are often no better than in other advanced economies, including in important measures of health and well-being such as life expectancy and childhood mortality. Clay County’s premature death rate is 12 percent higher than the rest of Minnesota, partially due to a high prevalence of opioid abuse and babies born with opioid withdrawal symptoms. Those statistics are only exacerbated by gaps in care. The county’s primary care access rate is one physician per 3,400 people, compared to an average of one per 1,100 for the rest of the state. And with 60 to 80 new families moving into the county every month, primary care resources will only be stretched further. Better care and outcomes are needed—and primary care holds great promise for transformational change if solutions can be identified, replicated, and scaled.

Transforming one practice “from good to great”

Helping Beautiful Things Emerge From Hard Places

Recently, Essentia Health–Moorhead partnered with the Peterson Center on Healthcare—a non-profit organization dedicated to improving health care quality and lowering costs nationally—as part of an effort to promote high-performance primary care. The Center, working with Essentia Health–Moorhead and two other practices nationwide, sought to replicate the insights of landmark 2014 research from Stanford University’s Clinical Excellence Research Center. The study, which explored what makes high-performance primary care practices stand out, uncovered ways in which the practices improved clinical and functional outcomes for patients, and brought “joy in practice” back to the lives of physicians, all at a lower total cost. The Center then used the research results to develop specific, actionable steps for practices, and provided hands-on implementation support to all three practices. Ultimately, the Center hopes to assist practices nationwide in their individual journeys to advance “from good to great.” Fostering an environment for primary care practices to deliver the best possible patient care in a financially sustainable way can set the foundation for a high-performing health care system nationwide.


The Center for Alcohol and Drug Recovery


The Vanguard Center for Gambling Recovery

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Before beginning any transformation efforts at Essentia Health– Moorhead, the entire practice team was engaged to find out what mattered to them. An experienced practice facilitator from the Institute for Clinical Systems Improvement conducted interviews, revealing a collective vision that centered around deeper relationships with patients and with one another. The practice then created a practice improvement team, led by a physician-administrator dyad, which included representation from every role in the practice.