With team-based care, everyone wins

An independent, multi-specialty medical group, Valley Medical Group has provided primary and specialty care to residents of Western Massachusetts for over 25 years. Many providers have long-standing relationships with their patients. Some see multiple generations of the same family.

They became an athenahealth client in 2000, and since then have leveraged athenahealth’s suite of medical record, revenue cycle management, and patient engagement services to streamline workflows and better manage their billing. In addition, athenahealth supported the practice through the process of achieving Level 3 certification from the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home (PCMH).

In recent years, the practice struggled to balance personalized patient care with the increasingly complex information associated with each visit. “Patient care is becoming more challenging,” says Martha Mastroberti, the practice’s healthcare informatics manager. “The demands on providers’ time are extraordinary.”

Practice leadership needed to keep providers focused on patient care while meeting quality and revenue goals. “The number of things providers have to keep track of is just exploding,” says Dr. Joel Feinman, president. “And if you layer on top of that the need to meet billing requirements as well as criteria for quality programs, that’s very difficult.”

The practice knew that athenahealth’s services could help providers better manage their time. “My job is to make primary care sustainable for our clinicians and for our patients,” says Steven Esrick, medical director.

So, Valley Medical made considerable changes to the way they approached patient care.

A team-based approach deepens connections to patients 

The athenaClinicals EHR helped support Valley Medical’s new team-based care initiative. The EHR makes it easy to assign work to other care team members, uses text macros to facilitate documentation, and helps providers quickly digest information entered by others. What’s more, encounter plans, templates, and workflows are constantly updated based on best practices of similar medical groups on the network.

With this kind of structure and support, the practice was able to implement a team-based model of care with the goal of building stronger, more personal relationships with patients while reducing the documentation burden on primary care practitioners. Now, practitioners see their patients along with a care team coordinator, usually a medical assistant, who takes vitals and conducts basic lab tests, in addition to completing documentation and providing any assistance the patient needs before or after each visit.

“Working with a care team allows us to parse out work to the people best able to do it,” says Mastroberti. “We make room for the provider to have a relationship with the patient, and take away tasks that detract from that.”

The practice is able to surface information when it’s needed, whether it’s a record from a hospital visit, an update from a specialist, or an alert that care that needs to be scheduled. The coordinator can then make sure the physican has the right information on hand for each patient interaction.

The new approach has had a profound impact on the practice. Now, the coordinators complete notes at the end of each visit. “The clinician will proofread it or make a couple of corrections, but essentially the notes are finished at the end of the day,” says Esrick. “Right off the bat, we went from an average of six minutes down to about two minutes per note.”

More than simply saving time, the team-based approach allows the practitioner to better connect with the patient in the room. The coordinator builds trust and familiarity with each patient as well, which serves as an extension of the provider’s relationship. “It’s truly magic what happens,” says Mastroberti. “We’ve had some extraordinary anecdotes from patients, and from clinical staff, about being in the room when that kind of care is given.”

“Bringing back the joy of medicine” 

The transformation has affected clinicians as well: satisfaction is rising, and the stress of completing documentation is noticeably lower. “One of the key pieces of feedback we’re getting from clinicians is, ‘This is what I went into medicine for.’ We are talking directly with the patients,” says Feinman. “We’re not filling out forms or documenting quality requirements, we are able to help somebody through a difficult time. It’s bringing back the joy of medicine.”

Practitioners using the team-based care model are spending significantly less time working after hours, and have boosted the number of encounters they close on the same day by 20%. “One of the things we’re finding with athenahealth’s solutions and teambased care is there’s less time outside of the exam room that has to be spent documenting,” says Feinman. “So I get more time for my life. That sustains me as a person and allows me to go back into the office the next day with more dedication to what I’m doing.”

Quality performance that doesn’t take away from patient care 

In addition to protecting providers’ time, Valley Medical says that athenaClinicals has helped improve performance on key quality measures. “athena’s quality engine helps us easily see what preventive care needs to be done,” says Feinman. “It helps us focus on the few critical things that have to take place today, and understand what’s needed in the future.”

athenaClinicals incorporates quality measures into clinical workflows so that providers are prompted to address them in the moment of care. “athena’s EHR makes a lot of sense for primary care practices,” says Dr. Fred Kim, a primary care practitioner with Valley Medical. “We can easily see what needs to be done and handle it during the visit. It doesn’t take time away from our patients. We went into medicine to make people feel better, not to spend our time documenting. I feel connected to my patients again.” Plus, the organization has seen dramatic improvements across key quality indicators.

Improving prevention with a clear understanding of care gaps 

The practice has been able to better identify and address care gaps. When patients arrive for an appointment, the coordinator can easily see needed preventive care and alert the provider before the visit.

athenahealth’s EHR also has reporting capabilities that allow users to look at care gaps by health center, provider, and even by individual patient. The team can then decide the best way to close those gaps.

“I’m proud of our clinicians and clinical staff, and I’m proud that we put our patients first,” says Esrick. “We’ve worked continually to improve. And we’ve let our providers know that they are valued.”