How Active Management Solves Common Healthcare Problems
Healthcare Simplified - Episode 2
July 24, 2017
The Greater Baltimore Medical Center (GBMC) is very progressive with its primary care model. This is especially true in some of their efforts to provide greater access to care.
Our first guest on the Healthcare Simplified podcast was Dr. Mark Lamos from GBMC. Mark explained how he has demonstrated wellness in his own life, as well as how GBMC has disrupted the typical primary care delivery model. In doing so, they have set up what they call “active management” to maintain cost and quality effectiveness for their own employee benefit plan.
This article covers the highlights of the interview.
Mark’s Personal Wellness Journey
Experience creates passion.
Over the years Mark ate the normal American diet, with all of its unwelcome consequences. After finally coming to grips with his own need to do the right things, he lost 140 pounds, exercised daily, and was able to get rid of a ton of medicines and pursue a better healthful situation.
At 65, he ran his first half-marathon and now weighs the same as he did in high school.
Medical Home Model
We asked Mark to share a little about GBMC’s primary care model. GBMC embraces the concept of the patient-centered medical home, Don Berwick’s idea of improving quality and performance, and using metrics to drive their healthcare system.
Their PCP model is built around the idea of not having urgent care, but having extended hours at every one of their facilities. Generally, they have between 5-9 providers at each site. They have basic laboratories available and their offices are spread geographically around the Baltimore Metro area, dotting the community they support.
Each of those offices are now not just primary care. They have specialists like gastrointestinal and cardiology participating directly at the sites.
They’ve also hired 10 behaviorists to support their push for psychiatric services available to every patient. When a patient with a behavioral or mental difficulty, GBMC performs a deep dive on the family to make sure they’re well.
They also use a single electronic medical record (EMR), Epic, for everyone. And they spent a lot of time developing the system to support their version of Medical Home.
They’re progressive in terms of providing access to care, and they use Epic to find gaps in care. They’re proactive, too: they produce a dashboard for every doctor every month, showing them where they’re doing well or not. There are bonuses available for improving quality.
They’re spending a lot of effort trying to do the right things, and it’s shown benefits. Within GBMC's Accountable Care Organization (ACO), they’ve been able to show that the quality measures are really good. There’s never been a question about quality from the insurance companies they work with.
“Active management” was a term that GBMC put together. It means that the medical director of the health plan for the employees has the ability to contact the patient’s physicians when it comes to medication choices or high utilizers or follow-ups from the hospital. This is because many of their employees don’t utilize their own physician group because they live outside of their geographic footprint.
The people that don’t use GBMC’s own offices need to be kept in the loop. What GBMC found was that many of those patients weren’t getting the follow-up. The reconciliation of medicines was haphazard, so they would have an admission for disruptive medicines.
Active management means they help pick the patients and the circumstances under which they contact the patient themselves or the patient’s physician, review the healthcare choices that were made by the provider, and review with the patients how they can best engage them with either a care plan directly or an office visit to make sure they cover all of their needs.
“The idea of ‘who, what, and where’ care is being provided by is absolutely mandatory,” Mark said.
How You Can Implement a Similar Active Management Strategy Quickly
It’s important that you have a partner in the above implementation. If the EMR hasn’t been tuned to try to answer these questions, you can get a tremendous help from “advanced management partners,” companies like Allegeant, who can help you with the data. You don’t know what the most expensive drug is; you don’t get the information that comes from other providers that are not part of your group.
In Maryland, the big thing is total cost of care, and they get a lump sum of money to provide care to all the people who call their hospital their health home. You need to know where everything’s being done, if somebody’s doing admissions at a hospital other than your own or outside of your system.
Then you sit down with your partner and go over the things you want to illustrate: high-cost individuals, the pharmacy products, an idea of the number of people you’d have at risk for hepatitis C. You have to sit down and have a real talk with your providers and say, “If we’re really in this thing for quality and cost, we’ve got to be on the same page.”
They have to be bigger discussions, and you have to be very transparent. It sounds daunting, but if you start slow, it’s surprisingly manageable.
To reach out to Mark and ask about GBMC’s active management system, email him at firstname.lastname@example.org.