We’ve all heard about the Affordable Care Act (ACA). What often gets lost in the heated debate over its implementation, however, is the fact that it relates to more than just insurance coverage.
In truth, the ACA attempts to address the health of Americans in four ways:
- By expanding insurance coverage – increasing access to healthcare
- By improving the quality of care that is delivered through innovative initiatives
- By enhancing preventive health – preventing illness from occurring and focusing on the outcomes of interventions
- By promoting community and population-based activities
Let’s use my recent experience with a client in the process of switching her primary care provider as an example of how the ACA is already changing the face of healthcare at the patient-experience level…
Health care is becoming “practice-centered”
One of the things I recommend to clients is that they seek to develop a positive relationship with their primary care practice.
I emphasize the word practice, rather than physician, because within the new model of “Patient Centered Medical Homes,” although the practice is physician-led, it often includes nurse practitioners and physician assistants who work alongside the physician to deliver primary care. In addition, it may include nurse case managers, social workers, pharmacists, nutritionists and physical therapists.
Patients need to assume more responsibility for their own health
My client was prepared for her visit. She had an agenda, the first item of which was “Our relationship.” This prompted a discussion of her expectations of the relationship, information about how the practice is structured and how communication would flow between the patient and the physician.
She arrived with her complete list of medical issues, surgeries, hospitalizations, allergies, immunizations and the names and contact numbers of other specialist physicians she sees for complicated medical issues.
She also brought a comprehensive list of medications that included daily prescription medications, herbal medications and nutritional supplements, medications taken on an “as-needed” basis, and medications taken in the past for various conditions.
Through her level of preparation, my client demonstrated to her new physician that she is an active and engaged consumer who thought it was important to put the time and effort into preparing for her meeting. She set the tone for the partnership she hoped to develop.
New roles and tools are emerging
After checking in and being greeting by a medical assistant who gathered information and conducted vital signs, my client was next greeted by a social worker who described her role in the practice and the team model it uses. She shared names and phone numbers of resources within the practice and discussed how the use of email through the Patient Portal was another means of communicating.
We learned that in this practice, it is standard procedure for all new patients to see the social worker first. Feedback regarding this approach (in place for about a year) from both patients and physicians has been overwhelmingly positive. To me, this is a great example of the new patient-centered team model of healthcare delivery, one that utilizes each professional to his/her fullest potential.
Physicians are learning to become “patient centered”
Following introductions, the first question the physician asked my client was what brought her here that day. The physician listened intently and, although she was documenting in the electronic medical record, she positioned herself to maintain eye contact through much of the discussion. She too had an agenda for what she needed to accomplish and she skillfully negotiated and prioritized so that both were satisfied with how to proceed.
Preventive health is taking on a greater role
The physician emphasized her keen interest in spending time helping patients promote health and prevent illness. And so, in addition to the obligatory review of test results and current health issues, they also spoke about managing hypertension, stroke prevention, medication management and behavioral recommendations surrounding exercise and diet.
The doctor asked about my client’s daily activities and daily intake of food and made several concrete recommendations regarding small changes that could be incorporated into her already busy lifestyle. She skillfully helped her agree on a set of measurable goals for weight reduction and exercise.
Health care is moving beyond just the “doctor’s visit”
Following the meeting and physical examination, the discussion turned to a blood pressure monitoring program that the practice offers. Here, blood pressure monitoring equipment is provided and the patient is asked to take daily blood pressure readings. These are then transferred electronically to the physician’s office for review.
The goal is to engage a patient by having her receive daily feedback on progress. It also provides data that the physician can trend over time, in order to make better decisions regarding medication management.
Reflections
Upon reflection, I have to say that this experience with my client may be the best new primary care visit I have ever experienced. My client was so pleased with the outcome, in fact, that she felt confident in making a change to this practice from a physician with whom she’d been associated for a long time (but with whom she did not feel a partnership).
For me, it was also a (positive) indication of the impact that the ACA is already having within our industry. In short, common sense healthcare delivered in a patient-centered and compassionate way!