Ambulatory Care Center Model Improves Patient Access, Lowers Cost

Linda Bodenmann, Chief Operating Officer, Southcoast Health System

Q: Why does Southcoast feel that it is important to move services into the community setting?
A: When we move services into the community, it not only provides an alternative to traveling to Boston or Providence for care, but also furthers our goal of reducing the overall cost of health care.

The cost of health care is reduced by working to make sure that patients stay healthier or, if they have a chronic disease, that the disease is managed more proactively so as to reduce the need for high-cost inpatient services.

We are building ambulatory care centers to ensure those much-needed resources are in the community. This provides better access for patients to get the services they need before they get so sick that they need to be admitted to a hospital.

Q: Southcoast’s new cancer centers are exceeding expectations. Why was it important for Southcoast to invest in this new service in the region?
A: The incidence of cancer is higher in the South Coast region than it is in the state as a whole. So, being the largest health care provider in the South Coast region, we have a responsibility to provide comprehensive, high-quality services so that patients don’t have to leave their community for care.

We recognized that while there were cancer services being provided in the community, they were not coordinated and focused around the patient. For example, a patient would have to go from one location to another to see different physicians, and those physicians wouldn’t necessarily have a convenient and easy way to discuss the treatment plan for that patient.

An important goal for our cancer program is the coordination of care among multiple disciplines by bringing the providers to the patients, rather than requiring patients to go from location to location to receive their care.

Q: Can you give us an overview of your vision for the ambulatory care centers?
A: The ambulatory care center offers multiple services that are more accessible in a less intimidating environment, including primary care, specialists, radiology and laboratory services. It can be scary to come to a big hospital and try to figure out which department you should go to and who you should see. In the ambulatory care centers, the focus is on primary care with the primary care physician taking the role of leader of the team. If a patient needs a lab test or an imaging exam or perhaps a referral to go see a cardiologist, he or she can get all those services in one location versus having to go to multiple places throughout the community.

The secondary focus is on urgent care. We know that patients need access to urgent care but can’t always see their physicians right away. At the same time, they don’t necessarily have a condition where they have to go to the emergency room. An urgent care center will provide another level of care, allowing patients the opportunity to receive the care they need in their own community when they need it, without relying solely on the emergency room.

This past year, we opened Southcoast Health System at Rosebrook, located at 100 Rosebrook Way, in Wareham, MA. Southcoast Health System at Rosebrook is a full-service medical practice location that brings together 15 Southcoast primary care and specialty physicians, the Southcoast Center for Weight Loss, and comprehensive outpatient radiology and laboratory services. Additionally, we will begin construction this winter on the Southcoast Ambulatory Care Center, to be located at 206 Mill Road in Fairhaven, MA. The new facility will include an urgent care center, approximately 20 Southcoast primary care physicians plus surgical and medical specialists with specialties in orthopedics, thoracic, urology, and endocrinology, gastroenterology, nephrology and pulmonary care. The new facility will also provide diagnostic testing, including radiology, laboratory and cardiac testing. Other features will include a pharmacy and physical rehabilitation services. The new center is scheduled to open in spring 2013.

Q: Do you think there is a general move in the medical community towards this type of care delivery model?
A: There should be a move within the medical community toward more community-based care because, ultimately, those services will help patients manage chronic diseases better and stay healthier. You don’t lower the cost of health care by merely lowering the unit cost of providing a procedure. You lower the cost by utilizing fewer of those procedures.

For example, if a patient with congestive heart failure can be seen in an ambulatory care center, we can help to manage his or her condition, and perhaps that patient will not move into an acute phase where he or she ends up in the emergency department and then has to be admitted to the hospital for a few days.

Q: What do you think has been the most significant change in the health care field over the last decade?
A: I think what we’ve seen in the last decade is that we are trying to shift from a system that rewards us based on the volume of services we provide to a model that rewards us based on the value of the services we provide. So, it is not only providing the service, but also making sure the patient has a good outcome. The measurement and reporting of quality measures is probably one of the most significant shifts in priority that health care providers have experienced over the last decade.

Q: Do you have a sense of what the most important health care developments on the horizon are?
A: It will be continuing to help patients manage their diseases, improving patients’ medical literacy, including understanding the impact of their daily living, nutrition and exercise so they can be active partners with clinicians in better managing their health.

It is our goal to find ways to give patients better access to the services they need so that, together, we can ultimately lower the cost of health care. There is no easy way to do that, but this is certainly what we believe to be an important step for this community.

MD News Future of Health Care 2011, Greater Boston



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