Primary Care Reimagined

Issue 28 | November 2017

Primary care reimaginedBaylor Scott & White Health is extending its primary care reach throughout Central Texas. We’re continuing a tradition of excellence in patient care by championing legislative efforts, expanding our primary and urgent care clinics, and delivering care in new ways enabled by clinical expertise and technology.

New, enhanced primary care services are building upon the considerable strength and resources of the Baylor Scott & White Health system to care for all patients—from pediatric to geriatric—in a vast geography with an increasing population. Primary care serves as the anchor of the entire health care experience, with teams of dedicated internal medicine and family medicine practitioners and allied health practitioners all focused on each patient’s overall health and well-being. Primary care physicians serve as the patient’s “medical home” (see issue 22 of The Catalyst to learn more), collaborating with specialists when appropriate to meet the specific needs of each patient, supported by the electronic health records system that simplifies communications among caregivers and streamlines patient care processes.

Now, we’re advancing our primary care approach even further, with the addition of more convenient ways to access primary care services from our physicians and other caregivers, through telemedicine (or remote) care, more primary care clinics, and new Convenient Care Clinic locations for those times when patients need to see a provider on a walk-in basis or outside regular clinic hours for non-emergency health issues.

The role of primary care

Primary care physicians are the hub of a complex system of care. “Primary care is meant to be that first stop, the first place someone goes when they need help,” says Michael Reis, MD, chief medical officer for the Central Regional Clinics at Baylor Scott & White Health. Dr. Reis is also chairman of the Department of Family Medicine and is an experienced family medicine doctor. “The primary care model is focused on team-based care centered on the needs of the patient – doing what’s best for the people who entrust us with their care.”

It’s well documented that primary care services can help us live longer and feel better, reducing death rates and costs associated with chronic diseases, such as cancer and heart disease. In many cases these health conditions can be prevented with the help of primary and preventive care. Today’s primary care efforts are increasingly focused on keeping people well—ensuring patients get their screenings on time and supporting lifestyle changes like weight loss and smoking cessation to eliminate problems down the road.

“Helping people live healthier is so important,” says Dr. Reis, “because there’s so much we can do. Most chronic conditions are caused or made worse by things we do to ourselves— whether we eat well or poorly, whether we exercise or don’t, whether the environments we live in are healthy or not.

“The reality is,” says Dr. Reis, “primary care physicians evaluate and provide treatment for about 90 percent of the issues for which our patients need help. Our job is to know when to refer for specialty care, and make the right referral. At Baylor Scott & White, we consciously select the specialist we think is best for our patient. When care is complete, that specialist and colleague sends the patient back to us and we continue care for the long term.”

Marlow Griggs, MD, a primary care physician at the Scott & White Clinic – Westfield in Temple, says, “Family medicine is a specialty and our extensive training is in breadth. It’s our job to know a great deal about many things, but not everything. Specialists are trained to go deep, knowing everything in one area. Together, we all serve key and complementary roles for patients.”

Easier access to care for patients

Baylor Scott & White is delivering primary care services in different ways that are more accessible and cost effective, such as through remote visits and patient monitoring. The idea of remote care or “telemedicine” has traditionally meant physicians could utilize technology to help diagnose or treat patients at other hospital locations, but Baylor Scott & White Health is advancing that idea to bring primary and specialty care to patients in places that are convenient to them, such as in their homes through web-enabled patient visits. This is especially beneficial for patients who live in rural areas, or those who need to have frequent interactions with their physicians to manage a chronic illness.

Given some of the barriers to telemedicine in Texas, clinical and administrative leadership at Baylor Scott & White participated in efforts to ease statewide restrictions on electronic patient visits (or E-visits) that limited eligibility to only those patients with a documented annual in-person visit with their provider. Subsequent legislative changes have opened up access to services like E-visits to more patients. E-visits involve a short online asynchronous intelligent interview for health conditions of a less serious nature. The results of that interview are then sent to a clinician for determination and diagnosis, with a treatment plan ready within an hour if the condition is appropriate for online care.

“For the right conditions, E-visits are excellent,” says Glen Couchman, MD, executive vice president and chief medical officer for the Baylor Scott & White – Central Texas Division. He helped lead the effort to amend the legislation, meeting with the Texas Medical Board to present results from a pilot program and explain the benefits of E-visits. “Things like colds, flu, and allergy symptoms; upper respiratory, urinary, and yeast infections; minor eye irritations; and conditions like constipation and diarrhea are all very appropriate for an E-visit.”

Justin Johnson, director of strategic initiatives at Baylor Scott & White – Central Texas, works with Dr. Couchman to deliver telemedicine solutions. He says, “E-visits are great for patients with routine conditions living busy lives. They tell us they really like the speed and efficiency. We can often save patients a trip to the clinic, or to urgent care or the emergency room. That means they don’t miss work, family time, or other things they prefer to do, and the cost to the patient is much less. Additionally, by taking some simple visits out of the clinics, it opens up appointment slots for others with more complicated issues.” (See issue 24 of The Catalyst to learn more about E-visits.)

Working together to meet a shared goal to benefit patients is one example of the kind of teamwork that underpins our primary care approach. Dr. Couchman says, “Justin and I shared with the board our organization’s results and our successful story. E-visits easily meet the standard of care and provide patients with good quality, safe care that’s convenient and lower in cost. The board was very receptive to our findings.”

Mr. Johnson says, “Many groups in Texas supported the recent legislative change. In our meeting with the Texas Medical Board, having Dr. Couchman as a family physician advocate that the standard of care with E-visits is appropriate and showing real results to validate that position was impactful.”

Video visits are another way telemedicine is connecting patients at remote locations with Baylor Scott & White physicians. Mr. Johnson says, “Video visits are like a privacy-protected Skype call. You can see, speak, and interact with your physician remotely through a secure video portal.” Video visits may help revolutionize care for patients with chronic conditions such as diabetes, chronic obstructive pulmonary disease (COPD), and heart disease.

“Patients who require regular follow-ups many times do not need an in-person visit,” Mr. Johnson says. “These visits are typically more consultative in nature and video visiting from the home or office is often much easier than getting to a clinic—especially for people who live a long distance away. A lot of innovative, effective care is being provided outside of the doctor’s office. Unfortunately, much of that care is not yet reimbursed by insurance companies. As such, we’re a bit limited in offering these options, but with improved legislation our hope is that soon insurance providers will be more responsive.”

Convenient Care Clinics

Convenient Care Clinics, formerly known as Urgent Care Clinics, offer a faster, lower-cost care option for non-emergency health conditions, compared to the cost of receiving care in an emergency room. Several locations are available and others are being planned for close-to-home care for less serious illnesses and injuries, such as flu and ankle sprains. Convenient Care clinics are staffed by family medicine physicians and advanced practice professionals, and offer extended hours seven days a week. Vaccines, health screenings, lab draws/tests, minor procedures, and physical exams are also available. For those with chronic conditions, such as hypertension and diabetes, follow-up visits including blood pressure and blood sugar checks are available. Baylor Scott & White is continuing to strive to deliver more convenient, cost-effective alternatives to urgent and emergency care with expanded walk-in clinic hours in more locations.

Clinics Expansion: Hill Country

Marble Falls is at the epicenter of rapid regional growth, with more retirees and others settling here and throughout the Hill Country. In 2013, Baylor Scott & White opened a specialty clinic and later a medical center to serve the growing area’s needs, offering an elevated level of health care excellence close by. Since then, the population has continued to grow and so has our need to expand our primary care presence in the Hill Country.

“We hear all the time how much people appreciate having excellent quality health care close to home,” says Tim Ols, president of the Hill Country region for Baylor Scott & White. “We’re growing and expanding to continue to meet our community’s needs.” Baylor Scott & White also runs seven primary care clinics in towns from as far south as Johnson City to as far north as San Saba. Upcoming clinic additions will include a state-of-the-art family medicine clinic in Burnet and a new clinic in growing Spicewood. Specialty care is growing too—since the specialty care clinic opened in 2013, patient volumes have grown from 500 per month to 500 per day. A $1.8 million clinic renovation currently planned will accommodate more specialists and expanded treatment areas.

The specialty care presence is an important component for those patients needing services beyond what primary care provides. Karen Gupton, director of operations for the Specialty Clinic in Marble Falls, says, “We offer care in 25 different specialty areas, and for a rural area like Marble Falls, that’s amazing. In the past, people moved away as they grew older to be closer to their health care provider. Now, they’re staying and the area is attracting retirees and young families alike.”

“People here are excited as we continue to grow our primary care and specialty care presence in the region,” says Blake Jamail, director of operations at the Primary Care Rural Health Care Clinics for Baylor Scott & White – Hill Country region. “As the ring of development around Austin continues to move westward, Hill Country towns like Spicewood, Burnet, and others will experience rapid growth.”

Our primary care efforts will continue to serve the best interests of our patients, with innovative programs and clinical expertise that residents of Central Texas can count on. The patient care journey starts with primary care: it’s the front door to patient care excellence, and a path to specialty care for patients who need it. In the words of Dr. Reis, “Primary care is challenging, fascinating, and rewarding. We celebrate and grieve, laugh and cry together with our patients. We treasure those long-term relationships. That’s why we do it.”

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