Efforts to reform healthcare may fail unless they employ four elements upon which SETMA depends in its transformative efforts:
1. The methodology of healthcare must be electronic patient management.
2. The content and standards of healthcare delivery must be evidenced-based medicine.
3. The structure and organization of healthcare delivery must be patient-centered medical home.
4. The payment methodology of healthcare delivery must be that of “Medicare Advantage”.
At the core of these principles is SETMA’s belief and practice that one or two quality metrics will have little impact upon the processes and outcomes of healthcare delivery. SETMA employs two definitions in this analysis:
¡ A “cluster” is seven or more quality metrics for a single condition, i.e., diabetes, hypertension, etc.
¡ A “galaxy” is multiple clusters for the same patient, i.e., diabetes, hypertension, lipids, CHF, etc.
SETMA believes that fulfilling a single or a few quality metrics does not change outcomes, but fulfilling “clusters” and “galaxies” of metrics at the point-of-care can and will change outcomes.
SETMA’s model of care is based on these four principles and these concepts of “clusters” and “galaxies” of quality metrics. We are achieving significant results with them.
Contrasting SETMA’s “model of care” with the other organizations participating in the Center’s study will allow SETMA and the Center to understand the processes of healthcare transformation more fully.
The SETMA Model of Care
· The tracking by each provider on each patient of their performance on preventive care, screening care and quality standards for acute and chronic care. SETMA’s design is such that tracking occurs simultaneously with the performing of these services by the entire healthcare team, including the personal provider, nurse, clerk, management, etc.
· The auditing of performance on the same standards either of the entire practice, of each individual clinic, and of each provider on a population, or of a panel of patients. SETMA believes that this is the piece missing from most healthcare programs.
· The statistical analyzing of the above audit-performance in order to measure improvement by practice, by clinic or by provider. This includes analysis for ethnic disparities, and other discriminators such as age, gender, payer class, socio-economic groupings, education, frequency of visit, frequency of testing, etc. This allows SETMA to look for leverage points through which SETMA can improve the care we provide.
· The public reporting by provider of performance on hundreds of quality measures. This places pressure on all providers to improve, and it allows patients to know what is expected of them. The disease management tool “plans of care” and the medical-home- coordination document summarizes a patient’s state of care and encourages them to ask their provider for any preventive or screening care which has not been provided. Any such services which are not completed are clearly identified for the patient. We believe this is the best way to overcome provider and patient “treatment inertia.”
· The design of Quality Assessment and Permanence Improvement (QAPI) Initiatives – this year SETMA’s initiatives involve the elimination of all ethnic diversities of care in diabetes, hypertension and dyslipidemia. Also, we have designed a program for reducing preventable readmissions to the hospital. We have completed a COGNOS Report which allows us to analyze our hospital care carefully.
