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November 26, 2024: Meet Margaret, a 47-year-old female employee in your company.

Employer Healthcare Solutions / Converging Health Website

Meet Margaret, a 47-year-old female employee in your company. How would your company’s benefits support her? Margaret is a 47-year-old hard worker and is a valued member of her work group at your company. She’s been employed by your company for 10 years. Margaret is married and has three children who are in high school. She used to be involved in her local church and loved to play racketball. Her husband’s job is very demanding and most of the care of the home and the kids falls to Margaret One Year Ago: She has been struggling with her health for several years. She has a Whole Person Risk Score of 104 based upon having multiple conditions, taking several medications, seeing multiple doctors, not being up to date in her preventive care, and not following effective pathways of care for back pain, obesity, fatty liver disease, and depression. In the last year, she used her full complement of sick leave and had to take a few more days off at her own expense. She does have a relationship with a nurse practitioner who she’s seen 4 times in the last year. While she’s had no hospitalizations, she has been seen in the local Emergency Room 5 times in the last year. Intervention Based on the Whole Person Risk ScoreTM the Personal Health Assistant, Sarah, assigned to Margaret reached out to her repetitively for a conversation. Finally, she reluctantly took the call and was pleasantly surprised. The call began the process of building trust and was a positive, supportive conversation where the PHA and she explored how the PHA could assist Margaret in being more successful with her health and well-being. Here is what the PHA learned: Margaret & Sarah’s 1st Year Journey During the initial 30-minute conversation Sarah listened and asked questions to better understand that Margaret was feeling confused, scared, and immobilized by concerns about how to use her benefits. While she knew that the ER and not working with the NP consistently was not the best way to deal with her problems, she did not know what to do. At the end of the call, Sarah and Margaret set up a second call to review her Personal Health Summary which reviewed all her diagnoses, medications, doctors, procedures, and recommendations to get healthier. After reviewing this Margaret realized that she needed to address these issues and take a different approach. With Margaret’s permission, Sarah shared this comprehensive summary looking at past utilization, and the key steps for the future with her PCP’s office. Sarah and Margaret made a list of the challenges, prioritized them, and set up the next meeting. Over the last year, Sarah patiently walked through the opportunities Margaret’s company offered. Margaret could barely believe all that was being offered and was so appreciative of what she had access to. She signed up for them as the problem they addressed became the priority and between the programs and her primary care doctor (supported by the NP) she gradually overcame them one by one. Margaret started with 2 key goals: to build a connection with her PCP and address her mood challenges. Sarah helped her engage with the employee assistance plan (EAP) to discuss the emotions she was experiencing and get supportive coaching about how to address them and how to communicate what was happening to her doctor. At the same time Sarah scheduled an appointment with the PCP collaborating with the NP she was seeing for an annual exam. These went well and her PCP took her off some of her medications (which had been causing side effects and financial stress) and put her on a mood-improving medication that she learned was both safe and inexpensive. During her initial visit, her PCP did a breast and cervical cancer screening exam and ordered her mammogram and colonoscopy which Sarah helped her get set up and done. At first, she felt a bit guilty that she wasn’t seeing her OB/GYN who delivered her children, but realized that this was time, energy, and cost that her PCP could save her. Her EAP coach helped her identify the key symptoms that bothered her the most and the PCP, EAP coach, and she kept working together until they were 80% resolved. This led to her wanting to be more active. She joined the MSK program offered by her company where again she got a coach. Basic exercise bands and tools were sent to her home, and she began – slowly initially – to be more active and to address her back and knee discomfort. She knew her weight was contributing to her fatigue, sleep, and MSK issues, and after a lot of encouragement from Sarah, she signed up for the weight loss program through an APP offered by her employer and she liked it. Margaret & Sarah’s 1st Anniversary of Working Together As shown in the table, Margaret is in a very different place. With Sarah, she has a trusted companion and coach on her journey who, while not a doctor or nurse, has increased her understanding and ability to use her benefits, the healthcare system, and her medical and medication issues. Her company that funds Sarah saved at least $10,000 on her healthcare as she has become more proactive and much less afraid and reactive. She is optimistic she will be able to work until retirement in 10-15 years.

November 26, 2024: Meet Margaret, a 47-year-old female employee in your company. Read More »

October 7, 2024: Talking about Risk

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care If you were to ask someone how they felt right now, most would say … “I feel fine”. Some are fine. They are young and healthy and have little need for medical services. Others respond “I am fine” but they have a number of significant risk factors. They may be diabetic, in CHF, experiencing all forms of distress and they are actually not fine. They do not use primary care preferring subspecialist care. They are not yet having an event that leads them to urgicare, the ER or in for a hospital stay. Others have dropped over the edge some time ago. They are both high risk and high cost. Using data to assess risk and responding effectively is the key. Being able to succeed with your value based proactive paid contracts will require that you and your system get very good at using data to risk stratify and developing processes within your practice that allow you to do the following: First, identify those people who are at high risk Second, create processes within your practice that ensure that staff can identify the risk within the individual patients they deal with each day and be sure that the high risk/low cost receive preferential attention when they contact your office. You want them in ASAP. C Third, your team needs a plan to reach out proactively to these patients, to get them in for a comprehensive visit. These people are the ones who most benefit from Advanced Primary Care. Your team can work miracles. Fourth, you and your team need to understand and effectively respond to the health literacy level of the patients. People’s motivation vary as does their ability to grasp ideas, interpret reports shared with them, etc. Fifth, your team needs to build loyalty among your patients so that they think of you first when they have a health/medical concern. Proactively sharing information that is relevant to them as patients is created “stickiness”. Create an e-newsletter or listserv so you can share materials with them. They like hearing from their doctor. It is easy and inexpensive with a platform like “Constant Contact”. We appreciate that if you are working in a hospital owned practice, the administrators will want to control this. But most administrators focus on marketing and not service. Work with them. Convince them over time.

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September 25, 2024: The Challenge of Complex Care Management Part D

Clinical Consulting, Employer Healthcare Solutions / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 22 Aligning Care Management Incentives Around Value Highly effective care management tightly embedded with the primary care team can be tremendously effective in improving patient outcomes. The converse is also true in most cases we have examined. Remote care management siloed away from the primary care team is minimally effective by comparison. We have already demonstrated that high value advanced primary care reduces admissions, ED utilization and total cost of care based on our experience with clients and in our practices where payment was aligned with improved health outcomes and lowering the health risk of our populations. So how do we measure and incentivize the work of care management nursing to steer toward high value work? Effective care management nursing is centered on the same factors as the rest of the primary care team. Trust is the key currency, which is tied to the relationship they can establish with patients over time. Continuity, competency, reliability, and compassion drive the trust relationship forward and this empowers patients to change. No patient will follow the advice of any clinician or nurse they do not trust. Look at every part of the CM RN workflow to ensure that what they are doing builds trust and serves the interests of the patient first over the interests of the system (ACO, hospital, or whoever). Documentation should be lean and specific so that the rest of the care team is clear on what part of the overall care plan the nurse with working with the patient on. Don’t consume precious time in make-work processes but invest their time to better understand their patient’s needs and help them navigate the next steps of their care. We believe that measuring high-risk patient’s trust and engagement with their care managers would be the pinnacle of assessing the value of the work done. We also want to measure how the total cost of care and health risk of those high-risk members declines the longer they are engaged by a care management nurse. Outpatient care management is not just “get ‘em in and out” as many ACO’s have in their “enrollment” metrics. Simply enrolling a patient, especially if those patients are not target in order of risk, does little to impact cost or improve health risk. We want to encourage gradual transition of patients who are making positive changes back to their care team’s oversight. Many patients, by the nature of their disease process or social determinants are going to need more help, not less, over time so some will need periodic long-term check ins by their trusted care management nurse to keep tabs on their decline and help them transition to palliative care. The major difference in care management in the primary care setting from that of inpatient or transitional care management is that the relationship of the patient with their primary care team is longitudinal and often lifelong. Having metrics that reward short, superficial contact with patients will not yield the outcomes that our patients need, nor will it reward systems with cost savings that allow you to pay for quality care management. Scott Conard, MD Michael Tuggy, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected] [email protected] Kathleen Dalton, RN, CCM, CMGT-BC [email protected]

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September 18, 2024: The Challenge of Complex Care Management Part C

Clinical Consulting, Employer Healthcare Solutions / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 21 Entities defining the work We have much to say about pseudo-regulatory companies that create standards and processes for both primary care and care management. As these companies do not actually take care of patients directly, they are not accountable to real patients or outcomes. Far too often, these entities focus on process, documentation and frankly, make-work instead on getting direct feedback from patients, clinicians and their care teams as to the effectiveness of the process they promote. Many clinics and care management departments have NCQA certification, but their patient loyalty, engagement and outcomes are abysmal. These same care teams have a lot of choice words to describe how the certification requirements impact their work with patients. “It’s all about checking boxes not about engaging patients in what really matters,” is a common refrain I have heard when surveying care management nurses. The primary metric needs to be improved patient outcomes measured mostly by patient input and reliable data on utilization of services. The Person-Centered Primary Care Metric, now adopted by CMS for its MCP and ACO Flex primary care initiatives, is an ideal example of a tool to measure these essential aspects of trust and relationship in primary care. A simple modification of questions would allow a care management department to get a strong sense of how the patients they engage feel about the effectiveness of their care manager. The focus must be on building trust first, meeting the patient where they are and developing an actionable care plan that the patient can pull off realistically. Gather data shouldn’t just be a long list of questions but should involve a care review of the patient’s active problems and apparent barriers to care, then when first contact is made, the care management nurse knows the patient to a depth that instills trust because they have done their homework. When access care challenges and barriers, the SDOH relevant bits of information will come to light as to what is really impacting that patient. Care plans are often a disaster if not written in a context of active problems, their interplay on the patient’s life, and setting realistic expectations of things the patient is willing to work on that week using motivational interviewing skills. A number of consulting organizations generate prebuilt care plans that are so generic and aspirational that they resemble emesis on paper. They are often lengthy, unrealistic, laden with platitudes, and far too many goals to be realistic. How about having a diabetic use a pillbox to help him remember to take his medications twice a day? That may be all that the patient can handle for the next month so perhaps that patient derived care plan should suffice, not a laundry list of ideals that we can generate with a Smartphrase. It is far better to have lean documentation, a workflow and a real plan of care that is coordinated and in sync with the primary care provider’s and the patient’s priorities. Care managers can certainly enhance and inform those priorities but neither the PCP nor the care management RN should be creating a plan in a vacuum for a complex, high-risk patient. Teamwork here is essential and should be a key metric to assess the quality of CM services. Kathleen Dalton, RN, CCM, CMGT-BC [email protected] Michael Tuggy, MD [email protected] Scott Conard, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected]

September 18, 2024: The Challenge of Complex Care Management Part C Read More »

September 11, 2024: The Challenge of Complex Care Management Part B

Clinical Consulting, Employer Healthcare Solutions / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 20 The CMS requirements and unintended consequences. In the typical FFS ACO, one of the previous core metrics that CMS has offered is the percent of patient enrolled in care management. That metric drives care managers to “enroll” patients within the ACO by completing an intake process. The payment associated with that metric was tied to the percent of the population enrolled in a measurement period. So how does this work in the real world? With that as the primary incentive to drive the ACO bonus payment then the nurses are asked to enroll as many patients as possible, regardless of risk, need or outcome. Enrolling patients is the focus, not the actuation of patients to follow their care plan, nor the engagement of the patient with the CM nurse or their care team. The result is a churn of patients with brief stints with care managers, then being discharged back to their own devices whether or not they have actually changed behaviors in a meaningful way. Nurses asked to work this way are keenly aware that they are not able to build relationships effectively nor are they always proactively seeking out those patients with the greatest need, as they are often the harder to engage. When volume is the primary metric, we see burnout and frustration wearing down these nurses from this moral injury. The 2024 MIPS Quality Benchmarks continue to evolve with both process and outcomes measure with highly detailed definitions of each numerator and denominator that qualifies a system to gain a tic mark towards achieving the metric. The 466 potential measures boggle the mind and are largely process measures and a number of these measures are very targeted to specific actions (i.e., perform screening for social determinants of health, a charge submitted for advanced care planning, a plan of care after a fall). Nowhere is there a reward for reducing the health risk of the patient as a whole person. There is a nod to patient engagement with the Person Centered Primary Care Measure, which is one of the few measures that actually looks at a person’s relationship to their care team, and especially a care management nurse if they are high risk and are lucky enough to have a care manager embedded in their primary care team. We so need fewer but better, more manageable metrics that focus on outcomes, lowering health risk and thus lowering costs. The complexity of data collection for 466 measures and even to know if they are accurate, is an enormous challenge. As a primary care physician, I want my care management nurse to work alongside me with my complex high-risk patients to help them understand their plan of care and adhere to it as much as possible, given the constraints of their life. The number of patients my care manager follows should be dependent on their complexity and the amount of engagement effort it takes to get them to change behavior in a positive way. This is where an accurate risk tool truly pays off – to both identify the best patients for care management but also to understand the workload posed by each of those patients. Kathleen Dalton, RN, CCM, CMGT-BC [email protected] Michael Tuggy, MD [email protected] Scott Conard, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected]

September 11, 2024: The Challenge of Complex Care Management Part B Read More »

September 4, 2024: The Challenge of Complex Care Management Part A

Clinical Consulting, Employer Healthcare Solutions / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 19 One of the main objectives of primary care and within value-based payment models is to improve patient outcomes and reduce the cost of care. The top 8-10% of the population consumes about 80% of the healthcare dollar in the United States. The highest risk patients on every primary care clinician’s panel are those with complex medical, psychological and social needs. In the current fee-for-service paradigm, many health systems, insurers and ACO’s have moved nursing resources from direct clinical nursing to care management roles to try to assist this highly vulnerable population. However, care (or case) management has often grown out of inpatient nursing departments, moving to transitional care management (to prevent readmissions) and now are trying to perform in outpatient settings with very mixed levels of success. We have observed and scrutinized a number of care management services, and we see several common themes that we feel need to be addressed if we are to truly have an impact on improving patient outcomes AND retain skilled, caring nurses to perform this vital service. We will dissect these in a series of blogs to dig deeper into the issues that many if not most care management services face. Kathleen Dalton, RN, CCM, CMGT-BC [email protected] Michael Tuggy, MD [email protected] Scott Conard, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected]

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August 23, 2024: Primary Care is an Investment, the Rest of Healthcare is a Payment (J. Constantz)

Clinical Consulting, Employer Healthcare Solutions / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 18 The message is clear: Investing in primary care is a powerful and effective strategy to improve healthcare outcomes, reduce costs, and promote equity. Decades of research have consistently shown that enhanced primary care leads to: Focusing efforts and resources on primary care rather than trying to reduce spending on sub-specialty and hospital-based care is a more efficient approach. Strengthened primary care has a ripple effect, improving the entire healthcare system by forcing downstream players to adapt and improve their practices. This shift can lead to significant reductions in the administrative super-structure and overall costs. Attempting to reduce costs by focusing on sub-specialty and hospital care is arriving at the dance too late. By the time patients require these high-level services, the opportunity to avoid, mitigate, or reverse disease has often passed. Here’s why: For employers, investing in primary care can result in better health for their employees, effectively providing a pay raise and increasing payments to shareholders. We have the evidence to support these claims. The data is clear: enhancing primary care is the key to a healthier, more equitable, and cost-effective healthcare system. Scott Conard, MD Michael Tuggy, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected] [email protected]

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August 19, 2024: Patient Loyalty

Clinical Consulting / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: The Future of Primary Care – Part 17 Competition among health systems for primary care patients. According to some reports, only 40% of employees when asked report that they have a personal physician. Once upon a time, in what we call the “Marcus Welby, MD” era, most people had a relationship with a primary care physician. When people had a medical concern, they contacted their primary care physician and the clinician treated problems over the phone or even made house visits. People over 55 remember Marcus Welby MD, those younger have no idea what it’s like to have a personal physician unless they grew up with a Family Physician as their care giver. So why is patient loyalty important? First, trust is the foundation on which improved health behaviors is built on. Patients who trust their family doctor will generally accept their doctors advice. Loyalty develops after trust is established, leading to continuity of care over the long haul. In addition to building strong relationships, you can also observe the patient over time and identify hidden patterns that allow you to see the big picture and the hidden forces that help you to understand what motivates/influences a patient. A hallmark of advanced primary care is spending more time with patients in order to better know them and to encourage them to trust you as their clinician. In a prepaid, value-based payment plan, you earn money if the patient stays with you, they stay healthy, and you help them avoid unnecessary Urgi-care, ER, specialist visits, hospitalizations, and tests. Your willingness to tolerate ambiguity and a scope of practice are extremely important in assessing your patient’s concerns. Remember, this is what Family Physicians, general internists, nurse practitioners and physician assistants were trained to do. So also is the patient’s loyalty to you and your practice. It’s the power and magic of relationship. Recently one of us spent a few days in a community hospital. At one point two volunteers pushed a cart with an upper and lower deck into the patient’s room. They excitedly explained that a patient could have as much of everything on the cart as the patient wished. It was like that lady on the train in a Harry Potter movie, selling candy to the students, only this was all free stuff… the woman volunteer kept explaining. This was clearly an attempt to “buy” the patient’s loyalty. While this may be inexpensive, it’s totally missing the point. If you want to influence a patient’s loyalty, work to deliver the best care possible. Communicate caring and compassion to your patients. Find ways to treat him/her well. The docs taking time to talk to patients at each stage along the way as opposed to sending messages to the patients and relying on the nurse to convey the message makes a difference. Making sure the docs and nurses have the time to communicate becomes critical whether in the office, in the hospital or over the phone. Dr. Tuggy was in clinic the other week and had a wonderful reminder of loyalty. A patient presented 7 years ago with vague abdominal discomfort and after a careful history and exam, he pulled out his portable ultrasound and found a 9 cm aortic aneurysm that was about to rupture. Dr. T quickly contacting the vascular surgeon, setting up a rapid evacuation to the hospital (2 hours away in this rural area) and the patient had emergency surgery and avoided catastrophe. The clinic visit last week was a celebration of life – between this patient and his doctor. The patient still sees Dr. T as “my doctor”, even though a new younger group of physicians have taken on his practice over 4 years ago. The service you see in the picture above is what will buy loyalty and if the patients has a need he/she will call you before heading to a hospital. It takes more than a quick “If you have a health care issue call us” to build patient loyalty. Trust does not come without real effort.

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August 9, 2024: The Patient’s Health literacy Matters

Clinical Consulting / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 16 A patient’s health literacy has a dramatic impact on their ability to learn and adapt. The primary responsibility for assessing and adapting to the patient’s health literacy falls on the clinician. The patient’s cultural and conceptual knowledge, print health literacy (writing and reading skills), oral health literacy (listening and speaking), and numeracy can each effect their ability to respond positively to new information. A patient’s assumptions and ideas do matter. There are a variety of methods that clinicians who want to succeed in the value-based, prepaid payment world can use to succeed. The lack of health literacy can kill a patient and put a major dent in your success. You succeed when your patients succeed What is health literacy? Definitions Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. What are the 4 components of health literacy? Arguably, the Institute of Medicine (IoM) presented one of the most influential models of health literacy. The IoM model contains four underlying constructs: cultural and conceptual knowledge, print health literacy (writing and reading skills), oral health literacy (listening and speaking), and numeracy. One of the complaints expressed by some clinicians argues that the clinician’s financial success should not be at the mercy of their patient’s noncompliance. In a value-based prepaid contract, the clinician/organization succeeds by keeping their patients as healthy as possible and away from the urgent care center, the ER, the hospital and unnecessary care. Deprescribing is also critical. The patients’ understanding of their health risk and how to improve their health is a major component of both clinical outcomes and financial success. In the fee-for- service world lecturing the patients about what they need to do was often considered good medical practice. And yet we know that well over 50% of what the clinician tells the patient during the office encounter is gone from the patient’s mind the minute she/he walks out the exam room door and by the time the patient gets home it may be well be that over 80% of what the clinician said is gone from the patient’s memory. It gets even worse if the news the patient received during the office encounter was new diagnosis/information that scared the patient. It’s more than a little unfair to blame the patient for this normal behavior. Rather it is incumbent on the clinician and the practice to get smart about the strategies they use to help the patient learn and adapt. Let’s start with a few underlying ideas. Not all patients are the same Talk about oversimplification. Patients come in all sizes and shapes. Some are well educated, and some are not. Even among the well-educated, some can process complex ideas during an interpersonal encounter and some struggle especially in the confines of an office visit. From a motivational point of view, the key issue is aligning with the patient’s goals. Assessing the alignment between your therapeutic goal for the patient and their goals and readiness for action is critical. If there is lack of alignment, you will not succeed. The second element involves “baby steps”. If the first step the patient must take is too far from their current behavior, failure is likely. Become an effective coach by breaking down your instructions/guidance into “doable” steps. Small successes over time lead to sustainable change. Help them to articulate and focus on the next specific step he/she needs to take to more towards success. The focus is always on the next specific step. Patient risk You may have integrated the idea of level of risk into your medical thinking. Patients have not. When a patient says… “I feel fine” they are not basing that assessment on data. It’s a feeling. Helping the patient to grasp the concept of risk takes time. Moving from feeling fine to “I am a patient at high risk, and I need to take action” is a quantum leap. Be patient and allow time to absorb the idea. Expect denial when the idea is first presented to them. We all have some level of denial built into our thinking and action. Culture rules facts There is wide divergence across cultures regarding baseline knowledge surrounding a wide array of issues. Sone cultures see a physician in a positive way and others see physicians as being less than trustworthy especially when there is divergence in race and age. The burden here is on the physician/clinician. Are you capable of being the physician/clinician a patient needs on any given day. Some patients on some days need to talk and perhaps even unload on the clinician. Not a good day to remember new information. Can you adapt to where the patient is today? Group visits When clinicians offer group visits, they all realize that the interactions between the group participants is often more valuable than the interactions with the clinician leaders. Remember motivation, not just information, is required to help people to learn and adapt. Use of social media These days there are presentations on almost every topic under the sun accessible online. From medical conditions, to mental health, motivational and all types of topics. Over time create a library of URLs that can be shared with the patient and their significant others. These resources can supplement the information you present during the office visit. One very smart first year resident had a brilliant idea. He noticed that he was giving the same basic talk to each of his patients who just learned that they are diabetic. He decided to video record his basic talk and he told his new onset patients… “I know what I just shared is a lot to remember so I will send to you a video I created with all of this information so you can listen to it when you want

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July 15, 2024: Feeding the Inner Healer/Helper: Part A

Clinical Consulting / Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 13 Sponsored by WWW.THEMDCEO.COM Stephen Covey identified Sharpening the Saw as one of the seven habits of highly effective people. According to Covey, “Sharpening the Saw” means “preserving and enhancing the greatest asset you have—you. It means having a balanced program for self-renewal in the four areas of your life: physical, social/emotional, mental, and spiritual”. We believe that offering team-based Advanced Primary Care requires an active effort to help each member of the team to continuously sharpen their saw. In most medical offices this is limited to vacations, Continuing Medical Education and professional development of physicians and nurses. Taking time to upgrade their knowledge and skills is the traditional method that is used. For clinicians it is clearly critical to maintain themselves as lifelong learners. While it’s a good beginning, it’s not sufficient for the challenge of Advanced Primary Care. Each member of the team needs to stay in touch with her/his inner healer/helper throughout the work week. We use the term “inner healer” to refer to the members of the team who have chosen a career in their respective professions. Staff members who have been hired to support the professionals also need to be oriented to and supported in their work as helpers of patients. The challenge is complicated by the limited time available during a busy and productive schedule of patients and tasks. Also, methods that are cost-effective need to be used. We believe there are some methods that can work. We strongly recommend that each member of the team read “The Art of Medical Leadership” written by Susan Oran and Scott Conard, MD. Each member of the office team is a leader. From physician to janitor/security guard, how people think, act and communicate contributes to the culture that supports the care delivery process. As we’ve said before, patients can sense the culture and warmth of the practice when they call in and when they visit the practice. Promoting patient loyalty to the practice is critical. A Patient-Centered Medical Home needs to feel like a home for all involved. How to Sharpen the Saw? Storytelling is a powerful method of communication and community building. Stories that members of the team tell one another, and stories told by the team to patients, vendors, etc. have an impact. During staff meetings, ask the team members to share stories of success and disappointment/failure. Ask each team member to share a story that describes the last time they felt pride in their work. Have one story told per staff meeting. Make a habit of this. Look at your website. Is it alive and vital? Does it tell the full story of your center? Ask the physicians, the nurses/navigators/care managers and the other professionals involved in the team to describe their “why”. Why did they choose their profession? Consider video recording these and sharing them via your website. This can be done with a cell phone. Prior to each new patient visit, send the patient a link to the clinician they will be seeing as a way of orienting them to the office visit. Ask grateful patients to share their story, videorecord it and share it through your website. At least get the story in writing and place a copy on the walls of the waiting room. This can be done slowly over time. Look at the walls in your center. You can communicate what is important in your center before the patient even engages with a clinician. The pictures also serve to remind the team members of their reason for working there. Many OB/Gyn practices have pictures of the babies they’ve delivered on their walls. Your pictures tell the story of what your practice values. Scott Conard, MD Michael Tuggy, MD Susan Lindstrom Laurence Bauer, MSW, MEd [email protected] [email protected] [email protected] [email protected]

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