Converging Health Website

April 12, 2024: The Importance of Philosophy of Care and Scope of Practice

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 6 Sponsored by WWW.THEMDCEO.COM We believe that the clinicians’ philosophy of care and their scope of practice are foundational elements that create the opportunity for success in a prospective payment-based system. A whole person approach to healthcare is the approach that will produce the highest levels of health and well-being among the patients served. In a prospective payment model, the whole person approach will also produce the greatest financial rewards. The core idea of whole person health care, what’s most important in taking care of our patients, is to understand what matters most to them in their lives and making that the centerpiece of how we try to help with their lives and their health care. This differs from the FFS orientation which focuses on identifying and treating disease. For the clinician, we begin with our belief that each person has an “inner healer” that can be activated and supported as a patient responds to the forces that set him/her back. What kinds of skills and assistance does a patient need to help them move toward health and well-being? Using the power invested in the healer provides us a lever that can help the patient move forward. It is the patient’s beliefs and actions that matter most. We are their guides and a resource they can use. The “Jedi Warrior” believes in and can tap into the “force” for health and well-being and works to support the patient on their path towards health. This approach to care juxtaposes to the clinician as “car mechanic” who fixes body parts. We draw heavily on the work of several primary care thought leaders. Listed alphabetically Steve Bierman, MD is the author of “Healing Beyond Pills and Potions.” Dr. Bierman understands the tremendous impact of ideas on health and healing—ideas held by patients, and ideas delivered by caregivers. His approach has resulted in lasting cures of so-called chronic diseases, regression and disappearance of advanced tumors, bloodless and painless surgeries, and resolution of a wide array of “gray zone” syndromes that defy diagnosis. Scott Conard, MD is the author of “The Seven Healers” and other books The Seven Healers are seven specific ingredients that every human being needs in order to survive and thrive in this life. These essentials are not limited by a person s nationality, skin color, or religion. They are universally required by all. The Seven Healers, in order of their necessity for survival, are Air, Water, Sleep, Food, Play, Relationships, and Purpose. Without these time-tested elements, you cannot flourish and live a meaningful life. Once you identify the problem, you can trace it back to the root cause and find the answer. https://www.goodreads.com/en/book/show/16070555-the-seven-healers Wayne Jonas, MD is the author of “How Healing Works” Dr. Jonas is a champion of whole person and integrated care. He believes that healing is as important as curing. For Dr. Jonas, whole-person care addresses the four dimensions of a human being–physical, behavioral, social and emotional, mental and spiritual, and it is delivered in a person-centered way. He created the HOPE Note a tool to elicit the information needed from a patient to better understand their issues beyond the regular medical visit. The HOPE note builds off the SOAP (subjective, objective, assessment, and plan) note that every medical student learns and is applied every day in practice. The HOPE note is a patient-guided process designed to identify the patient’s values and goals in their life and for healing. The role of the physician is to provide the evidence and support to help them meet those goals. https://drwaynejonas.com/ James Mold, MD is the author of “Goal Oriented Medical Care” The premise of Goal-Oriented Medical Care is that, prior to consideration of strategies, the health care team must understand the patient’s personal health goals and priorities. The addition of the goal-clarification step changes the focus from problem-solving to goal attainment, forcing a reconsideration of the meaning of health and the purpose of health care. It elevates the role of patients in decision-making, broadens the range of strategies, encourages individualization and prioritization, and creates a conceptual framework for true person-centered care. And while the idea is deceptively simple, it provides a blueprint for the transformation of health care systems trying to adapt to changing health concerns, scientific and technological advances, health and health care inequities, and rising costs. Scott Morris. MD, MDiv. is the author of “Health Care You Can Live With: Discover Wholeness in Body and Spirit” Dr. Morris is the creator and leader of Church Health in Memphis, TN. He knows that hope, health, and healing happen when we consider the whole person. His model of care connects the dots across faith, medicine, movement, work, emotions, nutrition, and friends and family. Whether caring for patients or reaching out to the community, he holds high the dignity and worth of each person. The Church Health Model for Healthy Living recognizes that our lives are complicated. We are better together when we help one another access the quality health care necessary to live with dignity, vitality and joy. He believes that all health care delivery begins with love of patients. He has developed a Model for Healthy Living that is a tool for individuals to use to take charge of their own health, and it reflects that true wellness is not just about our bodies but about the interconnectedness of body, mind, and spirit in all the ways that we live. https://tinyurl.com/2cf62zxx and https://tinyurl.com/4c8u94pb Scope of Practice refers to the range of services that can be offered through the primary care practice. Can patients receive services such as simple dermatologic procedural services, sports medicine services, treatment of common musculoskeletal problems, (Osteopathic manipulation therapy, physical therapy, massage, Acupuncture, etc.) brief office counseling for mental/behavioral health issues, etc. The goal is “one-stop shopping” as much as possible. The final issue here involves helping the clinicians to reconnect with and renew their understanding of and commitment to their core values. It’s more than continuing

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December 26, 2024: Case #2 – Meet Tom a 58-year-old spouse of an employee in your company

Employer Healthcare Solutions / Converging Health Website

Tom is the spouse of Elaine, one of your best employees. She has worked her way to a key supervisor position. Tom and Elaine have been married for 32 years. Tom works part-time from home as an editor for a book publishing company that often uses him to help new authors complete their manuscripts. They have three children who have all graduated from college. In his younger days, Tom was an active athlete who played golf and tennis. In the last 5 years, he’s become inactive because of pain in his knee that will not resolve. He tried physical therapy to no effect. Tom has a Whole Person Risk ScoreTM*of 125. He has developed several chronic conditions. Two years ago he developed essential hypertension. Initially, he used medications to control his blood pressure. Then he allowed the prescription to lapse. He’s been untreated for the last year and a half. He’s had a few episodes of chest pain in the previous six months which took him to the Emergency Room for evaluation. Tom does have a relationship with a general internist who he’s seen five times in the last year. His chief complaint when he goes to the GIM focuses on his knee pain. The GIM referred him to an orthopedic surgeon for evaluation of the knee pain. The Orthopod prescribed Oxycodone for the pain, He did not believe that surgery could be a helpful intervention. He recommended more physical therapy. Tom procrastinates in his decision-making. In addition, he’s gone to the Emergency Room six times in the previous year for various complaints. One of these resulted in a 2-day admission to the hospital for a workup of his chest pain. Since the date of the inpatient stay, he has not seen his doctor. Intervention The medical team decided that the My Personal Health Assistant should make the first approach. The following is an outline of the game plan “The rest of the story” – Tom’s story is common. The chance of him having a stroke, heart attack, or being diagnosed with COPD or lung cancer and becoming a high-cost claimant is high The Converging Health MyPHA model provides him with a guide to create a relationship and engage him until his risk is reduced. The Converging Health model prioritizes actions and can save money (over $1,500/year/person) when he becomes engaged with his guide. The MyPHA is able to reach Tom and they have a fruitful first conversation. Tom is worried about his health status but feels overwhelmed regarding where to start Tom thinks his doctor is competent and knowledgeable, but he does not feel they have a strong working relationship. He’s not sure how to strengthen their relationship While Tom is concerned about his health, he does not think it is all that serious. Most days he wakes up feeling fine. He listens as the PHA provides some data about his risk Tom welcomes the idea of the PHA talking with his doctor. He permits the PHA to share their conversation with his doc Tom underestimates what his doctor could do for him when he has an episode that he thinks needs care. He’s always used the ER instead of this doctor when he thinks what he is experiencing might be serious. He recognizes that his fear is driving his decision. Tom remembers receiving some emails about these, but he’s never paid much attention to them. He’s surprised when the PHA explains their potential value Tom admits that his fear of a serious problem leads him to deny the value of the screening. He agrees to discuss this more fully when he next meets with his doctor. The PHA offers to schedule an appointment with his doctor in the next few weeks. Tom accepts the offer. Tom is open to receiving the emails and commits to paying attention more fully when he sees them As a result of the conversation with the PHA Tom has agreed to take the first steps towards addressing his health issues. Supporting the doctor-patient relationship gets the ball rolling in the right direction. The PHA shares the full conversation with the doctor who is now more aware of how to work with Tom.

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