Audio Transcript
[0:06] Host: Hello, and thank you for joining us for this edition of the Valuable Insights podcast, a series dedicated to sharing value-based care success stories and best practices. I'm your host Sholeh Killingsworth, and in this episode on preventive exams, we will be talking to Dr. Diana Lozano from Valley Medicine Associates in Harlingen, Texas, and Gina Dominguez, registered nurse, a Care Allies embedded care coordinator, about how they improved patient engagement. Thank you both for taking the time to share your story today.
[0:37] Dominguez: Glad to be here.
[0:39] Dr.Lozano: Good morning. Thank you for having us.
[0:43] Host: So Gina, as an embedded care coordinator, you assist primary care physicians, such as Dr. Lozano, in improving the quality of care. I know one important part of improving care is ensuring patients come in for preventive screenings. Can you explain why focusing on these preventive screenings is so important?
[0:50] Dominguez: I think, you know, being able to detect any health issues early on can not only prolong our patients’ lives, but it also allows our physicians and patients, along with the health plans to coordinate the best possible care. And with that, keeping our patients happy and healthy, and knowing that behind them, a physician cares about their wellbeing.
[1:23] Host: And I know compliance with these types of screenings is often captured through quality reporting, so you also help Dr. Lozano, and her team, identify which patients haven’t completed their preventive exams. Can you explain how you work together to help patients get what they need?
[1:39] Dominguez: As embedded care coordinators, we're able to assist with flagging medical records, giving them alerts. You know a mammogram hasn't been done since a year ago? Two years ago? They're due. And we're able to flag and let office staff know, and then they assist with scheduling, calling the patient, so it's all a collaborative effort from the physician and office staff.
[2:03] Dominguez: We also track patients' progress toward achieving their goals. You know if, for example, we've been tracking a patient whose A1C in the past had been a 13, and here at Dr. Lozano's office, they have nurse practitioners who are always monitoring the A1Cs, making sure they bring them in for counseling. Why is it high? How's your diet? Dr. Lozano's office has been successful with following and tracking those goals. Most importantly, the offices are following up on scheduled exams, so if we schedule something that, in fact, was completed and if it's not completed, there's some follow-up. And that it's rescheduled again. So there's always follow-up, which is the most important thing.
[2:53] Host: So Dr. Lozano, it sounds like you have a process in place to use the information that Gina provides. Can you tell me a little bit about it?
[3:00]Dr. Lozano: So we have several MAs that we have on the floor. And then we have one MA that works pretty much in the back section away from the hustle and bustle of where the patients travel. And that person is just assigned to make sure they're going through day to day all our measures and seeing where we are.
[3:17]Dr. Lozano: We meet as a group for like 20 minutes on Fridays and go through everything in general for the different health plans and our quality measures. But then one person out of that group is always assigned to work on it daily.
[3:29]Dr. Lozano: So we have what we call registries, and it subdivides our insurance plans and then our member list. And then it goes with the different individual quality measures for each insurance plan.
[3:43]Dr. Lozano: So when you go pull up that information, you can see what I say it's more like live data on what we're missing. So you can go and scroll through those registries and see, okay, whose A1C is still above 9?
[3:55]Dr. Lozano: I'm just going to use an example that might be clearer that way. So we had X number of patients then we divided those patients so that each MA has a list of, say, 10 patients that are above nine. Their job, along with the mid-level, is to call them every two weeks, find out how they're doing with their blood sugars, and encourage them either to comply with diet, exercise, insulin, and medicines or if they see they're having a problem, flag a provider to see what we're going to do differently to adjust it.
[4:25]Dr. Lozano: So we kind of have little plans in progress. So that one MA does that all month long. And then every month, we rotate and a different MA goes into that position. And so that person, all day long, all they do is when they see that there is an intervention that they have to make, they'll start calling. "Okay, we see you haven't made your eye exam for this year, can we help you start setting it up and when?" And try and find out if there's an issue with scheduling it, why there's an issue and trying to come up with a better time for the patient or whatever the barrier was. So that, hopefully, they'll get it done. If we can get that all done behind the scenes before I even see the patient, it helps the office load faster with their visit for the day.
[5:08]Host: So once your MAs get ahold of these patients, how do you convince them to actually follow through?
[5:14]Dr. Lozano: I think patient education is one of the key factors in trying to get our patients more involved with what our recommendations are for their prevention and their health care, the more they know about their conditions or just staying healthy, as they get older, the more apt, they are to be more participating in their health care. And sometimes, I depend a lot on my nurse practitioner and my physician assistants to kind of do a lot of the education one-on-one. Along with my MAs, the minute the patients walk in the door, you know, they're the first people that get a hands-on, look at my patients before I even get to see them. And they're already recommending the flu shot, and why we need the flu shot. If the patient has more information as to why we're recommending some of these things, we're more likely to convince him to have them done.
[6:04] Host: And so, aside from awareness and education, what barriers have you encountered?
[6:09]Dr. Lozano: I think a majority of our barriers seem to be with social circumstances, sometimes we have patients that don't always comply with our recommendations, whether it be preventive or just treatment. And when we dive into the issues and try and find out exactly what's going on, there might be some social circumstances that prevent them from getting their health care, whether it be transportation, or people that get some assistance at home, or the family members. So when we get no, or we get a refusal, we don't just stop there, we try and figure out, okay, why?
[6:44]Dr. Lozano: I guess I can use an example, we had a patient who kept going into the emergency room for hypoglycemia. And so we had one of my nurse practitioners go do a home visit, and then the patient really didn't have any food. She kept injecting insulin because she thought she was being compliant, but she didn't have any food, so she kept getting hypoglycemic. So then we went, and we got some of the other families involved, figured out what was going on in the house, were able to fix the underlying situations where there was food available and had some more assistance, and then educated the family and the patient about how to give the insulin, when to give the insulin, the time to give the insulin and then it made an improvement once they were educated on what we needed to do to overcome this barrier. They were able to help us keep her out of the hospital and out of the emergency room. And you would think that something like that would be so basic, but it's not always that intuitive to everybody involved in the situation.
[7:44]Dr. Lozano: So I mean, I do think a lot of the issues with getting patients to follow, you know, just usual recommendations has to do with social circumstances. And we have to delve into those issues to figure out what the problem is so that we can fix it.
[8:00] Host: That makes perfect sense, and I know addressing these issues has actually made a huge impact on your practice. So Gina, can you tell me what kind of results you and your team have observed?
[8:11]Dominguez: So, based on the historical data for Dr. Lozano, she has had some impressive results. For instance, in one sample of patients that we measured for colorectal cancer screening, 94.1% of those that we needed screened were in compliance which is significantly higher than the national average of 67.1%. Additionally, for breast cancer screening, she finished at 98.3%, which is significantly higher than the national average of 72.1%. With all of that said, I think it is safe to say that Dr. Lozano understands the quality metrics that are required and educates her patients as to how these measures relate to their health and disease process. Without a doubt I can expect to see Dr. Lozano finishing just as high in percentages and ratings as she has historically done year over year.
[9:05] Host: It sounds like patients are very engaged.
[9:09] Dominguez: I know the expectations are set when you want to be a patient here. There's a standard, there are expectations, just like you have expectations of your provider, there's also an expectation of the patient.
[9:21]Dr. Lozano: It can be a little wearing if you have patients that really don't care about their health. And it's it can be a very difficult job. So here, maybe about six months ago, I did tell my medical records person who's in charge of enlisting our new patients that the very first question that they want to be part of our panel is that I want to make sure they understand that we're very pro preventative care, and we expect them to be involved in their health care and be involved in their health screenings when they become our patient.
[9:54] Host: Setting the expectation upfront. I like that. So besides that, is there anything else you would suggest to those who maybe want to get their patients more involved in this kind of process?
[10:07]Dr. Lozano: I think you have to start with looking inward at your office, looking at the workflow from when the patient walks into when they exit, you know, what the experiences are, and what the comments are because everybody gets feedback nowadays. You just have to start somewhere to make a difference and make a change. We all think that we can improve, but you have to know what it is that you need to improve on first. So, it's like self-reflection, knowing what it is that you're doing and then working on it.
[10:37]Dr. Lozano: We're constantly looking at our own numbers to see how we're doing so that we know what we need to improve on from the patient survey satisfaction. So we do our own mock survey satisfaction in our office to see where patients experience and how they feel we're taking care of them. We're looking at those on a regular basis and trying to see what we can improve on because I know we're not perfect and definitely still have room for more improvement.
[11:05]Host: And the year-over-year improvements Gina mentioned earlier seem to be proof that your efforts are working.
[11:12] Dominguez: I think here with the nurses, it's not like, Oh, you know, someone has more work. They all share it. And that's why it works. That's why they're successful here.
[11:17] Dr. Lozano: Yeah, out of sight, out of mind doesn't really work here in this office. You can't do this if somebody isn't pulling their weight. If somebody isn't pulling their weight, it shows. So I think everybody's kind of wanting to do a good job. We all care about our patients, we want them to do better. And so that is the driving force behind all this. I think we all like to feel like we're making an impact.
[11:41] Host: Definitely. Well, that is the end of the time we have here today, so thank you, Dr. Lozano and Gina, for joining us and sharing your stories. And thank you, everyone else, for listening to this edition of the Valuable Insights podcast.
