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Casey Health Institute: EVP/COO Tracey Gersh, PhD on Bridging Integrative Health into a PCMH and ACO |
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Written by John Weeks
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Casey Health
Institute: EVP/COO Tracey Gersh, PhD on Bridging Integrative Health into a PCMH
and Accountable Care
Note:
This
article is part of a recent partnership between the Project for Integrative Health and the
Triple Aim (PIHTA) and
the Casey Health Institute (CHI) for which the Integrator is providing media
support. The goal of the PIHTA-CHI partnership is to stimulate understanding of
integrative primary care medical homes (PCMH) via a multi-faceted look at the
model CHI is creating. PIHTA is an initiative of the Academic
Consortium for Complementary and Alternative Health Care (ACCAHC).
Other articles in the series:
.jpg) Tracey Gerch, PhD: CHI's EVP/COO
The Executive Vice President and COO of the Casey Health
Institute (CHI), Tracey Gersh,
PhD came to the ground-breaking, Maryland-based
integrative health center from roles as administrator and program developer at
a nearby federally qualified health center (FQHC).
Asked to compare the two environments, Gersh immediately spoke
to the mission and context in the FQHC "to bridge disparities for those who
might not otherwise be able to access care." With the typical FQHC's dependence
on grants from the federal government, the administrative environment was "one
of the most regulated places she's ever seen." She adds: "Accountability and
data collection are real."
Between CHI and an
FQHC
.jpg) Integrative PCMH joins an ACO
Much of this is not too far from Casey's patient-centered
environment, according to Gersh. She speaks of a "parallel process." The tone of
the work at CHI, she says, is a bit more "entrepreneurial - because we have to
be." And though the payment environment at CHI is mostly fee for service with
no federal funding, CHI has in common with the FQHC that "a lot of what we do
is uncompensated."
Unlike many integrative centers, CHI offers a sliding
scale to those who are uninsured or under-insured. For many of their patients, their
insurance coverage either does not include or has limited coverage for services
such as nutrition, chiropractic or acupuncture.
This means, as Casey acupuncturist Cory Jecman, LAc notes
in an earlier
interview in this project, many of the patients are integrative medicine
naïve, in part because of their insurance coverage. Oftentimes, they arrive for
treatment, said Jecmen, "because [their] primary care physician said to
come" rather than because of an interest in acupuncture or an alternative
approach or because their insurance company provides coverage.
Philosophy shift, breadth
of services and "patient-centered care"
.jpg) Comparing the FQHC and CHI environs
While both the FQHC environment and CHI aspire to make
the philosophical shift to patient-centeredness, says Gersh, CHI has the
distinct advantage in "the breadth and depth of what we offer." In CHI's
patient-centered approach, she explains, "we are not doing something to patients - we are engaging
them." The shift is from
provider-centric to patient-centered.
And CHI brings a great deal to patients: "We have so many things that it is
mind-blowing." She ticks off the services. First, the "best medical care, then
the multiple practitioner types - MDs, nurses, chiropractor, acupuncturists,
naturopathic doctor, massage therapists and coaches. These are all linked to "the
continuum to wellness, including prevention and aftercare."
What does she mean by "aftercare"? She summarized: "We
have a wellness center with a host of services, yoga, nutrition, and stress management.
We provide ways to connect to the community. We have a care coordinator and an
EHR [electronic health record]. Our nurses can help people navigate the system.
We can help them stick to their care plans."
Gersh describes Casey Health Institute's concept of "patient-centered"
as a work in progress: "No one is really trained in this." The Center's emerging
model "is to engage patients in plans" for care along the way, beginning with
pre-visit planning. The clinic focuses not only on bettering communications in
and among diverse internal clinicians and staff but also with health resources
in the community." All of this, Gersh said, "serves the
Triple Aim."
Payment bonus as a
Care First PCMH
One place where Gersh as COO is particularly happy in the
Casey Health environment relates to payment. As a qualified patient centered
medical home (PCMH) with Care
First, Maryland's Blue Cross Blue Shield plan, CHI routinely receives an enhanced
medical payment rate. This jumps routine payments by 12% in consideration
for a PCMH's commitments to a broad delivery of services.
.jpg) Recognizes CHI as PCMH
For CHI, Care First's new rate began July 1, 2015. This
coincided with a process on which Care First mentored them to identify high
risk and high cost patients: "A major influence on outcomes is how you do with these
[high risk] patients." She adds, however, that it is CHI's goal to apply a
similar thoroughness and individuation "across the board." She shares that Care First has some outcomes
incentives awards, on top of the advanced payment rate.
CHI co-founder David Fogel, MD noted
in a prior article in this series that he bets that the data-based outcomes
from CHI's experience will be a significant boost for the integrative care
field: "Integrative medicine is team-based collaboration. I think we will blow
values-based metrics out of the water with our outcomes using a team-based
staff model of care."
Has CHI any data to share yet?
Gersh confirms that CHI got off to a poor start in this
department. They had an EHR vender they fired. "Most of the data yet is in
aggregate," says Gersh and they have only just begun to contact patients after
their first visits: "We want their feedback." The ability to analyze
significant data over time is yet a ways off. Yet Gersh is convinced that now they
are set with a system and strategies to discover "who needs more care" and strategies
"to get the outcomes we want at lower costs."
Entering into an
accountable care organization
.jpg) ACO formed of 5 primary care clinics
The most recent step toward fulfillment on the CHI
founders' plan to implant these integrative services into the new era boosted
by the Affordable Car Act is a recent decision to join an accountable
care organization. For CHI the path began with some connections to an ACO
named Aledade and particularly the
business's CEO, Farzad Mosteshari,
MD a colleague of a CHI board member. The firm's pitch to primary care
practices on its website as to why to "embrace primary care" is as follows:
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"An ACO lets primary care physicians
capture the value they create for the health care system through improved care
coordination, chronic disease management, and prevention.
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"In an ACO, primary care physicians
continue to receive payments for their services - and get a share of any
savings from fewer avoidable emergency room visits, hospitalizations, and
unnecessary and potentially harmful procedures.
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"Most of all, joining an Aledade ACO
will help keep independent primary care practices flourishing, and prepare them
for the future as health care payment shifts from a system based on volume to
one based on value."
.jpg) Mostashari: Aledade founder
Gersh credited CHI co-founder Fogel's ability to "invite
conversation" as what got the dialogue with Aledade rolling. Leaders of the two
s did a deep check in on philosophy and values in a series of conversations. One
outcome was that, according to Gersh, Aledade "thought Wow! How interesting to
have a model like ours in this environment. They really wanted us to be
successful. They also thought we could offer a different perspective."
In joining, CHI linked with five other
conventionally-oriented primary care practices that formed the basis of the
ACO. Workgroups were organized to link teams in different work areas across the
practices. No big surprises, according to Gersh: "The initial conversations
vetted them."
Now it's wait and see on what can be learned from the EHR
and other experiences and outcomes as Casey Health Institute, starting January
1, 2016, becomes the first integrative primary care home partnered in an ACO.
.jpg) Betting on CHI's outcomes
Comment: I have the feeling of being involved in a kind
of gamble here. Terrific outcomes can be a huge advertisement for an
integrative model implanted in the center of the most progressive organization of
primary care in operation in the United States. Good comparative outcomes will
be a boost. Poor outcomes will likely produce the kind of surprise that the
seemingly endless series of negative
botanical studies from the NCCIH produced.
The bet from Gersh and Fogel and CHI is that when the
data come in, the case for integrative primary care will be made. Like a
veteran betting person at the track, I've done my analysis of the racing form.
I've a good feeling for this horse. Better yet, for a bettor: I know the trainer - Fogel and
many on his team - and have an idea through this series of interviews about how
well the horse is being cared for and handled. (I like, for instance, that both Cory Jecmen, MAc, LAc the EHR lead, and COO Gersh, whose doctorate is in clinical psychology, are each administrators whose work is grounded in clinical understanding.) Still, it's a little nerve wracking,
awaiting those first numbers.
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