Health care of the future – for employees

New model blends technology, personal touch

Health care workers in Boston are the first patients to test a new model of ambulatory care. As they adjust to telemedicine, health care teams and other innovations, they also are less likely to turn to the emergency room for routine (and costly) care.

"Our philosophy and our belief is that if you engage patients in a really great experience, you can then engage them to improve their health," says David Judge, MD, medical director of the Ambulatory Practice of the Future, a medical practice for employees and spouses at Massachusetts General Hospital.

There's good reason to encourage better health practices among hospital employees. A 2011 analysis of claims data found that medical care and prescription drug costs for health care workers are 10% higher than the general workforce.

They are more likely to be hospitalized for congestive heart failure, asthma, hypertension, HIV, diabetes, obesity-related conditions and mental health, and they were more likely to visit the emergency room. Yet they had fewer visits to a physician's office, the analysis found.1

The new practice at MGH makes it easier for employees to get care – and to get their questions answered – without taking much time off of work.

"It's not always easy to get into a primary care practice. That's not always [an employee's] first priority," says Andrew Gottlieb, NP, FNP-BC, director of Occupational Health Services at Mass General. "Without that relationship, it's a lot easier to just go to the emergency room."

Patient part of care team

The Ambulatory Practice of the Future began with a survey of employees, asking if they would be interested in a new model of health care. Each patient works with a team of providers – a doctor, nurse practitioner, nurse, and health coach. The patients set health goals and the team follows up on the progress. Some contact is maintained through phone calls or "virtual visits," and patients can email their health information or questions.

"The response was great," says Judge. "A lot of folks indicated that even if they'd been with a primary care doctor for a while they'd be interested in something like this."

Patients first walk into a "living room" – it's designed to be homier than a waiting room – and check in at a kiosk. (Soon, patients will use tablets to update their information.) They can expect to spend an hour with the care team for the initial visit, and if necessary, at later visits. Much of that time is spent with the physician or nurse practitioner, Judge says.

"Part of what's really broken with primary care is stuffing three or four encounters into an hour," he says.

There's a collaborative spirit as patients work with the team to develop a care plan, says Judge. That collaboration is built into the design, with a care team work area.

After a patient visit, a nurse or health coach follows up with a phone call. Patients with chronic health conditions receive more steady contact. Patients also have access to an online portal, where they can see lab and test results.

'There's a sense that we're coaching across the team, not just with the formal health coach," says Judge. "So it's a different culture. The way we built the space and use the team and technology reinforces that. Patients are a part of the team."

Telemedicine helps monitor pts

This futuristic practice is also experimenting with the use of telemedicine in primary care. For example, in one study, patients with newly diagnosed hypertension will receive blood pressure cuffs that transmit data wirelessly. Nurses will be able to review the information and monitor patients remotely.

Social networking is another tool to link patients in peer-to-peer coaching – getting support and information from other patients with similar health conditions. The provider teams also communicate with employee health and are aware of the interrelationship between personal health issues and the workplace, Judge says.

The emergency room is still there for true emergencies – but patients pay a $100 co-pay if the primary care clinic would have been a more appropriate point of care.

The Ambulatory Practice of the Future opened in 2010 to the 25,000 employees and family members at MGH. More than 3,000 have enrolled, and the practice will eventually expand to 7,000.

Judge expects the practice to show that a more inviting, patient-friendly environment also can be cost-effective and produce better health outcomes. "We are looking at a lot of metrics around chronic illness, prevention and wellness. We are looking at the overall utilization of health care resources and the cost of this population," he says.