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In This Issue:
Jeffrey Greenberg
At BWH, many staff and physicians including Jeffrey Greenberg, MD, MBA, are hard at work on a new framework for integrating and improving patient care. The goal, as Greenberg describes it, is to ensure that patients experience a seamless, coordinated process as they move from one physician to another-from a primary care provider to a specialist, for example-across a large health care network.
"We want to make sure that patients are referred only when they need to be, and that they are getting to the right physician within the right timeframe," said Greenberg, associate medical director of the Brigham and Women's Physicians Organization (BWPO) and attending physician at Brigham and Women's Advanced Primary Care Associates, South Huntington. "Additionally, we want to ensure the right work-up and testing are done before the necessary referral, so that care is as efficient and effective as possible."
In an article published online in JAMA Internal Medicine earlier this year, Greenberg and colleagues examine the concept of a "medical neighborhood"-an extension of the patient-centered medical home model of integrated and multidisciplinary team-based primary care.
Part of BWH's goal to make care more affordable and seamless, a medical neighborhood is comprised of ambulatory medical care, specifically primary care and specialists. It links primary care, specialists and other providers into one coordinated team, and includes hospitals, home health, pharmacists and other providers from whom patients receive care. It is personalized for each patient. The increased collaboration creates a better patient experience, while also reducing health care costs by making care more efficient and eliminating unnecessary referrals.
There are three main components of a medical neighborhood. The first is the ability to easily refer a patient to any specialist in a simple, reliable way. Greenberg says that until now, there hasn't been an official hospital-wide system that coordinates referrals; primary care practices and specialists handle them in different ways. Some specialists prefer being contacted by email, while others favor phone referrals.
"With 15 primary care practices and about 75 specialties, this amounts to many unique processes, which can lead to confusion and inefficiencies," he said. However, in January, BWH and the BWPO launched eReferral, an online portal that enables primary care physicians to request a referral from any BWH ambulatory specialist.
The second component of the medical neighborhood is the ability for primary care physicians and specialists to communicate in advance of (or sometimes in place of) a referral to better coordinate care. Greenberg and his team, including Vice Chair of Primary Care Joseph Frolkis, MD, PhD, are building a new module within eReferral called ‘Team Care.' Under the proposed framework, which is being piloted at four BWH primary care practices and six specialties, if a primary care physician believes his or her patient needs to see an orthopedist, for example, the physicians would communicate before a referral is made to make sure that is the best next step. If so, the orthopedist could suggest any testing or work-ups the patient would need to complete ahead of time.
The third, and perhaps most complex, part of the medical neighborhood is co-management, which is when multiple providers work together over time to deliver coordinated care to a patient. Greenberg says this is the most complicated component of the medical neighborhood because it is so individualized for each patient.
In the JAMA article, these three periods of communication are outlined in a collaborative care agreement, a document that details a set of expectations for referring clinicians and specialists. The authors suggest that formalizing a structure for co-management is an essential step in the creation of a medical neighborhood.
"Our physicians have really stepped up to the plate," Greenberg said. "They value the ability to have a resource to help answer clinical questions regarding referrals. In one month, there have been nearly 800 referrals sent through the new portal."