Perfect Patient vs Physician’s Pain in the A**: How Informed Patients can Lead the Way

by Kami Norland, MA, ATR, Community Program Manager

I have recently been on the hunt for a new primary care provider. My previous provider was fine. Her diagnostic assessments seemed accurate (as my self-assessments were verified from my personal WebMD and CDC searches—I know, I know, I can actually hear cringing and warnings to not self-diagnose from online sources as a hangnail could become fatal according to some websites). Despite my self-diagnosing tendencies, my provider appeared non-judgmental and trustworthy. However, her default mode of intervention was to prescribe a round of antibiotics and hurriedly move on to the next patient. During my time with her, there was no mention of how I could alleviate my ailments through nutrition, exercise or stress management. My visit lasted all of 10 minutes so she never really knew my name and when I left my appointment I spotted her in the back parking lot, lips pierced and lungs deeply inhaling on a thin roll of tobacco.

It was at that moment I realized that I needed to officially begin my search for a provider that was more in alignment with my needs and philosophies toward health. Admittedly, this is no easy task as I have exceptionally high standards for what good care looks like and should be as I travel across the country to small rural hospitals, conversing with the country’s finest physicians and leaders. I have witnessed effective leadership in health care and I know what it takes for a patient to receive high quality care focused on wellness. Top off this knowledge with a personal philosophy that could be rightfully classified as a “health nut” and you have the makings for either the perfect patient or a physician’s biggest pain in the a**.

I primarily conducted my physician search online, hopping from website to website. I held no real loyalty to my provider or the health system, other than wanting to assure that my electronic health records (EHR) could transfer to wherever I ended up. I read a plethora of physician profiles looking for someone who I could grow old with and who understood the value of focusing on wellness and quality of care. I narrowed my search down to two providers, one of which was a resident being overseen by the University Med School in town. Either provider seemed sufficient based on the short paragraph descriptions of their philosophy toward medicine and health, so I let the scheduling receptionist determine who I would see based on availability. 

An appointment with the resident was scheduled. During our first visit, I inquired about the resident’s knowledge of the Triple Aim (using my best “Minnesota nice” manners so as to not offend) and set forth my expectations of adhering to a wellness approach. To my surprise and glee, the resident was well informed and asked me questions about nutrition, exercise, stress management and the like. It was evident that she was also prepping me for completing a patient satisfaction survey as she simultaneously entered data into my transferred EHR. Bonus points were even given to my new physician when she later called me to follow up on my physical and emotional well-being from a small procedure.

In the coming era of value-based care, rural health facilities have the opportunity to be seen as transformational leaders in health care rather than just vendors of health services. Implementing this change from the volume- to the value-based model requires an extensive change in how health care is experienced by the patient and the provider. As the provider, it’s about asking the patient the right questions. As the patient, it’s about receiving the kind of care that extends beyond the hospital walls where we can be reassured that our physician not only knows our name but also helps us to stay healthy and out of the hospital.

I don’t think I’m alone in my inquiry and “demands” of seeking a provider who recognizes that the value-based model, one that focuses on wellness and population health, is the right approach to care. I also am not alone in utilizing online sources and being an informed consumer of health care. 

Providers, if you haven’t already experienced the grassroots movement of patients defining their expectations of wellness and value-based care, be prepared to make this transition.

Hospital leaders, prepare your board and staff for this transition by:

• offering education on the Triple Aim
• including wellness as part of your meeting agendas
• referencing practical tips from Improving Population Health: A Guide for Critical Access Hospitals, and help your providers perceive that they have the “perfect patients”

National Cooperative of Health Networks (NCHN) 2014 Annual Education Conference

By Kap Wilkes, MBA, Program Manager

There was a convergence of rural health leaders in St. Louis at the National Cooperative of Health Networks (NCHN) 2014 Annual Education Conference the week of June 16th. I had been getting ready for this conference for several months as I had the good fortune to be part of the conference planning committee. The volunteer group of planners spent a couple of hours a month together and a good number of hours on our own putting together the details; you can imagine how our time and focus increased as the date approached!

Over 125 rural health network leaders from a diverse variety of structures, types of members and network services came together to learn from each other. The highlight for me was to provide some of the content for the conference with my colleague, Joe Wivoda. We presented interactive and dynamic information on building meaningful and impactful collaborations, network sustainability using a systems framework, and using health information technology (HIT) for improved transitions of care.

There were many other learning opportunities at the Conference. More than five Rural Health Information Technology Network Development (RHITND) program grantees presented to their peers on topics like: implementing a rural health network care coordination service, creating a regional collaboration, making member’s health data meaningful for improvement and sustainability, network development strategic business planning, implementing an electronic population management tool as a network service and transforming member’s health care delivery through better use of data. All of these topics are opportunities for rural health networks to build their own infrastructure and capacity and to develop products and services that their members will value.

Another highlight of the conference was the Innovation Circles. We kicked off the conference by forming small groups to brainstorm and select eight topics that would be both relevant and pertinent for round table discussions; Innovation Circles, held later in the day. A cool thing happened; six Innovation Circles took place with robust discussions and meaningful exchange.

These Innovation Circles truly are incubators by bringing together smart, engaged people to share their experience, knowledge and expertise from diverse networks. This is a powerful equation for creativity and solutions. Some of the topics they discussed included:  Patient Engagement and Meaningful Use (MU) Patient Portal Development, Challenges of Care Coordination Across Networks and Systems, Challenges with Rural Staffing, Data Analytics: What and Then How to Measure and Challenges Sharing Health Information Across Uncommon Electronic Health Record (EHR) Platforms. My observation was that those who participated in the Innovation Circles and the education opportunities throughout the conference took away fresh insights, deeper knowledge and new connections. The impact of the NCHN Conference will be ripples of innovation and solutions across our country, and the outcome will be more wellness in our communities!

Small Doesn’t Have to be Small

By Rhonda Barcus, Program Specialist

Recently, I had the good fortune of attending the National Rural Health Association (NRHA) 10^th Annual Rural Quality and Clinical Conference in Atlanta, Georgia. I stepped off the plane to a cool 61 degrees. Now mind you, this is the middle of July in Atlanta! This was just the first in a number of unexpected pleasures for the day.

My second nice surprise came from the comradery of the folks attending. What a nice way to start the day with my friends from Alabama, including Rural Hospital Performance Improvement (RHPI) Project state partners, Jane and Bethany, and our friends from Jackson Medical Center, Jennifer and Angela. It is always a treat to spend time with such positive and motivated colleagues who continue to care and strive for the best. Thanks for letting me sit at your table even though I’m not official Alabama! It was nice to share the time with Mary Guyot from Stroudwater Associates as well.

For me, the big take-away from the conference came from a presentation by John Worden, PharmD, MS, BCPS, the Pharmacy and Laboratory Services Director at McPherson Hospital in Kansas. He discussed the amazing things that rural is capable of and that “small doesn’t have to be small.” He shared a concept that he uses with the hospital pharmacy—to run his department as an “enterprise.” He works to think Big and lead Big and to really focus on being at the forefront of innovation rather than waiting to be told what needs to be done. Along those lines, he pointed out that “rural is an entrepreneur’s dream” because the opportunities are endless, and it’s important for those working in rural to think in this way.  

A second outstanding point from Dr. Worden’s presentation involved the change in practice as a result of change in health care. He shared that pharmacists are no longer just “dispensing pills,” but it is now about putting professionals at the bedside. Pharmacists are now intimately involved in patient education, which affects discharge planning, medication compliance and ultimately readmission rates and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) numbers. This change in health care is really exciting for rural since there is already a history of relationships with patients and the community. He shared his concept of “high touch service” that really encourages and supports that one-on-one relationship with the patient.

The quality conference really was a reminder to me that the BIG things really are the small things…an unexpected cool day, time with good people, a reminder of the many opportunities in rural and the importance of relationships. Oh, and how can I forget…the warm chocolate chip cookies!