You may have heard that Group Health’s Executive Leadership Team recently built the 2011-2015 Strategic Plan. It came together with input from hundreds of people around Group Health Physicians and Group Health Cooperative, and is supported and endorsed by both organizations’ boards. It focuses on four areas:

• Profitable growth with a target of 932,000 insured members by 2015
• Affordability since we have a business reason and an obligation to bring costs down
• Quality with a target to rank among the top 25 NCQA accredited plans by 2015
• Staff engagement because without you, these targets are impossible.

The plan notes “Our patients get the best care when they are cared for by Group Health Physicians in Group Health Medical Centers.” And when this is not possible, it points to achieving the “highest level of ‘integrated care’ by partnering with preferred partners.”

It is a very bold plan, projecting “strategies that drive growth in our group practice in order to provide cost-effective, high-quality care. Our goal is that the majority of all new members will receive their care with Group Health Medical Centers.”

You often hear us “executives” talking about the importance of profitable growth, but it might not always feel like a good thing to you as you do your work every day. Certainly growth itself can mean more work for front line clinicians and clinical teams, and that can be painful. We know that taking on new patients—and engaging them in their own good health—takes time. But it’s what’s unique and important about our kind of medicine.

We can mitigate the pain of growth somewhat by getting ready for it with enough staff and space to welcome new patients. Still, growth can be hard on our front lines. So why is it a good idea? Here are some key business and strategic reasons to pursue profitable growth.

The world is rapidly changing around us. Washington added nearly 1 million new residents over the last decade, becoming the 13th largest state. Without growth, our market share—the portion of the total available health care market that we serve—declines. This decreases Group Health’s standing in the region and undermines our ability to negotiate effectively with hospitals, other providers, and health plans.

More coverage for each other, more time to learn. When we grow we can add more staff and more specialties, increasing our ability to cover for each other and meet sub-specialization needs. Related to this, with growth comes more opportunity for front line staff to take on new roles related to administration, education, or research. It helps development of knowledge, skills, innovation, and personal growth to be living, vibrant qualities in our work.

A volume of patients to attract the best of the best. Market relevance (often confirmed by growth) is in fact what keeps our jobs secure and is a measure of long term success. Growth is even more vital for our Consultative Specialty group. We need the referral base and patient volumes to attract and retain the highest quality specialists and subspecialists.

Fixed costs are spread more broadly. This makes a business model more financially sustainable in the long term. For our health plan and medical group alike, spreading infrastructure costs over a larger number of members means the cost of care per member is more stable over time.

We bring Group Health medicine to more communities. Growing also means spreading our influence to more people, living our founders’ mission to “serve the greatest number.” In doing this we help more people live better, healthier lives and relieve pain and suffering. Group Health has an obligation to be part of the solution. We CAN provide affordable, high quality health care. Being part of “what works” and seeing it thrive and grow is something we can all be proud of.

Our success in profitable growth is also part of leaving the organization in a better position than when we joined it. This is our responsibility to those who will follow us here.

Growth has to be profitable to do good in the long term. In the short term, growth can be painful for front line clinical people, and it means some tough decisions about structuring the business for its best future. But it’s a great dilemma to have. Let me know what you think.

Questions or comments? Respond to Open Mike

 

Through the work of Group Health Research Institute (GHRI), Nursing, Primary Care and Behavioral Health Services, more Group Health patients of all ages may benefit from evidence that integrating mental health and chronic illness care leads to more complete care and better health outcomes.

Click on the photo for a video about the TEAMcare research on Group Health News Blog

“This is a current gap in health care,” explains researcher Elizabeth Lin, MD, MPH, a Group Health family physician and an affiliate investigator at GHRI who worked on the study. “There is a lack of mental health care that works in sync with primary and chronic care. There can be no global health without mental health.”

Chronic conditions can worsen with depression
More than one in four Americans lives with multiple chronic conditions such as diabetes coupled with heart disease, and according to Dr. Lin, these patients account for the majority of total health care spending in our country. Because of the unique challenges these patients present, effective care plans can be a struggle for both patient and doctor. This struggle is compounded when depression enters the picture and leads to poor self-care.

Recently, a study conducted by Group Health Research Institute, along with researchers from the University of Washington, tested a team-based approach called TEAMcare to create an integrated care plan for these complex patients.

Over a 12-month period, patients worked with a nurse care manager and their primary care team to create individualized care plans meant to improve their self-care, manage depression and adjust medications to best treat their heart disease and diabetes. The nurse proactively followed up with patients, monitoring their disease control and depression. The nurse got support from a resource team that included a primary care physician, a psychiatrist, and a psychologist.

The results, published in the December 30, 2010 New England Journal of Medicine show that the study group had greater improvements in blood pressure, blood sugar and cholesterol as well as decreased depression scores.

“Now I know how to take care of myself.”
Benefits of the TEAMcare intervention were not just evident in the numbers. “I’m more aware of my health, my health care and how to take care of myself,” said one participant. “It’s a different kind of health care. I was only seeing doctors in doctors’ offices before, but this is care, actual care.”

Greater satisfaction with care can contribute to better self-care and in turn, better health. Another patient commented, “The difference is that now I know how to take care of myself. It was such an eye opener. My depression is under control now, and that’s a major change. I didn’t even really know I was depressed back then.”

To translate this study into a workable, sustainable and affordable model of patient care, Group Health researchers are now conducting a pilot, funded by a Group Health Partnership for Innovation (link only available internally) grant, on the feasibility of integrating TEAMcare into the Group Health medical home model of primary care.

Keeping an eye out for depression in teens
The work around TEAMcare isn’t the only place that we can find Group Health using research to find better ways to address depression as part of a patient’s care plan. Group Health Research Institute is currently recruiting adolescent patients to take part in the Reaching Out to Adolescents in Distress (ROAD) study that will test the collaborative care method to treat teen depression.

Dr. Laura Richardson from Seattle Children’s, an affiliate investigator at GHRI and lead investigator for this study, hopes that the outcome of this work will provide a better understanding of how best to treat teen patients for mental health issues in the primary care setting. Distinctive challenges apply to adolescent mental health care--it can be overwhelming and intimidating for teens to talk about depression with a stranger in a new environment. Addressing mental health with a primary care provider as a routine part of their total health can make the process less daunting and lead to better total health for teens.

Both the TEAMcare and ROAD studies reflect Group Health’s efforts to provide patient care that addresses all of the elements of a person’s health; both short-term and chronic, physical and mental.

Other co-authors of the TEAMcare study were GHP’s Dr. David McCulloch, MD, and GHRI’s Michael Von Korff, ScD, Evette J. Ludman, PhD, Do Peterson, MS, and Mary McGregor, MSN, and Carolyn M. Rutter, PhD.

Questions or comments? Respond to Open Mike

 

In 1990 Jeff Lindenbaum MD, established The Adolescent Center: an unprecedented, multidisciplinary care model in a teen-friendly setting. Joining Lindenbaum—a pediatrician board-certified in adolescent medicine—were psychiatrists, psychologists, psychiatric and pediatric nurse practitioners, and psychotherapists.

The service we know today began as a joint venture with Children’s Hospital. When Children’s withdrew to pursue other opportunities, Group Health leadership remained convinced of the value of this kind of care for teens, and preserved it.

Dr. Jeff Lindenbaum, Kathie Wurzbacher and their team have spent two decades serving Group Health’s teens. Among The Adolescent Center’s many successful outcomes: hospital admission and readmission rates for our patients with eating disorders are significantly below the national average.

Mental Health Counselor Kathie Wurzbacher, MEd has been with the Adolescent Center from the beginning and is co-director. “Our care setting is designed to manage the complex needs of adolescents with serious health problems: the anorexic who water loads before being weighed; the middle-schooler with ADHD who refuses medication; the high school football player with a seizure disorder; and teens stressed by family poverty who need intensive services,” she says.

Early patients now thriving parents and professionals
Since its founding, the Adolescent Center has provided medical and mental health care to over 9,000 teenagers. Among the first patients was a seriously ill teen with bulimia nervosa who is now 35. After completing treatment she finished high school, earned her bachelor’s degree, and served as a Peace Corps volunteer.

Having survived their adolescent crises, The Adolescent Center’s former patients are now moms and dads, students, volunteers, employees and employers. “They are thriving, successful in their family lives and careers, and making contributions to their communities,” says Dr. Lindenbaum. “Many now choose Group Health as their health plan and some stop by to say hello.”

Since its inception, The Adolescent Center has provided services to teens at Factoria Medical Center and Group Health’s Capitol Hill Campus. The Adolescent Center has been expanding and is now serving teens and their families at our Tacoma and Olympia locations. Services are open to Group Health’s adolescent members and their families, as well as to patients with other insurance plans.

Expanding our reach to school-based care
In 1994, Adolescent Center leadership, in partnership with the Group Health Foundation, obtained funding from the City of Seattle’s Family and Education Levy and began providing care to students at a teen clinic housed in Seattle’s Franklin High School.

Today The Adolescent Center partners with the Group Health Foundation to provide care to adolescents at four school-based clinics, and co-sponsors an additional three school-based clinics with the Seattle King County Department of Public Health. A smaller version of The Adolescent Center multidisciplinary model, each school-based clinic is staffed by a medical provider and a mental health counselor. Combined, these clinics served over 1,700 11-to-18 year olds in 2010.

“Looking back over our 20 years, we really want to thank Group Health and our primary care leadership for believing in the model and supporting its growth,” adds Dr. Lindenbaum, “And many thanks to our primary care colleagues for their referrals and support in serving adolescents and their families.” 

Questions or comments? Respond to Open Mike

 

We have dozens of surgeons, hospitalists, care managers and other clinicians giving care at Seattle’s Virginia Mason around the clock. The hospital’s Chairman and CEO, Gary S. Kaplan, MD, recently wrote to our medical staff to recognize Group Health’s role in a national honor they received.

Virginia Mason was just named The Leapfrog Group’s Top Hospital of the Decade, and was one of only two hospitals that received this recognition — the other being University of Maryland Medical Center. This is the first time this recognition has been bestowed on any hospital.

Dr. Kaplan writes:

“I wanted to thank you, as members of the physician community who see patients at Virginia Mason Hospital, for your very important role in helping us achieve these incredible honors from The Leapfrog Group. Your commitment to serving your patients and your dedication to providing the highest quality, safest care possible is an essential part of our every day work at VM.

We proudly share the Leapfrog Top Hospital of the Decade honor and fifth consecutive Top Hospital award with you. Congratulations, and thank you again for all you do on behalf of your patients.”

Looking at Press-Ganey patient satisfaction survey data from 2010, we know we’re giving our best to our members during their hospitalization at Virginia Mason. The Emergency Department / Hospital Inpatient (EDHI) initiative we implemented there in 2009—and rolled out to more locations through 2010—is playing a role. Overall patient satisfaction scores, compared with national averages, have risen from the 65th percentile and remained in the 90th percentile throughout 2010.

Congratulations to everyone at Group Health who cares for patients at Virginia Mason. You’re making a difference and it shows!

Questions or comments? Respond to Open Mike

 

Group Health’s 2010 Haiti missions were filled with both uplifting and discouraging moments, logistical challenges, and lots of team effort.

In all, seven medical relief teams spent one week each in Haiti last year, with some of the volunteers logging two trips. They treated many patients who had never been seen by a medical professional.

Dr. Joe Knight

Teams included physicians, physician assistants, pharmacists, nurse practitioners, nurses, and administrators. Medical staff who had ever done this type of work stepped up to the plate and became team leaders. One team even traveled in the face of a hurricane threat. All have amazing stories to tell about the patience and resilience of the Haitian people.

Building a lasting medical presence in Haiti
Many volunteers would like to return, but Group Health Global Health (link only available internally) has not yet made trip plans for 2011. This is due to the need for a clinic space, and because of severe transportation limitations caused by lack of decent roads and car rental costs.

Group Health Foundation funds paid for large purchases of pharmaceuticals, medical supplies and translators. Because lodging facilities were not available initially, these funds also paid for a few essentials such as portable toilets and showers.

Susan Barrett, RN

 

Group Health Global Health is taking part in a Healing the Children fundraiser on January 29 to help provide the Haitian people with a pre-fabricated medical center outfitted with supplies. EcoBlu has donated a one-floor pre-fabricated building that will go on a pre-selected site.

And because we want to establish a facility for our Group Health volunteers, we are raising money for a second floor with dorm rooms and kitchen. Additional funds will be used to fill a container with medical supplies.

If you would like to help Group Health medical staff build a lasting presence on the ground in Haiti, you can donate to the Group Health Foundation Global Health Fund, or to:

Healing the Children
8227 44th Ave. W. Suite M
Mukilteo, WA 98275
http://www.htcorwwa.org/

Questions or comments? Respond to Open Mike