SAMA HealthCare Services's Patient-Centered Medical Home

Description

Up until 2012, SAMA HealthCare Services of El Dorado, Arkansas operated as a traditional clinic. Their healthcare providers worked independently from one another, each having their own patient caseload. SAMA's administration began noticing that this encounter-based practice was affecting the continuity of care among patients, especially when a patient had to see a provider unfamiliar with their medical history when the patient's primary provider was unavailable.

In 2012, SAMA was one of 69 Arkansas medical facilities that participated in the Health Care Payment Improvement Initiative for the state of Arkansas, a byproduct of the Center for Medicare & Medicaid Innovation Model. This 4-year demonstration project initiated SAMA's transition from a primary care model to a patient-centered medical home (PCMH), serving patients through provider teamwork.

SAMA was able to hire additional staff and, instead of continuing to function as individual providers, old and new staff were put into teams, or "pods." Each of their 6 pods are made up of a leading physician and a combination of advance practice nurses (APNs), licensed practical nurses (LPNs), care coordinators (CCs), and care managers (CMs). A psychologist and a licensed professional counselor (LPC) also assist each team in meeting patients' behavioral health needs.

Below are some practices that make the SAMA PCMH model unique:

1. Patients are assigned to a pod, allowing each pod staff member to get to know their patient's health issues.
2. Particular responsibilities remain distinct among the medical staff, but collaboration among all team members takes place for each patient case.
3. A patient's health information is shared among the pod through a facility-wide electronic medical records system.
4. Instead of reviewing the patient's health information after their visit (as is common practice), the CC does so prior to the visit to stay current on the patient's health needs.
5. Each pod is associated with a color worn by every pod staff member and painted on the walls of its correlating nurses' stations and exam room.

An interview with SAMA's Administrator and developer of the pod system, Pete Atkinson.

Services offered

As the largest primary care physician group in South Central Arkansas, SAMA offers a multitude of services, including:

• Care management
• Behavioral health
• Clinic pharmacy attached to waiting room
• Radiology, including CT and MRI, and ultrasound. Results received within an average of 1 hour
• Echocardiogram studies
• Bone mass density testing
• Mole and lesion removal
• Certified diabetic education and treatment
• Full service lab

Results

By operating in this PCMH model, SAMA has doubled the amount of patients seen at the clinic in just 18 months. Overall, their continuity of care has helped to keep patients seen within their pod more than 90% of the time.

In order to measure their progress, SAMA administration regularly monitors how their results compare to the state and national averages.

• In 2016, 78% of SAMA's diabetic patients received potentially limb-saving foot exams, an increase from 56% the previous year.
• Open seven days a week with a provider on call 24/7 every day of the year, SAMA's on-site services prevented an estimated 880 emergency room visits, saving $2.6 million.
• The percent of patients with poorly controlled diabetes dropped from 19% in 2014 to 15% in 2015, compared to a national average of 30%.
• The number of breast cancer and colorectal cancer screenings was significantly higher than the Arkansas and national averages.

In 2016, SAMA Healthcare Services joined Aledade Arkansas, a primary care physician-led Accountable Care Organization. They were also accepted into Arkansas's statewide market of the Comprehensive Primary Care (CPC), a Centers for Medicare & Medicaid Services initiative that fosters collaboration between public and private healthcare payers to strengthen primary care.

Below are some publications that further describe SAMA's structure:

• El Dorado Clinic Takes a Colorful Approach to Medicine, The Journal of the Arkansas Medical Society
• One State's Healthcare Revolution, MSNBC
• Small-Town Practice Embraces Health Reform, MedPage Today

Challenges

SAMA reported that the largest barrier in implementing this new model was the staff turnover after announcing the new model. The required quick adjustment proved to be hard on some staff who were unwilling to change. Other barriers included the time it took to find and hire qualified staff, as well as providing education on the new model.

Replication

Since SAMA is an independent clinic, the administration was free to design a structure that met their needs. The pod model is a unique idea that was created by SAMA's Administrator Pete Atkinson in order to better coordinate patient care and improve work flow. The model can be replicated by keeping these 3 things in mind:

• Persistence is key. Revamping an old system is not easy, but it is worth it in the long run. Stick with the plan in spite of hardships.
• In order to have the best team, be willing to give ultimatums for staff members who are unwilling to conform to the new system.
• Be fluid. Attempt new things and be open to changing direction if they are unsuccessful.

Contact Information

Pete Atkinson, Administrator
SAMA Healthcare Services
870.862.2400
patkinson@samahealthcare.com