The Cleveland Clinic’s 17 family medicine sites also have used the practice coaches to assist with their quality improvement projects, said Dr. Rabovsky, who chairs Better Health’s Clinical Advisory Committee.
Dr. Corinna Falck-Ytter, director of the Diabetes Group Clinic at MetroHealth Medical Center, part of Case Western Reserve University, said the practice coaches helped her improve group educational sessions at her clinic.
Since she started the clinic years before on a tight budget, she and her team never had formal training in group dynamics or on motivational interviewing. The practice coach helped them learn how to get the most out of the teaching sessions, she said.
Courtesy of the MetroHealth System
Better Health's 11th Learning Collaborative Summit in September 2012.
Paying for improvement
So far, Better Health’s success has come without offering bonuses or other financial incentives to physicians for improved performance. But Dr. Cebul said the improvement would be faster if the payment system encouraged physicians to provide patient-centered primary care rather than just office visits.
For instance, having a nurse call patients if they miss a test or fail to fill a medication leads to better patient care, Dr. Cebul said, but it’s not paid for by insurance. And if those reminder calls help keep patients healthy and out of the office in the future, that only costs the practice more money under the fee-for-service system.
"The payment system is screwed up, and we’re getting exactly what we pay for – too many tests, too many visits, and too many treatments without regard to outcomes," Dr. Cebul said.