Clinical Excellence Committee Members:
Dr. Craig Matherne, Family Medicine, Dr. Marcia Sentell, Gynecology, Dr. David Moulton, Internal Medicine, Dr. Jill Wireman, Pediatrics,
Dr. Richard Hess, Clinical Pharmacist
Ben Franklin once said an ounce of prevention is worth a pound of cure.
Preventative medicine is a major focal point at State of Franklin Healthcare Associates, which has been scored as the top provider group in the state two years in a row by BlueCross BlueShield of Tennessee. Judged by a stringent set of 20 quality metrics that measure care administered to patients of all ages, SoFHA scored 99 out of 100 in 2018 and 100 out of 100 last year.
This level of sustained excellence didn’t happen overnight, and it certainly didn’t happen by accident. SoFHA has a Quality Improvement Team dedicated to ensuring everyone in the organization embraces a proactive approach to patient care.
Dr. David Moulton, Director of Quality at SoFHA, said the cultural shift started within the organization over a decade ago, and that investment has resulted in a greater sense of accountability at every level.
“If you were to ask administrators, providers, nurses, front office staff and back office staff about what’s important, they would all be able to tell you our mission and how it affects them,” he said. “You would find out that everybody understands about these metrics and why they are important. So it’s baked through our organization.”
According to Moulton, the paradigm shift at SoFHA came about when everyone took ownership of patient health. Instead of giving medical advice and hoping patients acted on it, SoFHA installed a system of care to make sure patients were getting timely cancer screenings, diabetic patients were getting yearly eye exams to prevent vision loss, pediatric patients were up to date on vaccinations and other risk factors were being addressed before they developed into more serious medical conditions.
This process starts with a primary care physician talking to his or her patient about the importance of preventative measures. If a patient refuses something like a vaccination or cancer screening, SoFHA physicians are trained to dig deeper, find out why the patient is reluctant and provide more targeted information to help the patient make a more informed decision about his or her healthcare.
“If you don’t understand where they’re coming from, you won’t connect with them,” Moulton said. “You need to get to that second or third line of understanding. You have to understand what framed their thought process in order to have this discussion.”
When tests are scheduled, there is a team in place to do follow-up outreach calls in order to ensure those tests are completed in a timely manner. These calls reinforce the importance of the tests to the patient’s overall health. SoFHA physicians also have clinical pharmacists available to attend an appointment with the doctor and the patient to address concerns about new prescriptions, talk about drug interactions and give recommendations.
According to Moulton, taking care of the common illnesses is the nuts and bolts of good medical practice. Common illnesses eventually lead to complications like heart attacks and strokes if they go unchecked. With that in mind, SoFHA took aim at diabetes prevention and management back in 2007. Labs were tracked, medications were dialed in and clinical pharmacists were installed to help diabetics keep their conditions under control.
In 2014, hypertension became a major focus. “When we first analyzed our blood pressure control at that point, we had about 66 percent of patients who had their final blood pressure of the year was controlled,” Moulton said. “So we’ve had an emphasis on blood pressure control and follow up.”
By last year, 85 percent of SoFHA patients ended the year with their blood pressure under control. Insurance companies have taken note of SoFHA’s success in controlling diabetes and high blood pressure, two building blocks for heart attacks and strokes. Moulton said other healthcare groups from around the country have called SoFHA to find out what the organization is doing to achieve these results.
When you add in the high marks SoFHA routinely gets in the areas of cancer screening and vaccinations, it becomes clear why SoFHA’s efforts to provide proactive care for patients of all ages is so highly regarded. And with every new provider being required to take ownership in the health of his or her patients, the culture of proactive medicine that has been so carefully cultivated at SoFHA is in good position to keep perpetuating itself into the future.