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CLINICA: THE FUTURE OF HEALTH CARE

     In addition to the daily effort we put into improving the health of individual patients, our staff has been re-examining Clinica's entire method of providing health care. In 1998, the Institute for Healthcare Improvement (IHI), a national organization examining ways to improve health care delivery in the United States, began a project to help medical facilities "redesign" their office systems. After watching several test sites, Clinica directors decided that our organization would benefit from incorporating office redesign principles into our clinics. All of our facilities have been re-organized into "mini-clinics" so that a consistent team of providers (three clinicians, nurses and medical assistants, receptionist, medical records technician, financial screener, case manager, social worker, etc.) works together to care for the same panel of patients. In addition, Clinica has changed its scheduling policies so that 75% of a day's appointments are available that day. This allows most people to be seen within hours, decreasing their inclination to go to an emergency room for primary care. It has also reduced our "no show" rate from 30% to 15%. Also, we now bring most services to patients in the exam room instead of moving patients from the exam room to the lab to the case manager's office to the financial screener, etc. This makes an office visit much simpler for people with small children or those who have difficulty moving around.
    
       Another way that we are trying to improve the care that we provide patients is by incorporating more "planned" care into its systems. In other words, we are being more proactive about getting patients the health care they need when they need it. This is especially true for our patients diagnosed with diabetes, asthma, depression or chronic pain. We have created health "collaboratives" that allow our providers to more actively manage the care of these patients and encourage patients to participate in and help manage their own care. Within six months of beginning our asthma collaborative, the number of our severely asthmatic patients seeking emergency room services dropped by half. Since beginning work with our diabetic patients, we have seen HbA1C (blood sugar) rates drop from 10.8 to 8.4. Our diabetes program has been nationally recognized for its success in reducing HbA1C rates among severe diabetics, as well as reducing morbidity, hospitalizations, risk of stroke, eye disease and amputations due to this chronic disease. As a means of providing high-quality care for patients with expensive, chronic diseases, the collaboratives have been exceedingly successful. In fact, Clinica was cited in a recent article published in the Journal of the American Medical Association as an example of how to provide high-quality care to people with chronic diseases (JAMA, Oct. 9, 2002; Vol. 288, No. 14, p. 1775-1779). A number of other organizations are also using Clinica as a model for redesigning health care systems. Denver Health and Hospital, the primary hospital for Denver residents, is using the Clinica model to rebuild their own clinics. The University of California at Los Angeles has invited Clinica's president/CEO to help design a curriculum for a health care administration program. And the national Institute of Healthcare Improvement also cited Clinica as an example of how to provide high-quality care to low-income and uninsured people, particularly those with chronic diseases.

      For the past two years, Clinica has been utilizing group visits as a means of increasing our patient capacity without hiring additional staff. Multi-patient visits were piloted by Kaiser Permanent in the early 1990s, primarily for use with seniors. Group visits allow a number of individuals with the same condition or health need to see a physician as a group. While one physician moves from patient to patient discussing individual concerns, the rest of the group receives educational information, gets a blood sugar measured, has weight or blood pressure checked, etc. Group visits have been an efficient and cost-effective means for us to deliver non-confidential care and health education to 15-20 patients simultaneously. We currently hold regular group visits for diabetic patients, newborns, well-child checks and school/sports physicals.

      Group visits have not only allowed Clinic to expand our patient capacity without adding to staff or facilities, but they have also been an excellent opportunity for patients to provide support and encouragement to each other.