A few months ago, 44-year-old Shari Harris started getting phone calls from a pharmacist named William.
He wanted to talk to her specifically about her type 2 diabetes. What had she eaten for lunch? How was she managing her blood sugar?
“He’s very personable, very nice,” said Harris, who lives in Summerville. “Doesn’t make you feel ashamed or like an idiot for not doing what the doctor tells you.”
While William Shealy technically works for Harris’ doctors at Palmetto Primary Care Physicians, it’s his job to make sure she doesn’t get sick. So he reminds her when she has an upcoming appointment and then follows up with her after that doctor’s office visit is over. He’ll review blood test results with her and discuss ways she can mitigate any risk factors associated with diabetes.
For example, she said, “He asked me what I ate for lunch and I told him typically it would be a Big Mac, fries and a Diet Coke.”
Shealy suggested she swap that out for a smaller cheeseburger instead.
“He’s given me little tidbits of advice,” she said. “He’s very friendly.”
There’s a technical health care term for this kind of customer service. Harris has been enrolled in a “patient-centered medical home.”
Insurance companies have historically only paid providers to treat episodic illness using tests, scans and surgeries. But in a patient-center medical home, doctors are paid to keep patients well. This model is part of a larger push to transform the industry from “fee-for-service” to “fee-for-value” health care.
“It’s all about patient engagement. Heretofore, the only way I made money was seeing somebody in this office. It was a widget-based economy,” said Dr. Robert Oliverio, whose practice, Moreland Internal Medicine, is now undergoing the process of becoming a patient-center medical home. Palmetto Primary Care Physicians has been certified for several years.
“Now, (insurance companies) want us to engage the patient before the appointment,” Oliverio explained, “take care of the patient during the appointment, provide them with a written plan of care and then continue to engage the patient subsequently to make sure that’s done.”
BlueCross BlueShield of South Carolina, the largest private health insurance company in the state, has 176 patient-centered medical homes included in its network, although the patients, especially those who only show up at the doctor’s office once a year for an annual checkup, might not notice much difference.
“By and large, it’s not going to help most of the patients. But there are about 40 percent of them that have one or more chronic diseases, 25 percent that have two or more diseases,” Oliverio said. “Those are people that are actually going to benefit the most.”
Noreen O’Donnell, who manages the patient-centered medical home initiative at BlueCross BlueShield, said the ultimate goal is to improve patient health, but that some of them may receive more help than others through this model of care.
“They’re going to start seeing some things happening differently,” O’Donnell said. “They’re not going to see it happen overnight.”
For example, patients might find it easier to schedule same-day appointments because primary care practices that have been certified as patient-centered medical homes usually accommodate customers on the weekends or after work. Other patients, particularly those with one or more chronic conditions, might receive letters in the mail notifying them that they’ve been assigned a case manager like William Shealy, as a point person for the medical practice.
Doctors’ offices must undergo nearly a year of training before they become certified as patient-centered medical homes. The program is free for patients.
“It makes it a little more personalized,” said Harris, who said she appreciates Shealy’s phone calls, but admitted, “I’m not a good student.”
Reach Lauren Sausser at 937-5598.