As one of the architects of the ‘Care Focus Team’ approach to senior healthcare, we talk to Carlos Romero MD, CEO of Reliance Medical Centers, to find out how having a Care Focus Team led by a Primary Care Physician benefits patients.
Q: “Can you tell me what a Care Focus Team is?”
A: “A Care Focus Team (CFT) is a group of clinical professionals, headed by a Primary Care Physician (PCP), that work together, not only to get well, but keep well the patients assigned to them. By organizing the clinical staff into CFTs means that patients get consistent, coordinated care by the same team, always. It’s a team-based approach to keeping our patients healthy. One person can’t do it as well; the PCP needs the whole team to work with a panel of patients. When we put that team together, we called it a Care Focus Team.”
Q: “How did you come up with the idea?”
A: “As a Doctor, over time, I became frustrated with the delivery of traditional primary care. Fortunately, being a business owner, I could work any way I wanted. A few years ago we started doing things differently. I started surrounding myself with staff that thought differently. Then, two years ago I partnered with Roberto Martinez, who brought substantial business and operational experience. We combined our know-how, and ideas and formalized what we call the ‘Care Focus Team.’ We spent many hours researching how others had broken the mold, saw what we thought would work and what others had proven to work. We combined and developed the team, their roles, processes, required experience, and personality. Some of the challenges we wanted to overcome from a primary care perspective were; lack of coordination between the providers that touch our patients e.g., hospitals, pharmacies, specialists, equipment suppliers, etc. Also, the lack of proper guidance on how the system works and how to tackle our health conditions. The growing chasm of personal attention and patients being just one more number, with financial incentives driven by procedures and sickness, not health.
I also saw that as patients get older, many aspects of their lives change. Some became more forgetful, not remembering appointments or taking medication correctly. Some had a partner pass and experienced loneliness and grief and not take care of themselves properly. Some would experience reduced mobility finding it hard to get to appointments. I saw first-hand that it was not just the consultation and treatment that impacted a patient’s health outcome, but also the social, economic and personal circumstances surrounding the patient. These factors can have even more impact on a patient’s health outcome. When we were designing the team, we also took this into account; we wanted to offer a more holistic approach.”
Q: “Can you tell me why a CFT is important for improving healthcare for seniors.”
A: “Certainly, the clinical professionals, and support resources at their disposal, work together. They each fulfill a function, coordinate and share information about the patients assigned to them. The benefits are delivered via two main concepts. First, a limited panel creates familiarity and insight, secondly, by bringing a broad spectrum of activities and know-how under the direct management of the PCP enables the doctor to understand the issues better and deploy solutions.”
Q: “Who makes up the Care Focus Team?”
A: “The head of the Care Focus Team is the PCP. The Doctor is overall in charge, leads and manages his dedicated team. The other members of the Care Focus Team provide the Doctor with services and information; giving additional support and care to patients.
The Personal Medical Concierge acts as a personal assistant to the patient and the team for all healthcare needs. They get to know their patients in-depth and assist in all healthcare matters; including coordinating external appointments and making sure they can get to it; contacting the patient after a consultation to find out if they have questions about the consultation or their medication. The PMC is there to facilitate support on all health-related matters. Also, the PMC is the coordinator and quarterback of the team. They process all information gathered and assists the team in absorbing it and facilitating the indications of the PCP.
Each team also has a Nurse Practitioner (ARNP). When we were thinking about how to create the team, we used my personal experience with Nurse Practitioners and researched the evolution of that role in healthcare overall. We recognized their indispensable part in our setting. Not all patient visits require an MD; many visits can be managed by an ARNP. This allows us to manage a larger panel without sacrificing quality and also for an escalation to the MD if the visit requires. Very important is that the ARNP is part of the team and also only sees those patients in their team’s panel.
Next, is a Medical Assistant (MA). Each Team has four MAs, and they too only work with the patients assigned to the team. They have fewer patients to work with and get to know patients well. Both the team’s PCP and the Nurse Practitioner have the same two MAs working for them. We also evolved their traditional roles to provide more comprehensive activities for the team.
Last, but definitely not least, is the Quality Analyst. Each Care Focus Team has a full-time Quality Analyst who analyzes patients records, test results, and treatments. Their role is to look at all aspects of a patient’s information to ensure the optimum health outcomes for a patient and provide additional information and analysis to the Doctor so that preventative care can be given to patients wherever possible.”
In summary, I can say that having listened carefully to Carols Romero MD, the Care Focus Team approach to senior healthcare offers real benefits to patients and quite clearly has a significant positive effect on health outcomes.
Reliance Medical Centers
3655 Innovation Dr.
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Lab: 7am – 4pm
111 Avenue A SE
Monday – Friday: 8am – 5pm
Lab: 7am – 4pm