Stanford Coordinated Care Illustrates What Comes from Collaboration
In 2012 Alan Glaseroff, MD, and Ann Lindsay, MD, were recruited to Stanford to develop Stanford Coordinated Care, a clinic for university employees and dependents with multiple medical issues. The clinic has achieved astonishingly good results: above the 90th percentile for primary care quality measures, 99th percentile for patient satisfaction, a 59 percent reduction in emergency visits, a 29 percent reduction in hospitalizations, and a 13 percent reduction in cost of care. They list 10 ways that the successful program epitomizes the benefits of collaboration:
The most critical collaboration is with the patients themselves. There is contact between the clinic and every patient on average once a week. The focus is on promoting people’s self-management, not just taking care of their problem. Shared decision making with the patient is the norm.
The clinic team consists of four physicians, a clinical nurse specialist, a licensed clinical social worker, a physical therapist who’s a specialist in chronic pain, a dietician, a pharmacist who’s also a diabetes educator, and four medical assistant care coordinators, serving in a new role within Stanford specifically designed to assist patients assigned to them. The team works in the same room during and between patient visits, which directly supports the communication.
Coordinated Care clinic staff often attend specialty visits with the patient when a big decision is at stake to make sure that the patient’s overall goals are brought into the decision-making process and that the benefits and risks of interventions are fully considered.
Stanford Primary Care 2.0 is an initiative aimed at providing high-value patient care. Many of its primary care transformation concepts came from Stanford Coordinated Care, which takes a nonhierarchical approach to teamwork and sees itself as a research and development shop. The key transformation is empaneling care coordinators, who have responsibility for patients rather than simply performing tasks assigned to them.
Patient advisors helped design the structure of the clinic. The types of patients who were likely to come to the clinic were asked what worked for them and what didn’t, and that input informed the ultimate design of the clinic. They continue to advise on communication and maintenance of quality.
Stanford Coordinated Care partners with the Stanford D-School in a Design for Health class. Postgraduate students work directly with clinic patients for 12 weeks. Students help patients improve self-management, while also working on their own health improvement projects.
Through work with the Institute for Healthcare Improvement and other state and national collaboratives, this clinic model has spread around the nation. Lindsay and Glaseroff have served as faculty with The University Health Consortium and the Pacific Business Group on Health to support care transformation for other university hospitals and businesses, respectively.
A dozen teams from all over the country have joined clinic staff in a workshop at the Stanford Coordinated Team Training Center. Participants include Bellen Health in Wisconsin, Unite Here Union from New Jersey, Group Health in Seattle, Kaiser Permanente and Intermountain Health.
Glaseroff and Lindsay teach in the School of Medicine, demonstrating the role of team care, the importance of eliciting and addressing patients’ goals to engage patients in self-management, and the care of patients with complex needs.
The clinic is paid on a capitated basis. Patients are not charged fees for services. That frees up staff to perform many services that might not be billable in a standard primary care practice. It fosters the multidisciplinary teamwork that is the hallmark of the clinic.