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Not Your Typical Doctor’s Appointment: Carolina Advanced Health

By Kyle Marshall | December 23, 2013 | Health Conditions

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The first thing most patients notice at Carolina Advanced Health is the undersized waiting room.

Don’t expect to spend quality time with a Southern Living magazine here. You wouldn’t have time to get past the table of contents.

“We take you right when your appointment is scheduled,” says Nikki Hudson, the practice manager. “No one should have to wait more than a couple of minutes, so we don’t need a big waiting room.”

Like everything else in this new kind of medical practice, the appointment system and waiting room are designed with patient satisfaction in mind. The primary care practice, in a suburban office park at the border of Durham and Chapel Hill just off Interstate 40, is attempting to take the frustration out of medical care — so that patients can just focus on getting better.

Jointly launched in December 2011 by UNC Health Care and Blue Cross and Blue Shield of North Carolina, Carolina Advanced Health wants to lead the way in providing quality care, reducing health care costs and improving the patient experience. The practice is designed to help patients with chronic conditions like diabetes and asthma, but is open to anyone.


Improved Patient Results

Early results show the approach might be working. At least Paula Coker thinks so. She heard about Carolina Advanced Health last year and thought it could help manage her diabetes and other health conditions.

“You aren’t hustled in as a number and only have 15 minutes with the doctor,” she says. Physician assistant Meg Beal “has spent an hour with me. You walk about feeling better because someone has listened to you.”

Many of the practice’s 1,500 patients echo those sentiments. The practice routinely surveys the patient base, and satisfaction scores are through the roof.

But what about health outcomes and cost data — the factors that are increasingly evaluated for physicians and hospitals?

In its first year of operation, Carolina Advanced Health achieved several notable success measures, including:

  • Ranking consistently above the 90th percentile among primary care practices for quality measures on patient test results and preventive care.
  • 64 percent fewer emergency department visits compared with the BCBSNC patient population as a whole.
  • No avoidable hospital admissions the entire year — a rare achievement among medical practices that keep track of such things. Avoidable hospital admissions generally are ones that result from poor management of a chronic health condition.

On costs, results are promising at this early stage, but meaningful cost data won’t be available until the practice has greater experience and a larger patient panel.


What Makes It Different

Dr. Thomas Warcup, recruited by UNC and BCBSNC from Rhode Island to be Carolina Advanced Health’s medical director, attributes the positive results to the practice’s team-based approach that puts patients at the center of their care.

“This is not about putting a check in the box to meet a quality standard,” he says. “What we’ve done is change the culture of patient care.”

Warcup and the practice’s two other primary care providers — a physician and physician’s assistant — head up a team that includes nurses, a pharmacist, a nutritionist/health coach, and a behavioral health specialist. All have their offices in the practice.

Each primary care provider holds a weekly meeting of the whole team, focusing mainly on reviewing high-risk patients’ cases. Throughout each day, teams meet in huddles to communicate patient status and solve problems.

When the medical team decides that a patient needs to see a specialist, referrals are made to physicians familiar with Carolina Advanced Health. The goal is to have the patient get the needed specialty care and then return to Carolina Advanced Health.


Wave of the Future?

The practice relies on technology to help improve health. For example, e-visits are often scheduled for follow-up consultation, medication management and chronic disease management. The patient receives a link by email to download a videoconferencing program for a video-based doctor’s appointment. About 12 percent of the practice’s patient visits are done this way.

The Carolina Advanced Health staff believes the patient-centered model is the wave of the future.

“It’s hard to go be a patient somewhere else,” Hudson says.