Provider Perspective – Kristen Ogden

Theresa Griffin-Rossi, Program Development Advisor, interviews Kristen Ogden

In this edition of Clinic Connection, we share a recent conversation with Kristen Ogden, Director of Clinic Quality, for 11 clinics accredited as Exemplary Providers by The Compliance Team.

TCT: Why did your clinics decide to become a Patient Centered Medical Home?

Kristen: CMH encompasses everything that benefits the patient. Our patients get personalized care and have better access to their care team.  The Compliance Team’s PCMH model was a good fit with RHC, it is more rural friendly. And so many different things are being required by each payer, it made sense for us.  We were already doing HEDIS measures and PCMH just put a big bow on it.

TCT: What changes or improvements have you seen in the clinics, in patient and provider/staff satisfaction?

Kristen: Patients are taking notice that the PCMH approach to care is different.  Educating on what a Patient Centered Medical Home provides is important especially offering the information on advance directives. They like the expanded hours and that they can talk to the nursing staff. There is more involved than just discussing lab results. They feel that we are investing not only in their healthcare but what matters most in their lives.

The providers and clinic staff were a little reluctant to adopt the PCMH care model at first, but now appreciate seeing the patients benefit from the expanded services we provide and the extra TLC that the care coordinators can give using a community approach. It has relieved the burden of the over-all staff.

TCT: Has there been any financial benefits from becoming a PCMH?

Kristen: The financial benefits have been very rewarding. PCMH is a requirement for us to participate in the PCHH Medicaid collaborative in Missouri which pays a generous PMPM for clinics who participate. We are receiving bonuses from private payers based off the case management of patients with chronic conditions, preventative care measures, keeping patients out of the ED and closing care gaps. The reimbursements have covered the cost of care coordinators, extra staff, and accreditation. Additionally, accreditation is an eligible cost on our cost report.

TCT: Has there been any difference in patient outcomes from following the PCMH model?

Kristen: We have noticed a drop in ER visits and better lab results.

TCT: Can you give us an example?

Kristen: A nurse from one of our clinics shared this encounter with me recently:

RN from OCH Clinic: “I left work one day to grab a quick lunch and noticed a man pan handling in the Walmart parking lot. His sign read something to the effect of money needed for medical supplies and he had a noticeable wound to his abdomen with a dressing covering it and a colostomy. I pulled into the parking lot and got out to introduce myself and ask what medical supplies he needed.

The man and I spoke for several minutes about his needs, medical and in general. He was living at the hotel down the street but would have to move out within the week. He was struggling due to being unable to get his disability income straightened out because he had no permanent address or transportation.

He did state he had a friend who was willing to let him stay with him short term and was struggling to get housing assistance due to past felonies. He also told me about difficulties he had with keeping a provider to help with his care, reporting he had been fired from a couple of providers.

I discussed our Primary Care Health Home program with him and explained how we could help him with these needs free of charge and we could help him get a doctor if needed. After we spoke for a few minutes and I took inventory of his immediate needs I could help with, I instructed him to stay put and I would be back from the clinic in a few minutes with supplies.

When I returned to the clinic, I gathered the medical supplies we had available and some shelf stable food and hygiene supplies and took them back to him at Walmart. I again encouraged him to contact us for help or pop in the clinic and ask for me anytime, although I really did not anticipate hearing from him.

 A week or two went by and he contacted me for more assistance, he was desperate for colostomy supplies as he was going through his supplies quicker than his insurance would cover the cost of more supplies. I was able to network with contacts at our local Alps pharmacy and obtain colostomy supplies to tide him over at no cost thanks to Alps’ generosity. We also scheduled him an appointment with one of our Providers and helped him establish care with OCH.

At first he could be very combative and abrasive with staff. Frequently, in the beginning of his care, he would have confrontations with staff if he didn’t feel his needs were being met and needed a nurse care manager or behavioral health consultant to attend appointments with him. As the first couple months of his care with us went on, we noticed he was running out of colostomy supplies early every month.

Another nurse care manager and I asked the patient to meet with us after an appointment to discuss his colostomy and have him show us his process for application. It was discovered that he was not applying the supplies correctly, leading to increased use due to leaking. After a short education and return demonstration of colostomy application, he was able to successfully apply his colostomy bag and no longer went into panic mode monthly due to a lack of supplies.

After working with our community health workers, he was able to get his disability income straightened out and moved out of his friend’s house and into a duplex with a roommate. Slowly, we began to notice he was less and less abrasive with staff and was needing less assistance from our team. Within about six months of meeting him, he was reaching out to us for his needs and was more cooperative, for the most part, with his plan of care. He was even able to reconnect with his adult child and his granddaughter, after establishing some stability in his life.

Of course, he still had needs transportation and some food assistance but, with the help of our team, he knew what resources were available to him and how to properly navigate them.

TCT: Is there any other information or advice you would like to share with our clinics who may be considering PCMH?

Kristen: I would tell them, do not be overwhelmed.  Have that first call with TCT and it will alleviate any reluctance, it certainly relieved my concerns!  Reach out to another clinic to get the first-hand story of their experience.  It really helps to have someone who can give you pointers on process and policies, how you can improve quality in your clinic.  Make sure you compare the TCT model with other accreditors. The TCT model is more simplified and just made sense for us.