EL DORADO – SAMA Healthcare Service is in the national spotlight for innovations designed to improve patient care in a state with high poverty levels that ranks next to last in the nation for the health status of its residents.
“SAMA is a picture of what primary care could and should be,” said an article by Geoffrey Cowley, “One State’s Healthcare Revolution,” published in March on MSNBC. “The clinic’s four teams, sporting color-coded scrubs, work as units to ensure that each of their patients gets enough care, support and follow-up to stay well and avoid hospitalization. …At a glance, we see that 40 percent of SAMA’s diabetic patients got potentially limb-saving foot exams last year—compared to 10 percent nationally—and that the clinic’s on-site services prevented 880 emergency room visits, saving the system a quick $2.6 million.”
SAMA has also been profiled twice in Comprehensive Primary Care (CPC), an Initiative of the Center for Medicare & Medicaid Innovation.
“Sometimes Arkansas feels like it’s five years behind everyone else,” Gary Bevill, MD, a SAMA physician partner, said in the CPC newsletter. “But not us. Our partnership has always pushed the envelope, and we see this as the cutting edge of where medicine is going.”
The program has already seen a far greater payback than the initial $500,000 grant received from Medicaid\Medicare for the patient-centered medical home model initiative. The program makes patient care a team approach with a focus on making sure there are good transitions between a hospital or nursing home and home, and that patients receive the preventative healthcare they need.
“We are part of the CPC Initiative being piloted in three or four states,” said SAMA Practice Administrator Pete Atkinson. “In addition to working with Medicare and Medicaid, Blue Cross Blue Shield of Arkansas and QualChoice are participants in the project. We are transitioning from a reactive healthcare system to a proactive healthcare system. The physician focuses on what the patient is there for, and the care coordinator is able to focus on preventative care.”
One of the biggest changes with the new initiative was hiring of four care coordinators who help handle transitions and educate people about when it is appropriate to go to the emergency room (ER). That effort has been highly successful.
It can be difficult to say exactly how much it might save to catch a cancer early when it is easier to treat as opposed to an advanced cancer. But it is certain it prolongs lives and reduces suffering.
“It has not just reduced costs, but perhaps has saved lives,” Atkinson said. “We have already found several cases of colon and breast cancer very early. If you are a woman who is 45 and hasn’t had a mammogram, they are going to make sure that happens. Colorectal screening is a big one, as well.”
One of the first things SAMA did was create teams. Teams are made up of a doctor, a nurse practitioner, three LPNs and a care coordinator. Each team wears a different color uniform.
“Patients are actually associating with their team,” Atkinson said. “It is working the way it is supposed to. It is almost like a sports team with patients cheering on their team. The team helps with continuity of care. When a doctor goes on vacation, patients will still see that same team. Each team knows their patients rather than bouncing patients around from practitioner to practitioner. With the teams, we feel like we can do a better job of knowing patients when they walk in the door.”
Nancy New, clinical informatics coordinator, is responsible for running reports to check SAMA’s quality measures to see how well they are taking care of patients including getting them in for preventative services.
“I’ve been in healthcare for 20 years,” New said. “I think it is pretty exciting. There is no one else in our area that is doing anything like this. Patients like being able to talk to the same person each time they come in. We certainly wouldn’t be able to do it without our EMRs (electronic medical records), which we’ve been on for 12 years. We were one of the first ones in the state to have EMRs. That tool in itself is huge in being able to provide quality care and continuity of care for the patients. All of our quality measures are run from that system, which helps us track our progress and how we are taking care of our patients.”
SAMA uses the EMR Allscripts, which includes a risk stratification feature that allows nurses to mark records and the physician confirm the stratification during the patient visit. Nurses review records for the next day’s appointments to risk stratify patients and make sure preventive care screenings are current. Allscripts has a clinical decision support feature that notifies the staff of needed screening or diagnostic tests. If screenings are needed, patients can visit the in-house lab at SAMA prior to the appointment.
The four physicians at SAMA and a staff of about 45 take care of about 19,000 patients. SAMA has been recognized by the Arkansas Surgeon General Joe Thompson for its innovative approach to healthcare.
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