Creating a Welcoming “Front Door” to University Hospitals

UH Primary Care Institute is achieving record results, building a culture of trust, kindness and compassion

UH Clinical Update | May 2022

By Cliff A. Megerian, MD, FACS, Chief Executive Officer; Jane and Henry Meyer Chief Executive Officer Distinguished Chair

I want to give the highest thanks to UH primary care physicians and nurse practitioners for all the work you do in the primary care realm, and for an absolutely incredible performance over the last few years during COVID-19.

It was our primary care teams who gave fearful patients a sense of comfort and the feeling of having a medical home during that time. 

I’m grateful for the incredible work done by the entire Primary Care Institute team, which is led by George Topalsky, MD, FACP, President of UH Medical Practices, and Mary Jane Zarach, Vice President of the UH Primary Care Institute.

Dr. Topalsky partners with excellent leaders, including eight regional medical directors of UH Primary Care. Because of this, we have been able to lead the nation in elevating the quality of care we provide our patients as well as the importance of how we take care of these patients through our ‘Zero Harm’ campaign.

One example is our enhanced efforts of realizing that the long-term health of a patient is dictated by how patients follow the tenets and directions of their primary care team. So I also congratulate our physicians and their nurse partners for the monumental achievement of increasing the number of yearly annual patient visits, which we know can improve health. The proportion of UH patients who now receive annual physicals has increased from the high 20 percent range to well over 75 percent.

This is highly reflective of the increased trust our patients have in our primary care physicians.

That increase in annual visits has also significantly reduced avoidable Emergency Department visits that can be costly for patients. Additionally, these annual visits have helped drive improved patient health, as reflected by the performance of our Medicare Accountable Care Organization (ACO).

As you are aware and as we have published previously, it is really the work of our UH Primary Care teams that has led to UH having the fourth lowest cost of all the ACOs who scored 100 percent in quality. Not only did we achieve 100 percent, but we also lowered our cost of care by 21 percent from 2018 to 2020.

We achieved 100 quality points out of a possible 100 and lowered the cost of care to possibly the lowest in the nation. And we should always recognize that lowering the cost of care does not mean we are giving less care, but that we are creating a healthier population by paying close attention to diabetes management, blood pressure management, and heart disease management, among others, by virtue of a patient’s close relationship with UH and increased touch points.

Both manifest from the trust our patients have in us.

Naturally, the word has gotten out and more and more patients have gravitated to UH because of our primary care physicians, specifically in 2021. We had nearly 232,000 new patients join UH last year, and it is abundantly clear that one of the major drivers of that is the culture of trust, kindness and compassion that our primary care professionals provide.

“UH Primary Care is unique in the country in its progressive application of Medical Home concepts and Team-Based Care support,” says Dr. Topalsky. “As the largest primary care employer in Northeast Ohio, we have been focusing on Population Health efforts to improve access and the health outcomes for our patients.

“As we have moved toward higher value we created our Advanced Primary Care model,” he says. “Now we have 16 practice locations with that model, and 81 physicians and APPs caring for patients in this model.

“By the third quarter of 2022, we will grow to 26 practice locations with 129 providers.”

An Advanced Primary Care Practice also includes a social worker (who can assist the patient with behavioral health needs), a nurse care manager, a specialized medical assistant and a pharmacist - all housed within that practice.

In addition, 48 practices have been enrolled into Primary Care First, a voluntary CMS program that reduces Medicare spending by preventing avoidable inpatient hospital admissions.  It improves both quality and access to care, particularly for those with complex chronic conditions and serious illnesses. The model also specifically aims to reward value and quality by offering an innovative five-year alternative payment structure that supports the delivery of advanced primary care.

Another new effort is “Hospital@Home,” which is how we are re-thinking acute care delivery. You will remember that during COVID-19, we began using Masimo SafetyNet to monitor patients’ vital signs remotely – which means many of them did not have to be admitted to a hospital, and therefore lessened the chances of them spreading COVID-19to others.

UH Hospital@Home takes that further in allowing many more patients to remain home for treatment that otherwise would have been delivered as an inpatient. One big advantage to the patient is that he or she can sleep at home – and likely sleep better. The patient gets daily visits (in-person or virtual) from a physician and nurse, and twice a day from a paramedic. Besides remote monitoring, the patient also receives equipment such as an oxygen tank or medication pump, if needed, or mobile X-rays; three meals a day, and 24/7 real time access to medical staff for questions.

All of these and other innovations show how we constantly strive to provide the highest quality and the highest value to all our patients.

Thank you to all who work daily to help us achieve this.