A model for integrated care

A model for integrated care

Integrated care is about aligning one cohort of physicians that all work collaboratively to provide the best patient care, often using the same medical record system and having the same goals in mind.

"Every member on the patient's health care team understands what's happening."

This is what the Rhode Island Primary Care Physicians Corporation (RIPCPC) model is seeking to achieve, says Stephen Montaquila, O.D., who chairs the RIPCPC eye care group of optometrists and ophthalmologists.

This new arrangement started taking shape last year. To date, it is the largest-known integrated care model of its kind among primary care providers and eye care professionals.

To illustrate what's possible, the optometrists and ophthalmologists in the IPA got together to determine if there was a set of best practices that could be employed within the group to ensure better care coordination. 

For example, the primary eye care providers and retina specialists have developed referral forms to ensure that the proper information is exchanged if an OD sends a patient for a retina consult. This way, the retina specialist has the necessary information to properly evaluate and care for the patient.

A virtual model of care
Inclusive independence is a specific goal of the IPA. It means that doctors can exist in their own office, "but there's coordination to the extent that there's a sufficient exchange of information so every member on the patient's health care team understands what's happening," Dr. Montaquila explains.

This virtual model of care offers the autonomy that Lawrence Ginsberg, O.D., one of 70 eye care providers in the IPA, was looking for (read more on page 14 of the October 2014 edition of AOA Focus).

Most of the ODs and some of the ophthalmologists who joined the IPA have independent practices. The arrangement gives them the ability to get referrals from primary care doctors, who in turn seek collaborative arrangement from the eye care providers. If an OD sees a primary care doctor's diabetic patient, for example, that provider can communicate with the OD to find out if the patient has had an annual eye exam, Dr. Ginsberg says.

To improve coordination, the IPA has developed a standard patient form for all of its physicians. If Dr. Ginsberg sees a patient in the IPA, he fills out this form with the patient information, which gets faxed back to RIPCPC headquarters. Because all of the electronic medical records (EMRs) do not communicate yet, the RIPCPC headquarters serves as the central location to keep records. The goal, though, is to get all EMRs to be uniform, Dr. Ginsberg says.

The main office takes care of all patient stats, which get sent to the patient's primary care doctor.

For now, RIPCPC is still in the building phase—coordinating doctors and getting protocols in place. "We're working closely with the primary care physicians to ensure that we are collecting the appropriate patient care data that needs to be shared, and understanding what patient care data they need to share with us, as well," Dr. Montaquila says.

April 10, 2015

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