Physicians Group of Southeastern Ohio Drives Adherence Performance through Partnership with Stellus Rx

Contributors

“As a mom, I love the saying that it takes a village to raise kids well. And it definitely takes a village to create better patient care.” That resonant message comes in loud clear from Dr. Amanda Williams of Physicians Group of Southeastern Ohio (PGSEO).

With 73 providers deployed across 24 locations in three different counties, PGSEO is a village unto itself. But even organizations with that size and scale need the right support to perform in value-based care—especially in such a large region, where connecting with patients on their terms can present a challenge.

That’s where Stellus Rx comes in. With a target of reaching 5 stars for medication adherence, and limited in-house resources to monitor and close adherence gaps, PGSEO looked to Stellus Rx for the expertise that would close gaps and extend PGSEO’s proactive care model for patients.

In less than nine months, Stellus Rx worked collaboratively with PGSEO to increase adherence performance in 90% of measures, year-over-year. That’s no small feat in such a dynamic environment… or as Dr. Williams put it, “With value-based care, there have been other programs that we initiated that ultimately disappointed us. Stellus Rx was the opposite—our work together has far exceeded my expectations.”

In this interview with Dr. Williams, we explore how her medical group continues to succeed in value-based care through adaptation, innovation and partnership.

Let’s start off with a snapshot of PGSEO as a practice and the patients you serve.

Dr. Amanda Williams: We serve a largely rural set of communities, with an overriding goal of providing high-quality, patient-centered care. I’ve been here at PGSEO for seven years, but this area has always been my home. I was born and raised here.

So when I think of my patients, those are some of my favorite people—very down-to-earth people. We have a lot of farmers, a lot of people whose lives and livelihood are connected to the land. That pushes us to deliver care in different ways than a lot of other practices. Take email, as an example. We admittedly have among the lowest number of patient emails, because a lot of the time, our patients don’t have them and, even more often, they don’t regularly use them.

We have to be able to sit down with our patients and spend time with them in person … meet them where they are in their lives.

What can you share about the care delivered at PGSEO and what makes it different from a more standard model of care?

Dr. Amanda Williams: There’s been a huge movement with value-based care, where we emphasize the importance of quality visits with our patients. In my practice, that looks like scheduling patients in longer-than-typical, 30-minute slots.

I don’t schedule 10-minute or 15-minute appointments. It’s crucial for me to have the necessary time and space to fully understand my patients’ situations. Additionally, I make sure to encourage them to recap our plan of care before they leave.

That’s an example of how care is different here: Quality care through a team-based approach. As a mom, I love the saying that it takes a village to raise kids well. And it definitely takes a village to create better patient care.

For example, that could mean Mary Smith, one of our high-risk patients, walks in the door. My front desk receptionist, Sheyenne, should know her as soon as she walks in. She sees Ms. Smith every two months, and that bit of personal connection is meaningful in the relationship that Ms. Smith has not just with me, as her physician, but with our whole practice.

Another thing we’ve done is create blocks on our schedule every single day for walk-ins, with our advanced practitioners available to help if my schedule is full. We have that in place so patients have a place to go for the care they need, without having to go to the ER or urgent care.

As PGSEO has embraced a value-based care model, how do you ensure that everyone in such a large organization is in sync?

Dr. Amanda Williams: The whole premise of value-based care just makes sense for our team. Think about the old-school, fee-for-service, volume-based quantity model and how it pushes providers to see more and more patients. Neither the provider nor the patient likes that, right?  Because you don’t have that time together and it’s extremely challenging to complete a diagnosis and treatment plan in such a short span of time.

The overriding message to our staff, to our patients, to our providers then, is that it’s back to the basics–we are truly here to help people and the decisions we make enable providers to have that time with patients.

Look at the work we’re doing with Stellus Rx. You’re coming in and doing behind-the-scenes work that otherwise, we would not have had the bandwidth for. You’re able to call the patients directly. Stellus Rx pharmacists reach out to the providers directly, and they do it in a very kind and direct manner to let us know things like suggesting a statin for our diabetic patient. This then creates more time and space for better patient care because of that extra help.

Can we dive a bit further into PGSEO’s experience with Stellus Rx as a supporting partner for driving patient adherence to prescribed medications?

Dr. Amanda Williams: I was first introduced to Stellus Rx through PGSEO’s relationship with agilon. Other agilon markets had utilized your medication adherence solution, and agilon informed us of extraordinary work they were doing in other markets.

However, with value-based care, there have been other programs that we initiated that ultimately disappointed us. Stellus Rx was the opposite—our work together has far exceeded my expectations.

From day one, everybody has been so kind, flexible, accommodating, and helpful. I love our providers at PGSEO, but I consider many of us to be very … let’s say headstrong. That can be such a beautiful thing, but when you implement a new program, our physicians can be somewhat leery of what it’s all about. The way Stellus Rx went about it could not have been better. The feedback has been extremely favorable.

Stellus Rx pharmacists are the ones who proactively see things, like, “Hey, this patient has an appointment coming up. Have you considered sending a refill on this or talking to them about this medication adherence issue?” Or sometimes it’s things like, “Perhaps prescribing this instead of that,” so they’re going about it proactively and respectfully. The Stellus Rx team has also been super helpful with financial barriers, which is something that’s an ongoing issue in medicine.

Prior to engaging with Stellus Rx, what had PGSEO done to try to fill these gaps?

Dr. Amanda Williams: We do have a chronic care management team, and for these higher risk patients, we can enroll them for additional support. Essentially, it goes back to the village analogy, where we can place more eyes on those patients.

That team is multifaceted, including a social worker and registered nurse. Prior to Stellus Rx, we would likely rely on the nurse or social worker for advice on how to help patients stay more adherent to their medications. However, this is reactive medicine, which is less than ideal.

In contrast, Stellus Rx has allowed us to be so much more proactive about the way we support medication adherence.

What does a successful partnership with Stellus Rx look like in 2024 and beyond?

Dr. Amanda Williams: As a physician, I often feel overwhelmed by the multitude of labs to interpret, phone calls to handle and other tasks demanding my attention. Right now, as I glance at my desktop, I see a daunting list of 50 items awaiting my analysis. Stellus Rx has lifted the administrative burden on physicians and staff members allowing everyone to work to their highest level, ultimately creating high quality patient care.

Initially there was a small workflow issue where maybe some providers were unnecessarily receiving messages that could have gone to the nurses. But we talked to Stellus Rx, and the team acted on it immediately, and they flipped the flow to make it work for us.

There’s a saying I heard recently that I really like: Unclear communication creates unfair expectations. In other words, we have to be clear about what’s expected and what can be done. I feel like the Stellus Rx team does just that.

We started in Q2 of 2023 and still had a very successful year of medication adherence performance. We have a full year of work together for 2024, so in theory we should do even better. On top of that, our providers are now used to Stellus Rx and what y’all are about and who you are. So with that—and with the workflow addressed—it should be an even better year.

What do you think about the future of value-based care and the way healthcare delivery will continue to evolve in that model?

Dr. Amanda Williams: My answer is that it makes me feel very hopeful that we’re able to get back to what we went into medicine to do, and that’s to make a difference in our patients’ lives. I know our healthcare system is a little bit broken, but I genuinely believe that proactive, value-based care can be the solution for this.

We’re actively pursuing several strategies to integrate this proactive approach into various aspects of care delivery. For instance, according to findings from journal studies, we’ve observed that scheduling appointments with higher-risk patients every two months significantly decreases the need for reactive care.

However, the positive impact on patient health outcomes is only realized when these appointments are proactively scheduled. Without such a schedule, high-risk patients are more prone to transitioning from one crisis event to another. They might end up in the ER and still have the same number of provider visits, but in an unfortunate, reactive manner. Therefore, ensuring proactive scheduling has been a top priority for us, driven not only by our commitment but, more importantly, by the well-being of our patients.

Similarly, scheduling patients promptly after their discharge from the hospital is crucial. The sooner we can see a patient post-hospitalization, the higher the likelihood of preventing rehospitalization. There’s a significant initiative within our organizations to prioritize these appointments, aiming ideally for within two days of discharge.

Another area where proactive care is vital is kidney health, particularly for patients with chronic kidney disease (CKD) at stage 4, who are at high risk. Our kidney care program serves as a bridge between the primary care provider (PCP) and the nephrologist, ensuring comprehensive support for these patients. This includes discussions on home dialysis options, dietary recommendations, high-risk medications and other pertinent topics.

At the end of the day, while we have an array of tools at our disposal, it’s essential to honor and respect each patient as a unique individual. This involves engaging in conversations tailored to their specific needs, discussing options, and addressing any questions they may have. Such dialogues require time, a luxury made possible by the shift towards value-based care.

Published: May 15, 2024