WRIGHT-PATTERSON AIR FORCE BASE — Ensuring the 37,000 patients at the 88th Medical Group of Wright-Patterson Air Force Base are receiving the appropriate care at the right time, at the right cost and at the highest standards possible is the mission of the medical management office.
“If patients are healthy, we have programs to keep them healthy, if they are living with a chronic medical condition, we try to ensure they get the best care and take measures to halt or minimize the progression of their disease,” said Crystal Kelley, 88th Medical Group health care integrator.
The utilization management office, which falls under the medical management, has the ability to pull and review the data of the 88th Medical Group’s patient population. This information allows the office the ability to forecast the medical needs of the community. The utilization managers can identify patients that may benefit from case management as well as other services. The data can also identify groups of patients who have unique needs such as those with diabetes and asthma.
Disease managers use the shared information to develop chronic condition programs to improve the health of patients such as patients with high cholesterol and hypertension. Data is also analyzed by the utilization management office to identify how medical personnel are using resources to ensure the proper utilization of services. This may include both examinations, such as specialized studies, as well as consultations off base.
Healthcare Effectiveness Date and Information Set is a tool used by the Air Force Medical Service and drilled down by the 88th Medical Group to measure performance on important dimensions of care and services. HEDIS is used by more than 90 percent of America’s health plans and measures a broad range of health issues to include diabetes, asthma, cancer screenings and mental health care. HEDIS is one tool that helps track if the community standards are met or if there are areas for improvement, such as patient education or case management.
“As an example of our quality of care review, if a provider is treating a child for an upper respiratory issue, because resistance to antibiotics has increased over the years, the usage of antibiotics is reviewed,” said Kelley. “The child may only have a cold or allergies and antibiotics may not represent appropriate care. Or if a patient comes in for lower back pain for the first time, to limit radiation exposure, we do not automatically send the patient to get an X-ray or MRI. The number of X-rays ordered are reviewed because the majority of the time, the exams are not indicated.”
Areas that Kelley said show room for improvement are the breast, cervical and colon cancer screenings. Kelley said it can be challenging to get patients to come in for these screenings. The medical management team is currently working with the clinics to improve patient awareness by encouraging patients to become more proactive in scheduling the screenings.
Another approach to ensure patients are receiving the best care possible is asking the patients themselves. The Patient Advocate office regularly meets with a patient advocate focus group to inform the group about what plans the medical group are proposing or changing. In turn, the focus group provides feedback, alternate ideas, or recommendations.
Kelley said they are continuously working to improve services and efficiency within the 88th Medical Group but understands that the patients are concerned with access to their providers. The medical management team continuously works with the group practice managers to find ways to improve access to the clinic staff.
Offering more flexibility and convenience for the patients at the 88th Medical Group, additional services have been recently added:
– More virtual appointments are being utilized if a face-to-face visit is not needed to care for a patient.
– Nurse Telehealth consultations have been added to decrease wait times to see a provider. Patients are able to speak with a nurse for triage, 24 hours a day. The registered nurse will assess the needs of the patient to determine if administered self-help at home is appropriate, if the patient’s condition warrants an acute appointment, or if the patient needs to visit the emergency room.
For additional information on population health, contact 937-257-0960. To speak to a telehealth nurse, call the nurse advice line at 800-874-2273.
