Home is where the doctor is

Family Care Network approaches health holistically, treats doctor’s office as a medical home

Dr. Deborah Hall joined the Family Care Network earlier this year. The network has 256 employees, including 50 doctors and nine nurse practitioners, at 12 Whatcom County locations.

 

The word “family” evokes the image of a nuclear unit of two parents, two kids, a dog and a white picket fence. But for the doctors in the Family Care Network, the word means much more.

The network is home to 50 doctors, nine nurse practitioners and a total of 256 employees in 12 Whatcom County clinics. And while all of the doctors practice family medicine, the word “family” means more to them than just the type of medicine they practice. They look at their entire network — including their clients — as one big family.

Each clinic does business under its own separate name, but they all belong to the same umbrella company and get the benefits of a larger organization. They negotiate en masse with insurance companies, share technological resources, have specialized staff that serve all 12 locations and get the support of the “family” of other networked doctors.

The network encourages another family concept as well. Family Care Network doctors want patients to feel at home when they visit — literally.

The concept of a medical home is that doctors manage total health care, rather than episodic, illness-oriented, complaint-based care, said Dr. Bertha Safford, vice president of the Family Care Network and a doctor at Ferndale Family Medical Center. Patients choose a primary care physician, and the doctor’s practice becomes the patient’s medical home.

The idea is that the clinic is a place where medical staff do more than react to patient complaints. Doctors in the Family Care Network instead advise patients about their lifestyle to maintain health as they get older, said Dr. David Lynch, vice president of the Family Care Network.

“By talking about that when people are younger, you can change people’s lives as they get old to maintain personal health,” Lynch said.

Physicians become patients’ medical partner — most medical problems can be managed by family doctors, Lynch said.

“It’s the idea of the old general practitioner, but married to modern training and experience,” he said.

 

Building a network

Although the Family Care Network formed as a professional limited liability company in 1999, its roots go back to the early 1980s.

“It grew out of existing practices that had already been working together in a less formalized way for many years,” Safford said.

Lynch said in 1981 several Whatcom County clinics formed an informal independent practice association that signed group agreements with insurance companies to reach incentives in patient care.

The seed of banding those clinics together was planted after the Group Health Cooperative in Seattle approached several Whatcom County clinics looking for doctors who could provide care outside the metropolitan area for client members.

Lynch said the idea of the cooperative, a group of individual practices under one business model and governed by its consumers rather than company executives, appealed to the clinics already working together.

“We realized we could do a better job if we were a single business,” he said.

In the late 1990s, the clinics used business consultants to start the process of unifying the practices, Safford said.

“But the physicians are the ones who had the vision,” she said.

The vision was realized in 1999, when the Family Care Network came into being. In eight years, the network has grown, adding a new practice in Fairhaven and eight doctors to its cooperative.

“For many physicians, we don’t come into medicine with a whole lot of business sense,” said Dr. Deborah Hall, who joined network member Family Health Associates in January 2006. “I’m glad to have the expertise that’s here.”

Hall moved to Bellingham from Colorado and said both the community and practice were a good fit. She said the size of the Family Care Network was attractive because of its ability to work with insurance companies.

“One of the advantages we have with the network is the ability to have more power to negotiate whether we want to take a contract or not,” she said.

Grouping individual clinics under a single business was more than a financial decision, Safford said.

“As individual practices we didn’t have the ability to get the things we wanted,” she said.

Lynch said the goal was to have high-tech support in each local office, whether in Bellingham, Everson or Birch Bay, with the ability to provide the same quality of care as a major medical center.

The network uses full-featured electronic medical records accessible through a secure intranet, a system Lynch said only 10 percent of U.S. doctors’ offices use.

“The ways we have been able to serve people from this one way alone is revolutionary,” Lynch said.

Staff at clinics, whether in Bellingham or Lynden, can call up patient’s records at the touch of a button.

“That’s the beauty of a computer,” Safford said. “When someone comes in and says, ‘By the way, what was my last cholesterol?’ I don’t have to go through an inch thick record looking for it.”

Lynch said the system allows doctors to stop wading through the immense amount of paperwork required and spend more time with patients.

He also said the computerized system improves accuracy and safety of the care the network provides. Allergies, health risks, past and family history along with current medicines are easily available to nurses and doctors. The system also allows doctors to electronically send prescriptions to pharmacies, allowing pharmacists to avoid deciphering the notorious bad handwriting of physicians.

But the electronic records also have other advantages. Lynch said the old model of care would treat symptoms — patients would show up with a problem and doctors would treat it. The network’s electronic records allow doctors to monitor patients’ health without coming in for an appointment.

“The doctor becomes aware of how his population is doing,” Lynch said. “If his patients are not getting the kind of care they need, he can intervene. More than half of people with chronic diseases do not get recommended care, even people with insurance.”

Safford said the electronic health records also give doctors the ability to measure patient care. With a couple clicks of a mouse, she said health care practitioners can check on how patients with chronic diseases such as diabetes are receiving care, or how many patients have not received regular pap smears or mammograms.

“It allows us to manage our patients prospectively,” Safford said.

Hall said she worked with a similar system in Colorado, but Safford said the Family Care Network’s model is a novelty in Washington.

“We’re looked at by other people around the state because we’re an innovative practice,” Safford said.

She said University of Washington medical students visit Family Care Network clinics to study the healthcare model.

“Our mission is to provide the best family care in the country,” Safford said. “We’ve been working very systematically on doing that.”

 

Family Care Network clinics

 

Bellingham

Bunks Medical Center

Family Health Associates

Stockburger Family Medicine

Foster Family Medicine

North Sound Family Medicine

Squalicum Family Medicine

Blackwell, Binder and Bloom

Medical Testing Center

 

Birch Bay

Birch Bay Family Medicine

 

Everson

Spadly Medical Clinic

 

Ferndale

Ferndale Family Medical Center

 

Lynden

Lynden Family Medicine

 

Health forum addresses insurance options

 

The U.S. healthcare system does not make sense, former Oregon Gov. John Kitzhaber, M.D., told audience members at a June 11 Whatcom Alliance for Healthcare Access (WAHA) conference. It does not make sense as a business model, and it does not make sense for social responsibility, he said.

“We can do better,” he said.

Doing better was the theme of the conference at St. Luke’s Community Health Education Center. More than 150 healthcare professionals, along with state, county and city officials and community activists, packed the room to not only listen to Kitzhaber, but to discuss the future of healthcare in Whatcom County.

“We wanted Gov. Kitzhaber to spark people’s imaginations,” said Heather Pedersen, administrative coordinator for WAHA.

Kitzhaber, who leads the Archimedes Movement, an Oregon-based group that advocates for equitable and sustainable healthcare, said the current system leaves an increasing number of people without health coverage. The primarily market-based healthcare system in the United States leaves those who cannot pay their medical bills without the ability to get quality care.

“The inability to pay medical bills is the second leading cause for bankruptcy,” he said. “Nobody competes for those who cannot pay them.”
Kitzhaber outlined three key steps to reform healthcare: describe a clear vision of what healthcare should be; expose the contradictions and inequities of the current system; and create a tension between the status quo and the vision to create change.

Kitzhaber has a history of creating change in the healthcare system. In the 1980s, as part of the Oregon State House of Representatives, he wrote the groundbreaking Oregon Health Plan, and the Archimedes Movement is spearheading new healthcare legislation in the state.

The former governor’s talk sparked conversations that spread like wildfire during lunch and the facilitated discussion groups of the afternoon. The groups were to answer two questions: what is the vision for healthcare in Whatcom County, and what are the steps to achieve that vision.

Conference officials sorted through more than 500 lines of text transcribed by facilitators at each table to find common themes in the answers.

Universal access to healthcare was one of the most common themes of the discussions. One of the inequalities of the current system is that it separates the poor into those who deserve healthcare and those who do not, Kitzhaber had said earlier.

“Everyone’s a deserving poor,” said activist Tom Hunter to the seven others at his table, which included representatives from Western Washington University, St. Joseph Hospital and the Bellingham School District.

Another theme was to widen the definition of healthcare and focus more on preventative measures than treating problems as they came. Kathy Knutzen, Western professor of physical education, health and recreation, said the number of chronic diseases could be reduced if there was a community-based focus on wellness and prevention.

Hunter agreed, but said there needs to be a shift in how the community thinks about healthcare.

“There’s no sense culturally of preventative medicine,” he said. “We do better when we have big problems.”

For more information on WAHA, visit www.whatcomalliance.org.

 

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