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Innovative Care Models and Uses of Clinical Practice Data – the future of Medicine

Our endeavor to improve the quality and performance of the health care system has many facets and often I am asked to point to examples of how our country’s approach to health care needs to change. We at HHS have been laser focused on the uses of innovative care models and how data generated by the clinical practice setting can be put to use.  Last week, I visited one of the sites of ChenMed – a real-world practice model which demonstrates these principles. 

ChenMed has developed a care delivery model focused on care for seniors in communities that have some of the most complicated health care issues, including heart disease, diabetes, dementia, and cancer (more than 70% of their patients have five or more chronic conditions – truly the sickest of the sick).  Their model is to focus intensely on prevention methods, routine care by clinicians devoted to this care model, and uses of their own information technology systems to guide clinical operations.  ChenMed is based in Southern Florida but has expanded this model throughout the Southeast Region of the country, integrating the same practice principles to similar urban settings – and succeeding. 

Dr. Christopher Chen, CEO, gave me a tour of their Hallandale health center yesterday.  Dr. Chen and Bryan He demonstrated to me how their uses of data are guiding their clinical staff on decision making from the moment the patient walks through the door.  Dashboards, clinical decision tools, automated reminders, in house pharmacy and drug utilization tracking systems are part of every care encounter.  Overseeing the operations is a “air-traffic control” center that monitors the flow of patient services, measures patient experiences, and guides management decision making in real-time through each office visit.  ChenMed’s performance is tracked at multiple levels, including patient satisfaction and disease quality measure performance (such as hospitalization rates and hemoglobin A1c levels at a practice level for diabetes care effectiveness). Dr. Chen also impressed upon me how his performance-based care model required them to build their own information technology system to accommodate the types of practice they use to engage their patients in a non-fee-for-service based model. 

I came away with a new appreciation of how data-driven health care is changing outcomes and how innovation is occurring on the front lines of America’s primary health care delivery system.  We need to advocate for policies and innovators that test new approaches and gain insights in quantitative ways to improve the outcomes of all patients.