1. Dr. Steven Roth Jennifer Nappi RN NCM Thundermist Health Center

2. What We Hear Patients Want Relief From What Ails - Our patients want to be healthy, but… - Easier treatment is better, e.g. The Silver Bullet Epedient ( fewer doses, shorter courses) Convenience - Right time - Right place - No wait

3. What We Hear Patients Want Instant Information - X- Ray - Rapid tests – flu, mono, strep, urine, HbA1C, pregnancy, lipids, etc. - Answers to all their questions The latest and the greatest: - what they learn from the media (drug ads, doc shows, news reports) - one myth perpetuated by the present healthcare system: the higher the tech the better the care.

4. What Patient a Patient Centered Medical Home Offers Access Affordability Appropriate Diagnosis and Treatment Education

5. What Thundermist Has Done Open Access – doing today’s work today Extended hours: three evenings until 8pm, Saturday hours at all sites construct sliding scales offer discounted medication via 430B grant with CVS Comprehensive services Incorporate NCMs in each office

6. For Hospital Inpatients (IP) Collection of daily admission and discharge data by our NCM’s (South County & Woonsocket) THC – South County physician does hospital social rounds connecting with our sickest patients and tracking of admissions and discharges

7. Hospital IP continued NCM follow up on labs & imaging studies the PCP received which is some cases is the first indication of ED/IP admit Beginning relationships with SCH discharges case managers

8. New Work Flow NCM follow-up on Inpatient visits RNs follow-up on ER visits Front line staff follow-up on Urgent care Developed Patient education materials to be mailed to all patients - Appropriate Use Packages for ED/UC visits

9. Use of template Tracking patient ER/Hospital visits Tracking type of follow-up Produce data for insurance companies

11. Preliminary data Tracking NHPRI ER/Urgent care visits for 2 years ER visits - decrease Inpatient stays – about the same Urgent care visits – about the same

12. Steps taken THC – South County has established relationships with hospital care managers THC – South County & Woonsocket Receive/can access daily ER visits/inpatient admits THC Quality Management Team - Reassess & develop work flow based on clinical data

13. Challenges Strengthen established hospital relationships Establish relationship with Kent County for WW office (in progress) Continue to assess & revise work flow as needed to improve patient care Work in concert with insurers to improve patient education on the patient’s plan of care

14. Challenges continued Process to expedite DI & lab tests from the office Facilitate process to send visit information to specialists Educate the patient, staff, general community & the medical community on the role of primary care giver as the orchestrator of the patient’s health care