The MedVantage Clinic: A Novel Primary Care Intervention Model for a Hospitalization- prone Patient Population

From the 2023 HVPA National Conference

Audrey Shawley BA (The University of Queensland – Ochsner Clinical School), Kathy Jo Carstarphen MD, MA, MPH (Ochsner Health), Sarah-Pearl Siganporia MD, Richard Li MPH, Sarah Hill MPHTM, Liam Kavanaugh MD, Sakshi Sharma MS, Nicholas Regennitter MD

Louisiana has one of the highest healthcare burdens in the nation. In 2022, the state ranked 50th for overall health outcomes. It possesses the highest economic hardship index score in the nation, and is among the ten states with the highest percentages of adults with obesity, diabetes, cardiovascular disease, chronic kidney disease, and multiple chronic conditions. This heavy burden of disease and poor health outcomes makes Louisiana a high-need area for adequate primary care provision.

Patients with complex health and social needs experience challenges in the standard volume-based models of primary care provision. The Agency for Healthcare and Quality defined complex patients as persons with two or more chronic conditions, or multiple chronic conditions. Some physiological and chronological older adults experience complexity due to their high medical needs, which are difficult to address within a short appointment time, especially if there is extended time between visits. Older adults and low health-literate patients also struggle with care coordination tasks such as scheduling appointments, navigating the clinic and hospital, understanding medical instructions, and securing transportation to the appointments.

Our community case report is : retrospective review of the agile implementation of a multiple-intervention primary care system, designed to target the healthcare needs of complex patients in Louisiana. This dynamic approach to primary care provision was undertaken through establishment of the Med Vantage Clinic (MVC), a small-scale clinic that functions within Ochsner Health, a large hospital system and multi-specialty ambulatory practice. The MVC was a hub for core and adjacent clinical services aiming to: (1) establish appropriate goals of care; (2) utilize targeted interventions to improve patient compliance; (3) increase preventative healthcare Choose sidebar display access; and (4) address social determinants of health that serve as barriers to care.

In 2020, the MVC grew to four locations, with five practitioners and a clinic enrollment of over 600 patients at the initial site and 850 at the additional sites. The clinic has demonstrated its feasibility as a clinical training site for medical students and residents, and a referral center for complex and older adult patients.

The current primary care system often leaves patients navigating a detached web of physicians, social workers, and other resources. The MVC was able to improve the quality and accessibility of healthcare for elderly and complex patients in the New Orleans, LA area by creating a novel inclusive approach that simultaneously tackles medical and socioeconomic determinants of health. Future improvements will include formal assessment of the financial sustainability of the clinic and adjustments to optimize core services to streamline collaboration with adjacent clinical services.

Clinical Implications:
The authors anticipate that this intensive approach to care for complex multi-morbid patients will result in overall reduction of healthcare expenditure and improved quality of life. Increased access to a comprehensive unit of preventative medicine resources in one place can decrease the number of preventable emergency room visits and hospital admissions for complex and older adult patients. By avoiding expensive ED and hospital admissions through relatively low-cost preventative primary care measures, the implied cost savings can contribute to the overall financial sustainability and scalability of the MVC. This financial analysis work to estimate incremental resource benefit generated by the MVC is ongoing and will be the subject of future publications.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog