For three months William Harris has been steering clear of the greasy fried chicken, banana pudding and other foods he's been eating his whole life that have helped to push his blood sugar level too high.
Working with a nutritionist and health educator as well as his doctor has helped control the Greenville man's blood glucose and kept him off medications for diabetes.
The approach to Harris' health is part of a growing wave of medical care provided by more than 1,850 physicians in the Upstate in a new network called MyHealth First that aims to improve care while reducing costs by measuring how well doctors do their jobs.
Until now, said Dr. Angelo Sinopoli, president of the network, physicians have been caring for patients without a way to gauge the outcomes. The network will change that by using technology to measure what portion of patients get the standard tests and treatments and how many of them get better too.
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"By getting that number of physicians to willingly collaborate and to agree on standard clinical guidelines, on clinical metrics on how we measure performance, and to be willing to coordinate care among the physicians ... quality will go up and overall cost of health care will go down," Sinopoli told the The Greenville News.
"Our belief is that partnering with a network is the way all successful health systems will function in the future," he said.
Research has shown that despite spending trillions on health care, Americans only get about half the medical care recommended by practice guidelines, such as the standard number of blood sugar tests for a diabetic, the appropriate medicine for a disease, and follow-up for depression.
Poorly coordinated care is at the root of many of these problems, said Sinopoli, who is also chief medical officer for Greenville Health System. The new network provides the performance report cards and implements care management resources for all participating doctors.
"It's making sure that everybody gets all the care they need," he said. "So in real time, the practices and care managers the network is contracting with help physicians work through the system in an efficient manner, not duplicating services or ordering unnecessary tests, and providing follow-up when they need it."
It's especially important for people with chronic illnesses, such as asthma, diabetes and congestive heart failure, he said.
"With a diabetic, for example, we know from previous studies that in the U.S. that although we may agree there are seven things a diabetic should be receiving, only about half get the standard of care," he said. "The attempt here is to document what the guidelines are and create a system where we assure that patient gets all the things done."
So in the past, while a doctor may have ordered a blood test, the patient may not have gotten it, he said. Or if the test was performed, the glucose level may have been too high, but there may have been no follow-up, or intervention may not have occurred until the next office visit, which could be months down the road.
The concept also extends to dealing with socio-economic issues that can affect whether patients get that care, he said, such as affordability and transportation.
Socio-economic factors like lack of access are the biggest single factor in determining adequate care, Sinopoli said.
"Part of what the network will provide is a care management program that identifies those issues and brings resources to the table, for example, help with transportation, access, education and coordination," he said.
For instance, patients may not have the ability to leave their homes for a variety of reasons. In the network, a nurse may be sent to the home to draw blood or the patient may be linked with telemedicine for a remote consultation.
And because patient participation improves outcomes, physicians in the network will partner with their patients to develop customized treatment plans.
Physicians who fail to meet the standards will be provided with support services to help reach the benchmarks or will be excluded from the network, he said.
Though GHS is a member and is paying for the IT systems necessary to support MyHealth First, the network is an integrated group of physicians and healthcare providers in a separate entity overseen by its own 12-member board of managers, Sinopoli said.
It operates across nine counties - Abbeville, Anderson, Greenville, Greenwood, Laurens, Newberry, Oconee, Pickens and Spartanburg.
Networks like these are growing across the country, driven by national reimbursement and regulatory changes, said Alwyn Cassil, an independent health policy consultant with Policy Translation in Silver Spring, Maryland.
The Centers for Medicare and Medicaid Services, for example, is emphasizing payment for outcomes as opposed to the traditional fee-for-service model where providers are paid more if they do more no matter what results, she said.
"Very clearly, physicians, through Medicare and even private payers, are facing far more requirements to do a better job of collecting data and reporting on their performance," she said.
And hospitals are being penalized by CMS for readmissions. As a result, she said, they are being forced to reevaluate their roles and move to more outpatient care.
"There is increasing pressure on hospitals to move beyond the four walls of the hospital ... and a way to integrate clinical care that improves care for patients and allows the providers to give the care more efficiently and save money," she said.
"If you can provide better or comparable care for a lower cost, that's a win-win for everybody," she added, "if those cost reductions get passed on to those of us who pay for care."
Such a large network connected by technology also potentially provides a hospital with a larger patient base, she said.
The system is slowly changing so that providers have the incentives to give the right care as efficiently as possible, she said.
"This idea of aligning payment incentives is a very important one to get enough critical mass to really change behavior and how care is delivered in the real world," she said.
Sinopoli said providers are under increasing pressure to find ways to offer good care at an affordable cost, and private insurers are increasingly offering incentives similar to CMS, as well.
"It's no secret that the U.S. healthcare system is unsustainable," he said. "Health systems and providers need to provide a more coordinated approach to the populations they serve."
Harris' internist, Dr. Joanne Skaggs, said the team approach is what made the difference in his health.
"It's different than just come to the doctor's office, get refills, and see you at the next appointment.
"It's more of a conversation and partnership."
Want to learn more? Go to myhfn.org.