NHB was highlighted due to having several processes identified as “best practices” such as the coordination between the Urgent Care Clinic and Family Practice to providing timely patient-centered care.
“The DHA came to assess our implementation of the medical home concept. In regard to the best practices, we have some good ideas that are still being implemented. DHA has been watching the Puget Sound area and NHB in particular and have heard good things on what we’re doing,” said Cmdr. David V. Thomas, NHB Deputy Director for Medical Services, Ambulatory Care Nursing Specialty Leader and coordinator for the visit.
PCMH - more commonly known as Medical Home Port – is NHB’s standardized primary care
team model designed to provide better access, continuity, wellness, and disease management for patients.
The best way to find out if the program is effective is to simply approach those providing healthcare as well as those receiving it. Which is exactly what happened in the focus groups.
“We have heard wonderful things about Naval Hospital Bremerton. We’re not here for an inspection, but to learn and have one conversation lead into another. We know that we need to talk to those on the staff doing the work and also hear from the patients so we can make the best decisions based on the best practices,” said Regina M. Julian, DHA PCMH Primary Care Chief, who lead the visiting team of Tri-Service team of Army, Navy, and Air Force experts on primary care standardization, optimization and collaboration.
“What’s working? What doesn’t work? What needs to be changed? What recommendations do you have? Going over challenges and opportunities are all things that we can take and present back in Washington, D.C. on your behalf,” Julian said.
According to Julian, NHB is one of 15 ‘listening tours’ the DHA Tri-Service team is visiting to focus on subjects as better continuity, better access to care, especially for acute needs, and reducing costs.
Emphasis was also placed on understanding what staff consider access to care with Medical Home Port might very well be different with what patients think.
“Negative comments always get more attention than good comments. That’s what we have to deal with and access to care remains a priority,” explained Julian.
An afternoon session had the DHA team meet with patients so they could voice their likes and dislikes on receiving their medical care with NHB’s Medical Home Port teams.
“How easy is it to get access to care here? We hear about cool stuff from the staff on what they’re doing, but we need to hear from patients also,” added Lt. Col. Del Lofton, U.S. Air Force Medical Service Corps, and Access Improvement Working Group Chair.
One beneficiary explained that the main reason she came to the focus group session was to share her opinion about the overall management of her care and experiences by Cmdr. Lucelina Badura, Navy Nurse Corps officer on one of NHB’s Medical Home Port teams.
“I thought I had a cold, which she quickly diagnosed as pneumonia. That was important to catch because I have had chemotherapy treatment. She knew my background, and surprised me by mentioning my white count. She looked at me and not just at her computer when I was being seen. I liked that. She also checked up on me so I felt like I was in good hands,” the patient said.
Another patient explained that a visit to the eye doctor went from cataract treatment into immediate handling of a skin condition by the Dermatology clinic. That instant same-day referral from one clinic to another was a theme echoed by more than one patient in the forum.
Another patient shared that her care has been excellent all through her pregnancy and knows she can schedule a timely appointment and ask anyone in the OB/GYN department or Northwest Beginnings Family Birth Center any question. But…
“Once here, parking isn’t always ideal. There’s not always a good spot so I’m searching for one. It can be a gamble. It is what it is,” she said.
“Parking is a prime example of access to care. More convenient parking is important to patients,” Julian added.
“When I approach a staff member in a clinic, I really don’t want them to tell me immediately what they can’t do. I need to hear what they can,” commented one patient.
“We realize that customer service can be an issue. Just a smile and being nice to someone can go a long ways. We are working on it. We are putting together a program to have ideally the same approach to treat patients with appropriate focus,” said Lofton.
Medical Home Port goal was initially implemented in stages starting in 2011to improve the partnership between the patient, his/her primary care provider and their primary care team, and where appropriate, the patient’s family. The partnership focuses on sustaining and enhancing wellness in patients as well as efficient delivery of comprehensive health care services, based on every patient’s needs.
Patients have an entire team responsible for their healthcare. In addition to a primary care manager (PCM), there will be a registered nurse (RN), along with a hospital corpsman and/or medical assistant as part of the healthcare team. Additional physicians/providers are also part of the team to fill in during absences. This team will partner with each patient to fulfill administrative requests and provide additional medical services.
Patients already enrolled in TRICARE Prime at NHB are automatically assigned and can contact the TRICARE Regional Appointment Center (TRAC) at 1-800-404-4506 to schedule an appointment. Beneficiary with a question can contact the clinic directly to speak with their Medical Home Port Team. A representative from their team will contact them within two business days for non-urgent issues.
“We also need to make sure we have multiple ways in place so patients can get in touch with their nurse or provider, where it’s by secure messaging with RelayHealth, on the phone or face-to-face,” Julian stated.
NHB continues to stress with all patients on enrolling in RelayHealth, a secure messaging system. RelayHealth allows two-way communication between patients and their primary care manager and Medical Home Port Team to answer questions, refill medications, receive test results and more.
Patients can request appointments, renew prescriptions, ask non-urgent questions, and receive lab results, all from their home computer. This can reduce phone calls, waiting-room time, and the time it takes to travel to their doctor’s office. Patients can use www.relayhealth.com/patients to consult with their doctors about non-urgent medical care needs.
The Nurse Advice Line (NAL) available at NHB is staffed by a team of registered nurses who answer healthcare questions and provide live advice 24/7. NHB beneficiaries have the option to contact the NAL for professional medical advice to help decide whether self-care is the best option, or wait for an appointment with their primary care manager, or seek urgent or emergency care. Call 1-800-TRICARE (874-2273) and select option 1 to connect to the NAL. Beneficiaries may still call their Medical Home Port Team for medical advice and appointments during business hours.
NHB has approximately 31,000 TRICARE enrollees in the West Puget Sound area of the greater Kitsap Peninsula, and another 5,150 in the Eastern Puget Area serviced by NHB’s Branch Health Clinic Everett.
“I consider everyone as part of my military family, and like a family, we can talk about what’s good and what’s bad, and what can be better. This is our system and we want to make it better for everyone,” said Julian.