Cornerstone Health Care: Grace E. Terrell, MD, President and Chief Executive Officer

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Grace-Terrell-thumbAs the healthcare landscape changes, more physicians are considering either hospital employment or other avenues that will allow them to focus less on running an office and more on providing quality care to patients.

One multispecialty physician practice in North Carolina offers a unique model for physicians to practice under, in addition to pioneering new models for care delivery.

Building a physician-led, value-driven organization

Cornerstone Health Care is physician-owned and led, not just by virtue of its president and chief executive officer Grace E. Terrell, MD, being a physician, but also in how physicians play a role in decision-making.

Physicians run the board, they serve on committees, and some even become shareholders.

Cornerstone was formed in 1995, when many healthcare organizations were expecting to see some iteration of government reform. Terrell specialized in internal medicine and was working for her in-laws’ medical practice at the time.

She and a group of physicians from 15 practices in and around High Point, N.C., met together to discuss primary care and where the healthcare industry may be headed. After 18 months, the senior partners in these 15 practices decided to merge together to form a multispecialty physician group. Now, the practice spans a two-hour driving geographic range, 15 hospitals, and 375 physicians and advanced-practice providers.

The first few years of the organization were spent learning to become positive business leaders, growing the practice, and adding specialties. By 2005, the group began to expand, adding electronic medical records and building a 100,000-square-foot ambulatory clinic.

But then, the recession hit in 2008, local unemployment rose, and fees were cut. Cornerstone looked for a way to contain costs and increase value. Terrell said the organization immediately chose to implement a value-based model, and by 2012, the group had renegotiated all managed-care contracts to be value-based rather than fee-for-service.

“We had to make substantial investments in information technology and change the way we practice medicine,” she explained. “We are seeing year-over-year improvement now in our Medicare claims, plus improvement in cost, quality, and patient satisfaction.”

As part of being a value-driven organization, Cornerstone is recognized as a National Committee for Quality Assurance Level 3 Patient-Centered Medical Home.

Implementing patient-centered quality initiatives

Cornerstone’s physicians are developing initiatives to manage chronic conditions. They have also reorganized physicians into service lines rather than practices, where physicians work together to improve quality in their services.

“Our physicians meet together and pick the top three things in their service lines where they can make the most impact on quality or cost,” she said. “For example, our neurology group looked at migraine management throughout the organization and came up with protocols that are now being integrated into the EMR.”

IT investment has also been key to quality initiatives, as physicians have analytic and predictive modeling tools. Patient-care advocates, oncology patient navigators, and advanced-practice providers are also heavily used at Cornerstone.

“We are all having challenges with the shortage of primary-care physicians,” Terrell said. “We have a lot of mid-range providers, and we try to make sure we are using everyone to the full extent of their licensure. That is a mindset change for a lot of people and requires training. The things we are doing are a lot of hard work, and we face competition as there is a lot of consolidation in the market, but as long as we keep making sure we’re doing the right thing for patients, that usually gets us where we want to go.”

Transitioning to population health management

With reform now in place and a greater focus on managing chronic conditions throughout the healthcare industry, Cornerstone is also looking at ways to “morph from a traditional multispecialty medical practice into a true population management company,” Terrell said.

Current investments for the group include informatics tools and new facilities, including a concierge practice for dual-eligible patients and a facility for an extensivist who is seeing the one percent sickest patients.

In managing patients with diabetes, Cornerstone uses analytics tools to identify patients who haven’t been seen by a primary-care provider in the previous six months and suffer from A1C, hemoglobin, blood pressure, or cholesterol that is uncontrolled by standard definitions. Medical assistants then call those patients to invite them back to the practice, which has then tracked the differences in terms of controlling the disease.

This practice has also expanded to other preventive and management services such as screenings.

Furthermore, many service lines are taking a team-based approach to providing care, particularly in oncology and the heart-function clinic. Terrell said the group is seeing remarkable results with the sickest patients. She credits the success of many of these programs to the fact that the physicians are designing and putting them together. Everyone has a vested interest and those closest to the patients are the ones developing the solutions.

As a result, she is excited about the future and about Cornerstone’s role in the marketplace as healthcare faces monumental changes.

“Many people believe healthcare is too expensive and of lower quality,” she said. “There’s no reason why we shouldn’t work on it. We will continue to innovate and change to meet what the market needs.”

-by Patricia Chaney

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