Phoenix PCMH Takes a Broad-Based Approach to Providing Care

by HCE Exchange on June 16, 2014

Avein-thumbAvein Saaty-Tafoya, Chief Executive Officer

Adelante Healthcare is a not-for-profit federally qualified health center based in Maricopa County, Ariz. The organization operates seven health centers throughout the Phoenix metro area with plans for expansion into Peoria this fall.

Under healthcare reform, most care providers are seeking ways to keep patients healthy and transform the old paradigm of primarily offering sick care. Adelante Healthcare has forged its own path in this regard and is taking a wide-ranging integrative approach to care delivery.

Embracing a holistic view of treatment

As a recently accredited patient-centered medical home (PCMH), Adelante takes its mission to heart with a strong emphasis on providing personalized care. Evidence-based design and sustainability are incorporated into the physical environments, along with added hospitality elements.

“I joined the medical field because I really wanted to help people and leave the patients I serve better than I found them,” said Chief Executive Officer Avein Saaty-Tafoya. “Adelante Healthcare facilities are modeled after warm environments that people want to be in such as coffee shops or libraries.”

Adelante’s broad-based approach brings together medical care, dental, nutrition, integrated behavioral health, and even naturopathic medicine. As a community health center, most of Adelante’s patients deal with chronic diseases and diseases related to lifestyle, behavior, and stress.

“As a provider, it’s frustrating to sit in a room with a patient you’d like to help and the only tool you have is a prescription pad,” Saaty-Tafoya said.

Adelante encourages conversations about lifestyle factors that contribute to the patient’s disease and the development of a game plan that may include medication as well as nutrition and self-management techniques.

Saaty-Tafoya said patients are assessed to better understand their background, primary and preventive needs, risk factors, as well as personal elements of health they may not be aware of in an effort to provide an array of options.

“In the past, we may have given someone with chronic pain narcotics, but now, we might offer acupuncture, physical therapy, or even nutrition,” Saaty-Tafoya said.

This approach has generated improvements so far. Pain-management scores used to be low, mainly because it wasn’t a primary area of focus. The organization developed a multi-pronged approach to training and treatment, bringing in care-team members who may not typically be involved in pain management so that everyone was sharing observations.

Saaty-Tafoya said it is important to test all modalities and clinical guidelines with the same rigor, including nutraceuticals, which are already popular in some of the top cancer treatment centers in the world.

“We have a good handle on communicable disease,” she said. “Behavior and lifestyle, more than anything else, are determinants of quality of life and longevity. We made a mission change that has taken us back to our roots and that we hope will improve the health of our community.”

It has taken time for Adelante staff and stakeholders to adjust to this shift in practice, and the organization is still in the early stage of the PCMH model. But Saaty-Tafoya said she was able to get staff engagement once they understood the ways they could change lives. Providers are involved in developing and testing new approaches for quality improvement.

“Our providers are attracted to community health centers because they want to make a difference in patients’ lives,” she said. “We care for underserved patients, and we really want to see them improve. That mission is where we’ve gotten the care team to embrace this practice change.”

Integrating healthcare centers into the community

Adelante is in the early stages of an expansion project that would develop a community healthcare park involving partners from schools, business, and government. The center has a partnership with a local hospital system and wants to develop a colocation with other community services “so that when the community thinks about going to the doctor, they don’t think of it as detached from other aspects of their lives.”

This model has been done in other areas of the country, and Saaty-Tafoya hopes to make Adelante’s unique. She said the idea is in part prompted by the center’s membership in an accountable-care organization, which has given the center for-profit and not-for-profit partners.

“We have to have a broad approach to providing care because reimbursement is changing,” she said. “We don’t just want to survive. We want to thrive and have a measure of say in what the future of healthcare looks and feels like.”

Adelante has brought in a few partners and still has some ground to lay before the expansion project can be launched, but the center has already received positive responses. Saaty-Tafoya said the early adopters were open and ready for something new, and other partners are seeing the changes and opening up to new opportunities.

“We had gotten to a point in the old paradigm where leaders had enough,” she said. “They were being confronted by boards and strategic teams to achieve new goals, particularly those related to payment reform. If you don’t have an answer with the current model, you have to start looking for a different approach.”

Educating the next generation

Adelante is also actively involved in training and educating up-and-coming practitioners. The Mesa Health Center has become a workforce development incubator with multiple schools rotating students through the site, which is located on a joint vocational school campus.

“Medical students are getting a glimpse of how the patient experience needs to evolve,” Saaty-Tafoya said.

In all, Adelante has graduated about 50 students from its osteopathic medical program at A.T. Still University in Mesa, Ariz.

Adelante has an exciting future ahead, and Saaty-Tafoya said getting buy-in from frontline staff has been key to making everything work.

“Changing the culture is a true investment in time and some risk,” she said. “But it provides sustained dividends and improvements in difficult-to-achieve health outcomes. Sometimes to push innovation, you have to be on the edge of logic. Maybe it’s not what we’ve done in the past, maybe it’s not proven, but we’re dealing with people, and we have to embrace the human condition. ”

-by Patricia Chaney

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