Faculty from Yale General Internal Medicine are providing important leadership and clinical input to an exciting new setting for patient care and education - the New Haven Primary Care Consortium (NHPCC) which celebrates six months of operation this month on Saturday, April 24. The NHPCC is an innovative collaboration between Yale New Haven Hospital, the Cornell Scott-Hill Health Center, and Fair Haven Community Health Care.
The consortium, located on Sargent Drive in New Haven, opened its doors October 2020 and has already reached its pre-move visit volume for the respective collaborating centers. This is in spite of COVID-19 restrictions moving 60% of appointments to telehealth, said Daniel Tobin, MD, FACP, BS, associate professor of medicine (general medicine) and medical co-director of the Adult Medicine at 150 Sargent Drive alongside Laura Whitman, MD, assistant professor of medicine (general medicine).
“Telehealth has actually been a very positive change,” said Tobin. “It gives us the opportunity to meet patients where they are. For years, we have had essentially homebound patients for whom we had limited solutions for providing care. Telehealth appointments offer a way to reach patients who have difficulty leaving their homes.” Tobin added that when physicians ascertain a patient would benefit from an in-person visit, that appointment is immediately arranged.
Since the inception of this collaboration, faculty and residents from the Yale’s Department of Internal Medicine have staffed the internal medicine practice in the center.
“Despite the challenges of the COVID-19 pandemic, there has been a successful effort to keep the center as fully staffed as possible by Yale residents and faculty. Our number one priority is to provide the best possible state-of-the-art care for our New Haven community that is served by the NHPCC,” said Patrick G. O’Connor, MD, MPH, MACP, Dan Adams and Amanda Adams Professor of General Medicine, and chief of the Section of General Internal Medicine. “At the same time, we want to make sure our trainees are well-equipped to care for this population, so that when they practice independently they are sensitive to the health care and social challenges seen in communities like New Haven’s.”
Given the consortium’s early success, that goal may be right around the corner. At the heart of this success is the unique partnership across the three healthcare systems which make up the consortium along with the critical input of Yale School of Medicine faculty.
“We are so pleased with how smoothly things are going six months in,” said Mark Silvestri, MD, MHS, FACOG, chief medical officer, medical & dental services, Cornell Scott-Hill Health Center, and assistant clinical professor (obstetrics, gynecology & reproductive sciences). “That’s not to say there’s not still work to do, but we have made fantastic progress together.”
Silvestri said the first few months have been largely focused in two areas: basic workflows and communication. “We have been getting to know each other so we know who to contact for what, and establishing regular clinical operations meetings and site-wide leadership meetings. That way, we have the right avenues of communication to be able to resolve issues and work together to improve things going forward,” said Silvestri. “We have done a lot of work in those two areas these first few months to get the consortium functioning well as a large clinical practice site.”
The appreciation for this partnership goes both ways. “One Cornell-Scott practice which we’ve implemented at the consortium is their weekly operations meetings,” said Whitman. “All relevant stakeholders are present, and we are able to do real time problem solving. Anybody is able to bring an issue to the table, and we all are able to address our piece of both the problem and the solution. Very often by the end of that meeting, we have come together and solved the problem as a group, which is incredibly empowering.”
One example of this, said Tobin, is in patient care. “We had a consortium patient being cared for by women’s health who needed an intra-muscular anti-psychotic medication. The workflow for that treatment had not yet been sorted out, but we were able to get relevant stakeholders together in an operations call and figure out a solution.”
Whitman and Tobin also stressed the significance of Cornell-Scott’s behavioral health system. “If we are seeing a patient in the clinic and have an urgent concern about their mental health, we can pick up the phone and arrange for real time assessment on-site and a warm handoff to the behavioral health team,” said Tobin. “Our patients no longer need to wait for a referral to be processed to see a mental health specialist in these situations.”
Looking forward, the consortium is expanding its staff and reviewing its collective performance to improve care. “As I look to this next year in 2021, what's exciting for me is the chance to work together toward certain clinical quality outcomes,” said Silvestri. “We are starting to review our collective performance on certain chronic disease management goals and preventive care goals. We want to utilize the expertise of both organizations to provide the best possible care to our patients.”
Another future goal said O’Connor is to work with our patients and partners to develop the NHPCC as a site for patient-centered clinical research which is focused on the needs and priorities of our community. “We will focus on using research as a way to enhance the health of the NHPCC patient population in a manner which engages them in a meaningful way in the conceptualization, design, and conduct of that research,” he said.
The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.