In 2008, Mayor Thomas M. Menino convened a summit of Boston’s leading healthcare, academic, policy, and community leaders to address primary care access in the city. As a result of that summit, Mayor Menino formed the Mayor’s Task Force on Improving Access to Primary Care in Boston, which created a set of recommendations that have served as a roadmap to increase access, improve quality, and integrate public health efforts with the primary care system.
Since 2010, the Mayoral Prize for Innovations in Primary Care has recognized Boston-based organizations that are transforming the primary care landscape and improving our city’s health in three settings – Healthcare, the Community, and the Workplace. As Mayor Thomas M. Menino’s tenure concludes, we catch up with past winners to learn not only what the Mayoral Prize has meant to them, but also to learn what further achievements they have made since accepting the award.
Harvard Vanguard Medical Associates (HVMA), now part of the Atrius Health care group, is a non-profit, multi-specialty medical group practice that offers over 480,000 patients quality care in more than 21 offices. Founded in the late 1960’s as part of Harvard Community Health Plan, it has provided eastern Massachusetts with over 30 years of excellent medical care.
As the very first organization to win the Mayoral Prize for an innovation in a healthcare setting during its inception in 2010, HVMA has been a pioneer of primary care with the development of the Shared Medical Appointment (SMA) model, which extends patient-physician time and eliminates unnecessary patient-wait time through shared group appointments.
Carried out since 2007, the SMA is a 90-minute patient group visit made up of 8 to 12 patients sharing one medical visit with their personal primary care provider and a medical support team, made up of a documenter (medical note-taker), a behaviorist (group facilitator that stimulates dialogue with patients), and a nurse/medical assistant who takes vital signs and conducts maintenance screenings. Through this model, SMAs allow patients to have adequate face-to-face time with physicians without the dissatisfaction of appointments being cut short while equipping physicians with adequate support and ample time to thoroughly address their patient’s needs.
Under Harvard Vanguard, the SMA program is one of the largest in the country with over 8,000 patients who have voluntarily participated in this new, alternative form of primary care. In addition to improving the efficiency of medical appointments, it offers systematic support to physicians and fosters emotional and social support between patients. The SMA model was primarily designed to meet the needs of the most vulnerable patients: the elderly; patients with chronic disease, pain, or addiction; and residents who have limited access to care. To adequately address the needs of these patient groups, SMAs provide them the opportunity for peer support with groups experiencing similar health and social concerns.
Harvard Vanguard’s SMA model reached success due in large part to using a highly organized approach and to building collaboration between providers and medical staff. Using the SMA model has shown a 200% to 300% increase in the number of patients that can be seen in a 90-minute appointment. Data showed that on average for 90 minutes, 8.6 patients were seen in a group visit compared to 4.5 patients seen individually. Not only is the SMA model efficient, patients are allowed to drop in or come to appointments last-minute without an issue.
The additional component of a medical team behaviorist also relieves health inequities by providing special care needs to underserved and high-risk patients in steering discussion to addresses depression, family/social distress, substance abuse, and anxiety, health symptoms often seen in underserved communities. SMA visits have also demonstrated equal, if not better quality of care for patients in comparison to individual visits, where under the same group of physicians, the percentage of patients that received After Visit Summaries (AVS) was 70%, while patients in the SMA who received an AVS was over 98%.
After winning the Mayoral Prize for Innovation three years ago, there are now a total of 22 SMA models currently active across all 10 of Harvard Vanguard’s sites. To date, the SMA model has now expanded beyond internal medicine to other specialized health areas, including dermatology, pediatric asthma, opiate addiction, neurology, and cardiology to name a few.
In addition to the positive reception the SMA model has received from patients and medical care providers, Atrius Health has been making great strides in expanding the model to other Atrius Health/Harvard Vanguard sites with no previous experience with SMA where it is fully supported and in other specialty areas other than primary care. With the SMA model growing in leaps and bounds with its increasing success and popularity, Atrius Health continues to be on the forefront of innovative care, challenging the status quo on the way we delivery care and transforming the healthcare system in raising the bar for quality care for patients from all walks of life.
With a demonstration of overwhelming success, Atrius Health hopes to expand the SMA model to other provider groups, particularly within Boston community health centers, in addition to making it a standard form of care and an integral part of their health care delivery system nation-wide.
To learn about all our past Mayoral Prize for Innovations in Primary Care winners, please click here.