Western North Carolina Pediatric Collaborative — An Organic Process

The Western North Carolina Pediatric Collaborative is not an accountable care organization, but the Collaborative’s story could serve as an example of how an ACO could develop organically when a group of doctors and community health providers come together to reap the benefits of collaboration and accountability to their patients and their community.

“This process and this project are helping to build local infrastructure and local capacity for future ACO readiness,” said Melissa Baker of the Buncombe County Health Department and Innovative Approaches, integral partners in the Collaborative. “A lot of people feel they’re part of this. It’s a grassroots, collaborative and consensus model.”

The seeds of the Collaborative were planted two years ago when three pediatric practices in Western North Carolina joined with Innovative Approaches, Community Care of Western North Carolina (CCWNC) and, the Mountain Area Health Education Center (MAHEC) to pursue the patient centered medical home (PCMH) designation.  That effort was so successful that a year ago the group decided to expand to a patient centered medical “neighborhood” and pull together multiple practices — pediatric, family practice and specialists – to collaborate and improve community health. The current resources, structure and support for the on-going project are provided by Buncombe County Health and Human Services, through the Innovative Approaches grant project, Community Care of Western North Carolina, MAHEC, and a local pediatrician, Dr. Calvin Tomkins, from Asheville Pediatrics.

“We realized we’re all in the same boat in the day-to-day work that we do. We decided that, instead of us each banging our head against the same wall each day, we could come together and somehow work toward something where everyone is doing it together,” said Carrie Pettler, Quality Improvement Specialist for Community Care of Western North Carolina. Collaborative participants “sit around the same table every Wednesday from nine to 11 and have open discussion about how to move this forward; how to make this better. I think that’s been a very organic and successful model.”

The group’s first initiative focused on asthma. The second initiative has looked at obesity. The collaborative members, working with MD Champions and Specialists, developed a work flow model that they call “the Matrix” to help each of the 15 participating practices streamline their work for the treatment and prevention of asthma and obese patients. The Matrix includes evidence based guidelines, team-based care, how to document their work through Electronic Health Records (EHR) even though the practices may use different EHR systems, clinical quality measures (such as PCMH, MU and HEDIS goals) and how to help providers get paid.

The process “helps providers glean a population health perspective,” Pettler said. They are able to do this in a “collaborative environment where they can bounce ideas off other providers, learn from people who are having successes, learn from other people’s challenges, and implement these things into a practice in a seamless way. Their time in the office is more focused on the patient and the lessons they’ve learned from the collaborative and less focused on trying to do that work individually in their practice on their provider time.”

Mission Hospital in Asheville has shown interest and has begun sharing their data. Their Primary Care Counsel will likely join future Collaborative meetings. The hope is to grow the Collaborative’s executive committee and governance structure to encompass all the health care stakeholders in the area, including community services.

“The Western NC Pediatric Collaborative is unique from other ACO type organizations in that public health is involved,” said Baker. “We’re looking at ways we can connect clinical providers with community resources and support.”

The existing group believes this model is scalable to more practices in the region, including adult care, and to other communities throughout the state. Funding, however, is the limiting factor for this project.  The Collaborative currently is working off of the limited resources of the three participating groups and its doctor champion, Dr. Tomkins. They are applying for grant funding as well as additional funding sources.

“There’s a lot of community buy-in and support,” Baker said, hoping that maybe another organization would be willing to continue to fund this promising work. “We’re doing this for multiple reasons – for [providers], for patients, for families, but also because the health of our community depends upon successful, viable primary care practices.”


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