Scope of Practice

At Ochsner, innovation happens inside and outside system’s walls

Andis Robeznieks , Senior News Writer

Founded in 1942 as a multispecialty clinic by five Tulane University physician-professors, Ochsner Health System has had huge growth but has maintained its legacy as a doctor-run organization focused on innovation.

Help Move Medicine

Medicine doesn’t stand still, and neither do we. AMA members don’t just keep up with medicine—they shape its future.

This AMA Health System Program partner provides coordinated care for patients who visit its 40 owned, managed and affiliated hospitals and more than 100 outpatient health and urgent care centers that are all connected by an integrated electronic health record system used by more than 4,500 physicians.

Ochsner physician leaders spoke with the AMA about how they are moving medicine forward in the system’s home base of New Orleans while fulfilling its mission “to serve, heal, lead, educate and innovate.”

Where other health care organizations are run by administrators or a government entity such as county or state university, Ochsner Health System is run by clinicians and has been since its inception as a multispecialty group practice, according to hospitalist Jason Hill, MD, Ochsner’s associate chief medical informatics officer.

Also, team-based coordinated care is not an esoteric concept at Ochsner. It’s how they manage chronic conditions such as hypertension and diabetes, said endocrinologist Pavan Chava, DO.

“Working with a team has been one of the most pleasurable parts of my career,” said Dr. Chava, Ochsner’s director of diabetes management services. “Like they used to say: ‘It takes a village to raise a child,’ it really does take a team to take care of patients with diabetes.”

What makes Ochsner different is what makes it poised to adapt well and shape the future of health care, according to Phil M. Oravetz, MD, a family physician and Ochsner’s chief population health officer.

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“We’re finally seeing a shift from an illness model to a wellness model,” Dr. Oravetz said. “We’re finally collecting social determinants of health data on our patients and we’re using that data to develop interventions to keep people well and healthy.”

He adds that, when the Ochsner multispecialty group was founded in the 1940s, that type of practice was considered “a really new and radical idea.”

“But they innovated in that model, and it’s been growing ever since,” Dr. Oravetz added.

Wanda Robinson, MD, a family physician and associate medical director for primary care in Ochsner’s West Bank Region, agreed.

“I believe in our culture and I like the fact that Ochsner is always leading the front lines into new areas and that we’re not afraid to take risks,” Dr. Robinson said. “As a physician, I have the opportunity to be creative in how I want to lead my group.”

The system received a $1.6 million National Institutes of Health grant last year to develop a program that will help primary care physicians manage patients’ pain while also screening patients to identify those at risk for developing opioid-use disorder (OUD).

The grant will fund the use of social workers and community health workers to assist primary care physicians as well as a screening tool that involves asking about personal and family history regarding substance and alcohol use and adolescent physical and sexual abuse.

“No matter where you are in the system, those questions are asked,” explained Dr. Hill. “And, if they’ve been asked before, they’re not asked again.”

Drs. Robinson and Oravetz described how Ochsner is now using a new EHR module to track social determinants of health and environmental factors that can have an impact on patients’ well-being. So far, the system has received data from 30,000 patients.

Outcomes include identifying those who may not know where their next meal is coming from or who have transportation problems.

“We’re offering those types of services now,” Dr. Oravetz said. “We’re partnering with our communities, with our local governments and with our payers to do this in a coordinated fashion.”

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Dr. Robinson said the idea is to treat the whole person and not just their physical or mental symptoms.

“So, we need to partner with local schools, churches and other social organizations,” she says. “As a physician, I can only go so far, but—if I partner with other entities in the community—then we can make a larger impact.”

Work with schools includes reaching out to students who may be interested in a career in science or medicine and let them see what it’s like to work at Ochsner.

Ochsner’s population health efforts earned an enterprise award from the Healthcare Information and Management Systems Society for using its IT system to find and close 50,000 gaps in care.

Dr. Hill described the three-part process Ochsner used to do this:

  • Identify the population of patients with a particular chronic disease state.
  • Make sure you can track that disease state.
  • Be able to figure out where those patients are and who is taking care of them.

Dr. Chava noted how this is also done through the Proactive Ochsner Encounter program, which identifies whether a patient with diabetes needs an eye exam or hemoglobin A1c check. Even if the patient is at an Ochsner facility for a totally unrelated reason, such as seeing a urologist, Dr. Chava said the other clinician is notified and can suggest to the patient, “Let’s get this done today.”

Ochsner uses telehealth and remote monitoring to manage patients’ chronic conditions. Its Digital Medicine Hypertension program has been 30% more successful in controlling patients’ blood pressure than what is typically achieved, Dr. Hill said.

The digital medicine program involves supplying patients with wireless BP cuffs, having them measure and submit results via the patient portal once a day or twice a week. Medication is then adjusted according to an algorithm designed by the patient’s doctor and implemented by the digital medicine care team which includes pharmacists, advanced practice providers and health coaches.

“You can’t think about medicine in the context of working out of a clinic,” Dr. Hill said. “Our patients don’t want to do that. They want to do medicine out of their houses or off their phones.”

He added that this also allows clinic visits to be more substantive, holistic and include discussion of a lifestyle plan.

Dr. Robinson agreed.

“Sometimes we focus on the physical aspects of the patient and do not realize or recognize that there are other components to that individual,” Dr. Robinson said. “It would be wonderful if we had the time to really meet the patients where they are and to be able to address their real concerns and what they perceive as being the best version of themselves or what they perceive their health goals are.”