Dean History: 2000s- Dean - WI

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Dean Medical Group's History

A Tour Through The Decades

Dean History: 2000s

  • Today, the Madison East Clinic serves Madison’s east side and surrounding communities.
  • Located on the St. Mary’s campus in Madison, the Dean & St. Mary’s Outpatient Center provides expanded services to offer the best possible care at the lowest possible cost.
  • Dean acquired Northview Clinic in Janesville in 2001.
  • With demand increasing for uninsured patient specialty care, retired Dean Clinic physician Ernie Pellegrino founded the Benevolent Specialists Project (BSP) Free Clinic.

2000s: The Value Model of Care

When Joseph Dean began practicing medicine in Madison in 1904, he was a solo practitioner. When he retired in 1938, Dean Clinic had seven physicians and approximately the same number of support staff.

When the Dean Clinic celebrated its centennial in 2004, it had grown to include hundreds of physicians, thousands of other employees, a multispecialty network of clinics that spanned southern Wisconsin, and a health plan to provide insurance services as part of an integrated health system.

Dean Clinic marched full-speed ahead into the 21st century as it expanded its services and launched several quality improvement initiatives in its continued effort to provide the best possible patient care for the lowest possible cost.

In 2001, Dr. Ernie Pellgrino, retired Dean Clinic physician and former member of the board of advisors to St. Mary’s Hospital, founded the Benevolent Specialists Project (BSP) Free Clinic to provide specialty care for uninsured patients.Two new clinics and an outpatient center also in opened in Madison and Dean acquired Northview Clinic in Janesville.

Navitus was formed

In 2003, Dean Health Plan was a founder of Navitus Health Solutions, a pharmacy benefit management company (PBM) committed to lowering drug costs, improving health and providing superior customer service in a manner that instills trust and confidence.

Navitus was initially created in response to a request for proposals from the state of Wisconsin Employee Trust Fund to have one PBM manage their employees’ pharmaceutical-related needs rather than have each health maintenance company (HMO) or insurance company do so separately. At the time (and currently), Dean had the largest percentage of state employees of any HMO in Wisconsin, and so was particularly motivated to maintain management of this aspect of care for its patients.

Navitus negotiates rebates and discounts on behalf of its customers and passes those savings back, not marking up the cost for drugs it manages for its clients.

This new business venture flourished such that what was initially a Madison-based PBM that operated exclusively in Wisconsin has since grown to manage several million subscribers throughout the United States.

Improving quality and affordability

In 2003, Dean Clinic was also was one of the founding members of the Wisconsin Collaborative for Healthcare Quality (WCHQ), a voluntary consortium of health care organizations whose mission is to publicly report and bring meaning to performance measurement information that improves the quality and affordability of healthcare in Wisconsin.

WCHQ developed a unique set of care measures that enabled medical groups to collect and report data on all patients in their practice. Dean began using these measures to drive internal improvement efforts and reach across health care organizations, both sharing their knowledge and learning from the highest performers.

Dean specifically used WCHQ to drive improvement and efficiency in patient care through the dual mechanisms of performance measures and public reporting.

Metrics-based practices

As the decade progressed, Dean implemented metrics-based practices across the organization in an unprecedented fashion.

Not only were service-based best practices quantified to identify and implement those practices throughout Dean’s regional network of clinics, but patient satisfaction was incorporated and prioritized among these metrics. The steadfast goals remained serving the patients, improving quality and maintaining appropriate medical costs.

According to retired Chief Medical Officer Dr. Mark Kaufman, the result was “we now measure the outcomes of our care. We don’t just think we’re doing a good job. We know it. And, we also know places we ought to improve…to really believe we are patient-centered, we have to verify that. Metrics are the compass to get you to the direction you want to go.”

Value model of care

In conjunction with its commitment to participate in WCHQ, in 2005 Dean launched a new “value model of care” that has subsequently informed and improved practices across the Dean Health System. Dr. Kaufman explained, “It’s thinking about what you’re doing as a provider in driving toward higher-quality/best practice for lower-cost.”

The model is based on the premise that when you practice high-quality care, your costs go down. This is achieved through:

  • Measuring outcomes and related costs for every patient, and using this data to inform practices resulting in the highest quality of care at the lowest cost: Operationally, this means systematically identifying and employing evidence-based medicine and proven treatments and techniques that take into account the patients’ wishes and preferences. This component addresses the question “How can we know what works unless we measure our results and track them over time?”
  • Standardizing evidence-based best practices of care throughout the Dean Health System: A big driver for Dean has been to identify national research-based guidelines or care pathways that are identified as best practices and then to apply those best practices to every patient treated within the Dean system, regardless of which clinic they attend or physician or care team who manages their care. The value model embodies figuring out who’s doing what most effectively and generalizing it across the organization with the desire that the same benefit will be achieved throughout the system.

Since its implementation, the value-based model of care has contributed to measurably improving the delivery of care for Dean patients’ in cancer prevention, control of high blood pressure for all patients and specifically diabetic patients with hypertension, patient satisfaction and in many other areas.

Primary care redesign

In 2008, the value model led Dean Clinic’s administrative leadership to conclude that Dean was still not getting the kind of quality and results it wanted from primary care. As a result, Dean embarked upon a primary care redesign that has transformed the entire organization and continues to evolve today.

Dr. Kaufman explained, “Primary care redesign was really about looking at how we deliver care to all of our patients, [evaluating] care teams, satisfaction, quality outcomes, service outcomes, financial outcomes, and clinical effectiveness outcomes. So it really is a continuing process every day about how we run our primary care system.

“I think primary care redesign is one of, if not the most, critical pieces of clinical redesign that a health system has to undertake if you're going to get to that goal of flipping the paradigm from a sick model of care to more of a wellness and maintenance model of care."

Some of the main components of primary care redesign are:

  • Increase access patients have to their doctors and other primary care team providers.
  • Redefine team-based care so that physicians and other care providers effectively work together to coordinate the best management of patient needs and produce the most desirable clinical outcomes, with physicians leading the teams.
  • Improve the coordination of care within individual clinics and across Dean Health System, offering a consistent patient experience with standardized best practices across the entire system.
  • Continually quantify patient-centered care delivery to be able ensure that patients are receiving the highest quality care and are satisfied with the care they receive.
  • Focus particular attention on developing systems that support the higher need or acuity (sicker) patients.
  • Increase focus on prevention, wellness and early intervention.
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