Codman Square Health Center is moving toward a “team approach” to its patient care as part of a larger adjustment to major changes in the local health care sector, including last summer’s abrupt closure of Carney Hospital. The streamlining of services, with a pilot rollout in September, is part of an overall effort to manage a larger patient load, according to the center’s leadership.
The key change involves a shift from an older, fee-for-service model that focused on physicians seeing as many patients as possible and being paid on a per-visit basis, to what is known as a “capitation” model – a flat-fee-paid-per-patient team team approach that will include primary care, behavioral health, scheduling, nurses, and other providers.
(The Health Center is also planning to roll out a new mobile health care option with the expected launch of a mobile treatment van next spring. See related story on Page 12.)
Codman CEO Dr. Guy Fish said the change will launch in September as a pilot with three Family Medicine providers and be scaled up with the hope for a fully integrated care model for all patients within a year. He said the goal is to reduce administrative burdens, and “physician burnout” while improving quality of life for patients. “Both patient and physician will benefit from all of that,” he added.
Implementing the change will be two new Codman hires: Adela Tego, chief operating officer, and Alex Jean-Baptiste, chief nursing officer The center’s long-time chief medical officer, Renee Crichlow, will also be leading the effort.
“These three departments and heads of departments are working to re-define our care delivery system,” said Fish. “Our payment model right now seems to be geared toward how many patients a provider – mostly doctors – could see per hour. That’s not a good way of running a medical practice, especially when visits gets shaved down to 7 to 10 minutes per patient and then the additional administrative burden.
Tego told The Reporter that the capitation and team care model is not new, but rather something MassHealth has encouraged since 2023 after studies showed it yields better medical outcomes. However, it will be new for Codman.
“As we are transforming Codman, there will be a culture shift for the organization,” she said. “It is a huge change because Codman has had a reactive response to the community and patients and we’re shifting to a more proactive response…We’ve done a pulse check and what we are seeing is everyone is open for a change here and patients are up for change…Adding the integrated team approach will allow providers to build trust and will give patients more accessibility.”
The model is also centered on working with patients, particularly complex patients, to make sure they get well. Incentives are built into the system for positive outcomes for patients, ideally resulting in fewer visits.
“In capitation, if you manage patient health effectively, you will see a reduction in their visits, but their visits will be of a higher quality,” Tego noted.
For those using the health center, the changes will be obvious: The leader will be the primary care doctor whose team will include a medical assistant, nurses, and an administrative supporters involving position like an appointment scheduler. Once matters are fully integrated, the teams will include a clinical pharmacist and a behavioral health specialist.
Each patient will have the same providers who will meet once a week to discuss patients under their care. They will be tasked, Tego said, with overseeing everything, from outcomes to lab results, referrals, and outside challenges like transportation and food insecurity.
“We want them patients to stay with their team so they have these relationships with staff and providers every time they come in [so they will] feel comfortable,” she said.
Internally, the leadership team will run needs assessments frequently, and be working with Bay Cove Human Services to manage the new system.
Fish said he looks forward to seeing things blossom under the staff, providers, and administrators in the building since they should be able to take on a larger volume of patients while providing better quality care.
“There’s a lot of energy,” he said “in taking ownership and having the health center work to be able to deliver even better care than they have been delivering these past 44 years.”
