August 2022
Rob Chamberlin, MD, the CMO of the MaineHealth ACO, introduces new tools available to MaineHealth providers and practices to help plan and complete Medicare annual wellness visits. Plus, Carrie Gordon, MD, updates us on the Let’s Go childhood obesity prevention program.
Additional Information
AWV resources on the MaineHealth Medical Group intranet page
Julie: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a neighborhood potluck monthly podcast for health care providers. I'm Julie Grosvenor.
Mike: You know, a potluck sounds really nice, Julie.
Julie: It does.
Mike: It does. And I should say, I'm Mike Clark. Julie and I are practicing physicians and liaisons with MaineHealth ACO.
Julie: That's right. In this episode, we'll get an update on childhood obesity prevention from the MaineHealth Let's Go! program.
Mike: Yes. But first, we check in with our own Rob Chamberlin, the ACO's chief medical officer, to learn what new tools are available to help physicians complete the all-important Medicare annual wellness visits.
Julie: That's right. So we've got an action-packed episode, so let's dive right in.
Mike: Welcome to our Meaty Topic for this month. As many ACO participants know, especially primary care folks, annual wellness visits are all the rage right now in value-based care circles. These AWVs, as they're called, are the health maintenance visits, during which patient and physician review a health risk assessment form. They also fill in documentation gaps, review screenings, and generate a wellness plan that patients can take home with them.
Julie: AWVs have been shown to improve the rate at which patients complete preventive screenings, so that's a good thing. They can also improve documentation that's useful for pre-visit planning or to streamline referrals. And from a value-based care perspective, they help provide Medicare with important data that lets them set reasonable cost and quality benchmarks for us.
Mike: That's right. So, it turns out AWVs are valuable for everyone, and establishing them as a regular item in the practice, however, can be a challenging workflow. So here to tell us what tools are out there to make AWVs easier is Dr. Rob Chamberlain, chief medical officer of the MaineHealth ACO. Welcome, Rob.
Rob: Thanks, Mike. It's good to be here again.
Julie: Well, we're glad to have you. So, Rob, you heard our little introduction there. So is there more to add about why AWVs are important right now?
Rob: You know, the AWVs, I think, are really important right now because they're just such a good anchoring visit. And by that, I mean they're different from any other visit that we do as PCPs, and because of that, we can build out infrastructure and support and systems to make these really valuable for patients first, but also really valuable for us as PCPs and our whole care team. And as much as we're moving more and more towards value-based care, I think having this type of a unique visit around which we can build systems and support structures is really important.
Mike: So that makes sense. But, you know, as a fellow primary care doc, I find those visits sometimes overwhelming and saturated, so to speak. So, let's kind of cut to the chase. What tools are currently available to MaineHealth docs and practices out there that might make AWVs a little easier?
Rob: It's a good question, Mike. And you're right. When we have a lot asked of us, it can feel overwhelming. And to the credit of MaineHealth, they really have invested a lot in supporting us, the primary care teams, in these visits. So I'll briefly organize that around the idea of people, processes and technology. So MaineHealth is invested in people to do a lot of pre-visit planning for us before the visit. So we have a whole team of nurses who will go through a chart and pre-visit plan for me before my patient comes in. And we also are now paying for some doctors, actually, as part of our agilon partnership, to go through and do some pre-visit planning for us. In terms of processes, there's a group across the whole MaineHealth Medical Group that's looking at all kinds of workflows and functions such as patient identification, outreach, communications, scheduling, documentation. So there's a whole team that's looking to align all those processes so that they work much more smoothly for us. And then, in terms of technology, the Epic team here at MaineHealth has really done a fantastic job, so that, in the ideal workflow, a patient will be able to get their health risk assessment through MyChart ahead of the visit. When they come in and check-in that information just flows right into the office visit note. All these tools for functions that really help provide high-quality care for our patients, the 4 Ms which our geriatric team really helps us build out, advance care planning, all the appropriate screenings. It's kind of all right there built into the template note within Epic. So we really have a lot of people, processes and technologies to help us with these visits.
Julie: Well, that sounds great. Is there any particular advice you have for non-MaineHealth practices or providers who maybe don't have access to those tools?
Rob: So, I see my patients within the MaineHealth system, but I would say that St. Mary's also uses Epic, and so some of the same capabilities that we've leveraged within our Epic systems here I would believe might be available to the St. Mary's care teams, although I haven't worked within the St. Mary's system, so I don't know how their Epic is built out. For our private practice PCPs, I often think about Mike Clark and how engaged he is with his practice and how they can just pivot on a dime and kind of this idea of a team sport they really exemplify. And so the AWV really is about getting the whole team involved. And so as a private practice PCP, you can quickly iterate with your MA and with your medical secretary, and the whole team to figure out what workflows can work best to support patients and to support you as you're doing these AWVs for your patients.
Mike: You know, I have to agree. I always say that my best work is usually done in collaboration with my MA and my front desk. So you really do need the whole team to be successful. So, personally, Rob, from a practicing physician's perspective, what do you like about AWVs?
Rob: Yeah, at the risk of sounding like I'm just drinking the Kool-Aid, I actually really love AWVs. For me, because they are different and they're unique from any other visit, it's just a different type of conversation with a patient. So, for example, I have a clinic schedule pulled up here and if I look through the patients who are coming in, I have a patient coming in for anxiety. Then another one is coming in for hyponatremia and lymphadenopathy and then anemia, then leg swelling, and then the one after that for emphysema, CKD, neuropathy. And then I have someone who's in there for an annual wellness visit. When I see that, I'm like, Oh, that's a visit where I'm going to be able to pause a little bit. I'm going to be able to step back, think a little bit more broadly. You go to bed worrying about the things you missed. This is a chance where I can go through and say, Okay, am I missing anything? Is there anything I haven't talked with the patient about yet this year? Are there quality gaps that I haven't closed? And then I get back into the next patient, after that is high pain and elevated ferritin, and then it goes back on to kind of the regular cadence of primary care, which is great in its own ways, but I just really value that annual wellness visit. Have a different type of visit have a different type of conversation with the patient.
Julie: Great. Well, Rob, we really appreciate you joining us, and we thank you for your insights.
Rob: Thank you, Julie. It's really appreciated. Appreciate the opportunity to be here.
Mike: Thank you, Rob. And we'll provide links to AWV resources on the web page for this episode. Go to MaineHealthACO.org/BACON and look for episode 40.
Julie: Welcome to the Sizzle, our segment on ACO participants doing good work both inside and outside of work. This month, our producer Paul Santomenna spoke with Dr. Carrie Gordon. Carrie is with Maine Medical Center's Weight and Wellness Center, and shared the latest on the Let's Go! Childhood Obesity Prevention Program.
Paul: So, Carrie, tell us a little bit about Let's Go! Just a reminder about what Let's Go is all about.
Carrie: Well, Dr. Tory Rogers started the Let's Go! Program many years ago, and its primary focus is on prevention of childhood obesity, and especially over the more recent years, she's expanded a lot of her project work into helping people better treat childhood obesity and has branched into even adults with obesity with her healthy eating and active living program. So it's a wonderful place where she tries to connect not only with health care practices but also with schools, with aftercare programs. And really over the years, she's done a lot of different innovative things to try to help support not only people who struggle with obesity but also the people who are taking care of them.
Paul: Mm-hmm. So what are the current strategies that Let's Go! Is using around childhood obesity and obesity in general?
Carrie: You know, the bullet strategies have been pretty consistent over the years with the 5210 messaging. And I think really looking at how you put those things into action. You know, she's done lots of different projects. But so, for those who don't remember, I think most people, most kids who come into clinic already know what the 5210 strategies are. But making sure you're getting five servings of fruits and vegetables every day, you're getting at least, sorry, you're getting only 2 hours of screen time. You're getting at least one hour of activity. And we're not having sugary drinks and beverages every day. That's our zero.
Paul: So give us a little background now on the prevalence of childhood obesity right now. Have there been changes over the years?
Carrie: Yeah, there's a lot of really interesting data. I'm not a data person, but I know you guys wanted to talk about data today, so I did pull up some stuff that's current. So interestingly, during the pandemic, the rate of obesity among children aged 2 to 19 increased from 19.3% to 22.4%. And that's national data, which also coincides with our rates of type two diabetes, which has increased during the pandemic and children, is pretty concerning. I wouldn't be surprised if that was also the case for other the other comorbidities that we see. And interestingly, in the US, childhood obesity alone is estimated to cost about $14 billion in direct health expenses. Just I can imagine the numbers for adults if this is what we have for children. And you know if you're looking at Maine specifically, you know, we're our rate in Maine is closer to 14.9% and about in high school age students. And to put that into perspective, the lowest state is Utah, which was 9.8%, and the highest rate was in Mississippi, which is 23.4%.
Paul: Tell me a little bit about how you work with and support primary care providers and pediatricians since they're sort of on the front lines here.
Carrie: Yeah. I think because Tory, who started Let's Go!, was a primary care pediatrician when she developed all this. That's really one of her most passionate areas. And I think that's one of the reasons why I really wanted to work with Let's Go!, because even working in the obesity program and that's my job now, is clinical obesity work in pediatrics. It's so challenging because we don't have all the resources we need, even when you're working in the setting where that's my focus. And so I think, you know, especially during the pandemic, we keep asking more and more and more of primary care so how we can make these things easier and more comfortable and help resources be developed, the better we're going to do. And so like this year we did a Project Echo and I think Educational Focus, I think, is also a strategy that we're going to be working on next year, but we're going to do it in a different way, and that's still sort of being developed. But looking at what educational tools we can have for people who want to learn more about the physiology of obesity and the tools, the new medications that we're using now to treat obesity, which can really improve our effectiveness. You know, we're going to start doing a trial with a virtual dietitian and we're going to start with a small number of practices. But hopefully, that will expand because, you know, working with primary care in our Echo, we heard some primary care docs from certain areas of the state felt that their dietitians locally didn't have a strong interest or maybe the skill set needed to do a really good job with children with obesity. And so trying to have a dietitian who's done motivational interview training, who knows a lot specifically about obesity care, who can support these patients from across the state in a virtual capacity. That's just another one of the tools that we've been looking at and, you know, making sure we're linking to what the AAP recommendations are, which they're coming out with some new guidelines this year and making sure our clinical strategies that we've developed through Let's Go! are matching, you know, sort of the national recommendations. So all that stuff.
Paul: So if folks want to find out more about Let’s Go! or find resources on this topic, where can they go?
Carrie: The Let's Go! website is a great place to find things, including things like the conference registration. There's also, if you have specific questions, there's so much on the website. If you have any trouble, there's a contact link where you can send an email in. And I never mind if people email me, I'm in the MaineHealth database. Carrie.Gordon@mainehealth.org. if you have any questions, if there's anything more that wasn't clear or you want to be connected with the right person.
Paul: Yeah. We'll provide a link to the website on our podcast web page, too.
Carrie: Great
Paul: Great, Well, thanks. Thanks for taking the time, Carrie.
Carrie: No problem.
Carrie: And good work. Thank you.
Carrie: Yeah, there's always lots of exciting stuff to do.
Paul: Just a quick postscript to our interview with Carrie. If you're a practice interested in becoming a Let's Go! Partner, you can go to the clinical setting page of the Let's Go! website and you can fill out a contact form and request resources. Partners get access to online training and workshops as well as tool kits and more.
Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. And if you have questions, comments or suggestions, we'd love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.
Julie: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thank you for joining us. We'll see you next month.
Mike: See you next month.
Mike: You know, a potluck sounds really nice, Julie.
Julie: It does.
Mike: It does. And I should say, I'm Mike Clark. Julie and I are practicing physicians and liaisons with MaineHealth ACO.
Julie: That's right. In this episode, we'll get an update on childhood obesity prevention from the MaineHealth Let's Go! program.
Mike: Yes. But first, we check in with our own Rob Chamberlin, the ACO's chief medical officer, to learn what new tools are available to help physicians complete the all-important Medicare annual wellness visits.
Julie: That's right. So we've got an action-packed episode, so let's dive right in.
Mike: Welcome to our Meaty Topic for this month. As many ACO participants know, especially primary care folks, annual wellness visits are all the rage right now in value-based care circles. These AWVs, as they're called, are the health maintenance visits, during which patient and physician review a health risk assessment form. They also fill in documentation gaps, review screenings, and generate a wellness plan that patients can take home with them.
Julie: AWVs have been shown to improve the rate at which patients complete preventive screenings, so that's a good thing. They can also improve documentation that's useful for pre-visit planning or to streamline referrals. And from a value-based care perspective, they help provide Medicare with important data that lets them set reasonable cost and quality benchmarks for us.
Mike: That's right. So, it turns out AWVs are valuable for everyone, and establishing them as a regular item in the practice, however, can be a challenging workflow. So here to tell us what tools are out there to make AWVs easier is Dr. Rob Chamberlain, chief medical officer of the MaineHealth ACO. Welcome, Rob.
Rob: Thanks, Mike. It's good to be here again.
Julie: Well, we're glad to have you. So, Rob, you heard our little introduction there. So is there more to add about why AWVs are important right now?
Rob: You know, the AWVs, I think, are really important right now because they're just such a good anchoring visit. And by that, I mean they're different from any other visit that we do as PCPs, and because of that, we can build out infrastructure and support and systems to make these really valuable for patients first, but also really valuable for us as PCPs and our whole care team. And as much as we're moving more and more towards value-based care, I think having this type of a unique visit around which we can build systems and support structures is really important.
Mike: So that makes sense. But, you know, as a fellow primary care doc, I find those visits sometimes overwhelming and saturated, so to speak. So, let's kind of cut to the chase. What tools are currently available to MaineHealth docs and practices out there that might make AWVs a little easier?
Rob: It's a good question, Mike. And you're right. When we have a lot asked of us, it can feel overwhelming. And to the credit of MaineHealth, they really have invested a lot in supporting us, the primary care teams, in these visits. So I'll briefly organize that around the idea of people, processes and technology. So MaineHealth is invested in people to do a lot of pre-visit planning for us before the visit. So we have a whole team of nurses who will go through a chart and pre-visit plan for me before my patient comes in. And we also are now paying for some doctors, actually, as part of our agilon partnership, to go through and do some pre-visit planning for us. In terms of processes, there's a group across the whole MaineHealth Medical Group that's looking at all kinds of workflows and functions such as patient identification, outreach, communications, scheduling, documentation. So there's a whole team that's looking to align all those processes so that they work much more smoothly for us. And then, in terms of technology, the Epic team here at MaineHealth has really done a fantastic job, so that, in the ideal workflow, a patient will be able to get their health risk assessment through MyChart ahead of the visit. When they come in and check-in that information just flows right into the office visit note. All these tools for functions that really help provide high-quality care for our patients, the 4 Ms which our geriatric team really helps us build out, advance care planning, all the appropriate screenings. It's kind of all right there built into the template note within Epic. So we really have a lot of people, processes and technologies to help us with these visits.
Julie: Well, that sounds great. Is there any particular advice you have for non-MaineHealth practices or providers who maybe don't have access to those tools?
Rob: So, I see my patients within the MaineHealth system, but I would say that St. Mary's also uses Epic, and so some of the same capabilities that we've leveraged within our Epic systems here I would believe might be available to the St. Mary's care teams, although I haven't worked within the St. Mary's system, so I don't know how their Epic is built out. For our private practice PCPs, I often think about Mike Clark and how engaged he is with his practice and how they can just pivot on a dime and kind of this idea of a team sport they really exemplify. And so the AWV really is about getting the whole team involved. And so as a private practice PCP, you can quickly iterate with your MA and with your medical secretary, and the whole team to figure out what workflows can work best to support patients and to support you as you're doing these AWVs for your patients.
Mike: You know, I have to agree. I always say that my best work is usually done in collaboration with my MA and my front desk. So you really do need the whole team to be successful. So, personally, Rob, from a practicing physician's perspective, what do you like about AWVs?
Rob: Yeah, at the risk of sounding like I'm just drinking the Kool-Aid, I actually really love AWVs. For me, because they are different and they're unique from any other visit, it's just a different type of conversation with a patient. So, for example, I have a clinic schedule pulled up here and if I look through the patients who are coming in, I have a patient coming in for anxiety. Then another one is coming in for hyponatremia and lymphadenopathy and then anemia, then leg swelling, and then the one after that for emphysema, CKD, neuropathy. And then I have someone who's in there for an annual wellness visit. When I see that, I'm like, Oh, that's a visit where I'm going to be able to pause a little bit. I'm going to be able to step back, think a little bit more broadly. You go to bed worrying about the things you missed. This is a chance where I can go through and say, Okay, am I missing anything? Is there anything I haven't talked with the patient about yet this year? Are there quality gaps that I haven't closed? And then I get back into the next patient, after that is high pain and elevated ferritin, and then it goes back on to kind of the regular cadence of primary care, which is great in its own ways, but I just really value that annual wellness visit. Have a different type of visit have a different type of conversation with the patient.
Julie: Great. Well, Rob, we really appreciate you joining us, and we thank you for your insights.
Rob: Thank you, Julie. It's really appreciated. Appreciate the opportunity to be here.
Mike: Thank you, Rob. And we'll provide links to AWV resources on the web page for this episode. Go to MaineHealthACO.org/BACON and look for episode 40.
Julie: Welcome to the Sizzle, our segment on ACO participants doing good work both inside and outside of work. This month, our producer Paul Santomenna spoke with Dr. Carrie Gordon. Carrie is with Maine Medical Center's Weight and Wellness Center, and shared the latest on the Let's Go! Childhood Obesity Prevention Program.
Paul: So, Carrie, tell us a little bit about Let's Go! Just a reminder about what Let's Go is all about.
Carrie: Well, Dr. Tory Rogers started the Let's Go! Program many years ago, and its primary focus is on prevention of childhood obesity, and especially over the more recent years, she's expanded a lot of her project work into helping people better treat childhood obesity and has branched into even adults with obesity with her healthy eating and active living program. So it's a wonderful place where she tries to connect not only with health care practices but also with schools, with aftercare programs. And really over the years, she's done a lot of different innovative things to try to help support not only people who struggle with obesity but also the people who are taking care of them.
Paul: Mm-hmm. So what are the current strategies that Let's Go! Is using around childhood obesity and obesity in general?
Carrie: You know, the bullet strategies have been pretty consistent over the years with the 5210 messaging. And I think really looking at how you put those things into action. You know, she's done lots of different projects. But so, for those who don't remember, I think most people, most kids who come into clinic already know what the 5210 strategies are. But making sure you're getting five servings of fruits and vegetables every day, you're getting at least, sorry, you're getting only 2 hours of screen time. You're getting at least one hour of activity. And we're not having sugary drinks and beverages every day. That's our zero.
Paul: So give us a little background now on the prevalence of childhood obesity right now. Have there been changes over the years?
Carrie: Yeah, there's a lot of really interesting data. I'm not a data person, but I know you guys wanted to talk about data today, so I did pull up some stuff that's current. So interestingly, during the pandemic, the rate of obesity among children aged 2 to 19 increased from 19.3% to 22.4%. And that's national data, which also coincides with our rates of type two diabetes, which has increased during the pandemic and children, is pretty concerning. I wouldn't be surprised if that was also the case for other the other comorbidities that we see. And interestingly, in the US, childhood obesity alone is estimated to cost about $14 billion in direct health expenses. Just I can imagine the numbers for adults if this is what we have for children. And you know if you're looking at Maine specifically, you know, we're our rate in Maine is closer to 14.9% and about in high school age students. And to put that into perspective, the lowest state is Utah, which was 9.8%, and the highest rate was in Mississippi, which is 23.4%.
Paul: Tell me a little bit about how you work with and support primary care providers and pediatricians since they're sort of on the front lines here.
Carrie: Yeah. I think because Tory, who started Let's Go!, was a primary care pediatrician when she developed all this. That's really one of her most passionate areas. And I think that's one of the reasons why I really wanted to work with Let's Go!, because even working in the obesity program and that's my job now, is clinical obesity work in pediatrics. It's so challenging because we don't have all the resources we need, even when you're working in the setting where that's my focus. And so I think, you know, especially during the pandemic, we keep asking more and more and more of primary care so how we can make these things easier and more comfortable and help resources be developed, the better we're going to do. And so like this year we did a Project Echo and I think Educational Focus, I think, is also a strategy that we're going to be working on next year, but we're going to do it in a different way, and that's still sort of being developed. But looking at what educational tools we can have for people who want to learn more about the physiology of obesity and the tools, the new medications that we're using now to treat obesity, which can really improve our effectiveness. You know, we're going to start doing a trial with a virtual dietitian and we're going to start with a small number of practices. But hopefully, that will expand because, you know, working with primary care in our Echo, we heard some primary care docs from certain areas of the state felt that their dietitians locally didn't have a strong interest or maybe the skill set needed to do a really good job with children with obesity. And so trying to have a dietitian who's done motivational interview training, who knows a lot specifically about obesity care, who can support these patients from across the state in a virtual capacity. That's just another one of the tools that we've been looking at and, you know, making sure we're linking to what the AAP recommendations are, which they're coming out with some new guidelines this year and making sure our clinical strategies that we've developed through Let's Go! are matching, you know, sort of the national recommendations. So all that stuff.
Paul: So if folks want to find out more about Let’s Go! or find resources on this topic, where can they go?
Carrie: The Let's Go! website is a great place to find things, including things like the conference registration. There's also, if you have specific questions, there's so much on the website. If you have any trouble, there's a contact link where you can send an email in. And I never mind if people email me, I'm in the MaineHealth database. Carrie.Gordon@mainehealth.org. if you have any questions, if there's anything more that wasn't clear or you want to be connected with the right person.
Paul: Yeah. We'll provide a link to the website on our podcast web page, too.
Carrie: Great
Paul: Great, Well, thanks. Thanks for taking the time, Carrie.
Carrie: No problem.
Carrie: And good work. Thank you.
Carrie: Yeah, there's always lots of exciting stuff to do.
Paul: Just a quick postscript to our interview with Carrie. If you're a practice interested in becoming a Let's Go! Partner, you can go to the clinical setting page of the Let's Go! website and you can fill out a contact form and request resources. Partners get access to online training and workshops as well as tool kits and more.
Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. And if you have questions, comments or suggestions, we'd love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.
Julie: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thank you for joining us. We'll see you next month.
Mike: See you next month.