Pilot Program Aims to Enrich Patient Care

News Article ImageA new clinical care option has been launched at the Emory Clinic. Emory Healthcare and the division of general medicine have partnered with Aetna to pilot a program called “Patient-Centered Primary Care” (PCPC). This approach to patient care is in conjunction with national efforts focused on the “Patient-Centered Medical Home.” 

“Research shows that the traditional methods of episodic care do not produce the best outcomes for patients, especially those patients with chronic disease conditions,” says Penny Castellano, MD, chief medical officer and chief quality officer for the Emory Clinic. 

“Patient-centered medical homes change the model so that we are rendering care continuously, not just while the patient is in the office for 15 minutes each year. Follow-up is much more proactive, and patients become active and astute in their care.”

The new practice is currently open only to Emory employees and their adult family members who are covered under Emory’s insurance program administered by Aetna. Certain patients with Medicare Advantage HMO/PPO membership, whose plan has agreed to participate in the pilot program, also can participate in Emory PCPC. Other insurance plans are expected to join the pilot program in the future. The pilot is expected to last 12-18 months, with contingencies to expand faster if there is demand and demonstrated results.

Patients participating in Emory’s medical home program enter into partnerships with intentionally designed care teams that include nurses, medical assistants and behavioral health specialists, led by their physicians.

The health care team acts as an extension of the physician before and after the office visit. The team monitors patient progress, identifies educational materials and opportunities, helps coordinate care with specialists and assists with transitions to and from other settings including the hospital or emergency room.

Physicians and the care team can correspond with patients by email through a secure online system called the Emory Healthcare Patient Portal. Patients can access the patient portal to receive test results, ask questions and receive answers in a timely fashion as well as view data from their medical records. Patients also can have clinical questions answered by booking a telephone appointment for a virtual visit. Additionally, same-day or next-day appointments for a clinic visit are available if needed. 

“The staff work as a team, and the patient is able to engage with all team members,” explains Castellano.  “Everyone becomes more efficient because the communication is better and the patient is engaged in the process.  Care is done with the patient, not to the patient.” 

The clinic area is designed for patient convenience and ease of communication for the care team. Clinic hallways with examination rooms are short and the rooms are arranged around workstations. Blood can be drawn conveniently in the suite. Although wait times are short, the waiting room is designed to be comfortable and private.

Emory Clinic primary care physicans Jennifer Zreloff, MD and Jason Higdon, MD, are the practitioners dedicated to the pilot program. Mental health providers are available.

“We are already seeing a lot of enthusiasm from both our patients and our providers,” says Castellano. “As the program continues, we expect to see better overall health outcomes in chronic disease conditions, less progression to severe disease states, less disability and less unnecessary costs to our patients.” 

“If the pilot practice succeeds we – and Aetna – have healthier patients while being responsible stewards of the cost portion of the equation by improving the outcomes without increasing the cost.”

For more information, visit www.emoryhealthcare.org/pilot


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.