Kirkwood clinic shows Grady's new model of care

With its brick facade and colorful hallways, Kirkwood Family Medicine isn’t what Ava Mosley was used to when taking her four children to a Grady Health System clinic.

She doesn’t have to park far away and trek up a hill with her 5-year-old son to get there. It’s smaller and less noisy than the aging clinic it replaced.

“[It’s] a whole lot nicer,” she said.

The new facility is key in a larger effort by Grady -- which runs the state’s largest safety net hospital -- to transform its image from a place that treats only uninsured patients and trauma victims into a go-to option for primary care. It's also part of a trend aimed at lowering costs by better coordinating patient care.

Patients make appointments instead of just walking in; nurses call individuals after visits to follow up. Expanded services, including X-rays and an attached pharmacy, save people from having to drive to another location.

Designed like a private doctor’s office, the center is part of a major, new push to attract insured patients, who may not typically visit one of its clinics. Grady spends more than $200 million each year caring for the poor and uninsured.

“Once you get a patient into our system, they realize many of the perceptions were untrue,” said spokesman Matt Gove.

It also reflects a larger attempt nationwide to curb rising health care costs by better coordinating care and diagnosing diseases early -- keeping patients healthier and reducing costly emergency room visits and avoidable hospitalizations.

The patient-centered medical home concept emphasizes preventive care and better communication between primary care doctors and specialists. The new health care law has helped fuel the trend by encouraging the idea of paying providers based on overall quality of care, versus a fee for every test or procedure.

Safety net hospitals across the country are moving toward a patient-focused model, said Dr. Bruce Siegel, CEO of the National Association of Public Hospitals and Health Systems. Health care is increasingly expensive, in part, because it’s become so fragmented with people bouncing between clinics and doctors, Siegel said.

“No one reminds them to take their medications,” he said. “They don’t know who to turn to when they’re not feeling well, so they end up in the hospital.”

If safety net facilities can save money, it's a win for taxpayers, Siegel said. Many are also trying to attract more insured patients by growing new lines of business, such as cardiac care, he said, adding that the more competitive they become, the less they have to depend on the government.

For Grady, all of its neighborhood clinics will ideally look like Kirkwood one day, Gove said. It now has six clinics, following the closure of two facilities last month.

Situated east of downtown Atlanta, the 14,000-square-foot, roughly $1.3 million center replaced nearby DeKalb Grady Neighborhood Health Center, which had 21,000-plus patient visits last year.

A medical home is about better access for patients, which was a hurdle at DeKalb Grady, said Kirkwood medical director Karen Duncan. People had to walk up a big hill to get there and just wouldn’t come in bad weather, she said. The Kirkwood clinic is in a shopping center, with plenty of parking.

It also has more services in one location, including a full-service lab, eye exam rooms and a cardiac specialist who visits regularly. With the clinic's room to expand, Duncan said she's going into the community to learn what services neighbors want. Podiatry or urgent care may be options, but it’s about what people need, she said. The center also has a partnership with Peachtree Hope Charter School in the same complex.

“Grady sites have always been in the community but not part of the community," she said.

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