Working Across Geographies to Share Ideas and Bring the Best Care to Patients


The Musculoskeletal Clinical Program, led by Hugh West, MD, Medical Director, is developing a model to better align clinicians and caregivers in musculoskeletal and orthopedic medicine around patients needing this specialized care. The model brings together teams, patients, and the best lessons learned from across our system to deliver extraordinary musculoskeletal and orthopedic care consistently throughout Intermountain—the best, safest, highest-quality, and most accessible and affordable care and great experiences—irrespective of where or when patients present.

Dr. West sat down recently with Mark Briesacher, MD, Senior VP and Chief Physician Executive for Intermountain and President of the Medical Group as well as Paul Krakovitz, Associate Medical Chief Officer for Specialty Care—to explain what his Clinical Program is doing to implement a One Intermountain model of care delivery.

In the Patient's Best Interest

The Musculoskeletal Clinical Program is bringing the various members of their teams into conversations with patients when it comes their course of treatment. This gives patients options—options other than surgery, which can be invasive, expensive, risky, and maybe even not the right course of action. Involving other members such as physical therapists in initial conversations with patients allows our patients to have generous time up front to best understand all the options and what may be most appropriate for their individual treatment plan. Surgeons have surgeon mentalities and may be predisposed to recommend surgery first, Dr. West says, which may not be in the best interest of the patient. However, physical therapy, nonsteroidal anti-inflammatory drugs, or other approaches, might.

According to Dr. Krakovitz, “We need to continue to educate to this model…showing how this improves the value to the patient, how we can take a patient who thinks they need to undergo a scary surgical procedure, and in the end, they may still require that surgery but [the conversation] gets them to a point where they’re ready for it and they know they’ve exhausted all their options. It takes education, it’s really starting with a thought leader like Dr. West, to get us to that point.”

Taking Time and Connecting Across Distances

Along with bringing clinicians involved in the specialty into the conversation early, at the most appropriate time for patients, Dr. West and his Clinical Program are also better aligning teams from within by holding weekly, highly organized, in-person and telepresence meetings. The meetings have been successful, with clinicians attending consistently. For these 45 minutes each week, the clinicians aren’t seeing patients, they’re not doing surgery, and they’re not making money. In essence they’re volunteering their time. So what is the value that these meetings bring?

Clinicians within the Musculoskeletal Clinical Program are participating, contributing, and connecting across great distances. “Clinicians have a latent hunger for learning, to be recognized by and to have dialogue with their peers,” says Dr. West.

“When they leave their training they become practitioners in isolation,” he says. For example, the Clinical Program had a goal last year to prevent venous thromboembolisms among their surgical patients. To identify what was being done already to prevent blood clots and the serious complication of pulmonary embolism, they asked 30 to 40 arthroplasty physicians what they were doing and got 30 to 40 different answers. “Over the course of the year,” says Dr. West, “through repeated touches on the subject at the weekly meetings we came to a consensus of what that care should be. That has not been built into the iCentra Power Plans yet, but just socializing the right care needed has reduced the incidence of pulmonary embolism dramatically in a very short period of time.”

Dr. West also provided an example of a total joint replacement surgeon in a rural hospital setting who, prompted by these weekly meetings, worked with the Clinical Program to set up a tour to see the care processes being followed in other parts of the Intermountain system. The physician shared with Dr. West that he got to know his fellow surgeons better, but even more valuable to the field trip was his ability to learn a better way of doing things and his eagerness to bring this to his own community.

“Our respect as an orthopedic group grows for each other with these meetings—we feel more comfortable having people we don’t work next to, on the peripheries of our system, taking care of patients rather than any past inclinations to send patients from all over, to Salt Lake,” says Dr. West.

Learn more about the Musculoskeletal Clinical Program’s new model of specialty alignment for care and their future continuous improvement plans by listening to the podcast here.