Cleveland Clinic Launches New Primary Care Access Model in Florida

A new primary care access model launched by Cleveland Clinic’s Primary Care Institute in Florida shows early signs of reducing barriers to care and lessening the strain on caregivers.

The Clinical Access Team (CAT) program pairs a physician with advanced practice providers (APPs) to ensure patients have timely access to primary care services during episodes of acute need. Teams were established at Cleveland Clinic Martin Health and Cleveland Clinic Weston Hospital in August 2024, with a third team deployed this January at Cleveland Clinic Indian River Hospital.

“We want to make sure the patients knocking at our door are able to get in,” says Surendra P. Khera, MD, MSc, Vice-Chief of the Primary Care Institute for Cleveland Clinic in Florida. “When patients are unable to see their physician, they are more likely to visit an emergency room or urgent care clinic. That’s not just a more expensive venue for care but can accentuate the wait times in those venues for patients who may need more immediate and urgent attention.”

Dr. Khera is especially concerned with the plight of patients who over time have lost their primary care provider (PCP) and are then placed back in the queue in search of a new physician. He calls these patients “orphans,” a term that captures the dark reality of patients who have lost their PCP and therefore timely access to care.

Access barriers

Cleveland Clinic’s CAT program aims to overcome access barriers for patients currently without a PCP, those needing timely follow-ups after hospital discharge, and patients requiring annual wellness visits (AWVs). The teams also provide improved access for complex patients needing proactive care to reduce readmissions.

“Unlike other primary care models, the Clinical Access Team is not establishing its own group of patients but instead acting as an extension of care,” explains Dr. Khera. "Our model is shifting the status quo from a traditional PCP as the sole provider of primary care needs to an alternative that opens up much needed access for multiple visit types without interfering in the time-honored relationship between the patient and the physician.”

In addition to bridging care gaps that can arise from physician departures, scheduled absences and same-day callouts, he says the Clinical Access Teams are also helping reduce appointment wait times for new patients.

Lowering wait times

A recent “secret shopper” survey conducted by ECG Management Consultants (ECG), a U.S.-based healthcare consulting firm, found the national average wait time for family medicine appointments is 29 days, far above the traditional 14-day benchmark.

“In 2023, the average wait time for a new patient to see a Cleveland Clinic physician for a non-urgent primary care visit at one of our Martin Health locations was 6 times the national average,” reports Chessie Wheat, Senior Director of Cleveland Clinic’s Primary Care Institute in Florida. “We’ve now got it down to just 30 days, which is a huge achievement for our care teams and support staff in those offices.”

She adds that since July 2024, wait times for new patients seeking primary care appointments are down 66% across the five-hospital regional health system in southeast Florida.

Value-based visits

In addition to improving patient wait times, the CAT program is focused on ensuring value-based visits are completed on time, including follow-up appointments after hospital discharge and Medicare AWVs. Research has shown both types of visits improve patient outcomes and reduce cost of care.

For example, a 2019 study published in the American Journal of Managed Care demonstrated an average decrease in healthcare spending of $450 per year among patients in an accountable care organization (ACO) who received AWVs, due in part to fewer acute care and hospital outpatient visits.

“Wellness visits can lead to early detection of health issues and better management of chronic conditions,” says Dr. Khera. “The CAT program has helped our region achieve a high rate of annual wellness visits with over 65% of Medicare patients completing these visits.”

Nationally just 45% of Medicare beneficiaries living in the community in 2020 had an AWV, according to the most recent data available from the Centers for Medicare & Medicaid Services.

Another study recently published in Preventing Chronic Disease found that follow-up appointments after hospital discharge prevent readmissions and improve patient outcomes, especially for patients hospitalized for heart failure or stroke.

“As a high-occupancy center for tertiary care, Weston Hospital has a significant number of patients who can benefit from timely transitional care following their discharge,” says Dr. Khera. “Our CAT physicians prioritize discharge follow-ups for patients who do not have a primary care provider and those unable to see their regular physician in the desired 7 to 14-day window.”

He notes that in-person visits are preferred in these cases but that virtual visits may be offered to accommodate patients with social determinants that limit their ability to visit in person. “Our team is working on creative solutions to ensure patients have timely access to the care they need,” Dr. Khera adds.

Strategic staffing

The crises facing primary care nationally are many, but an underlying theme is the overall decrease in the number of clinicians choosing primary care as a career option. Factors contributing to this trend include clinician burnout.

“The excess workload of managing collateral work generated by the electronic health record results in the need for clinicians to work after work, what many of us call ‘pajama time work’,” says Dr. Khera.

To address this issue while bolstering communication with patients outside of a traditional office visit, Cleveland Clinic in Florida now uses an innovative team called “In-Basket Captains,” who work in parallel to the CAT to improve access. This team is staffed by APPs who triage and manage hundreds of messages from patients daily, which would have traditionally awaited the clinician to answer amid seeing patients.

“Now we have a concurrent team that takes care of in-basket requests even as our busy clinicians continue to do their regular work,” explains Dr. Khera. “Additionally, when a clinician is on vacation the IB Captain continues to manage the in-basket messages and requests for things like medication refill requests.”

Each of Cleveland Clinic’s three local markets in Florida has two designated IB Captains providing support with prescription refills, form management, and the monitoring of MyChart communications. These individuals provide wrap-around services that free up time for clinicians to spend more time providing direct patient care. “It’s a win-win for our patients and caregivers,” adds Wheat.

Weston Hospital and Martin Health also have Express Care teams consisting of nurse practitioners and physician assistants providing walk-in care services. They ensure Cleveland Clinic patients have same-day access to care for common medical issues, such as cold and flu symptoms, urinary tract infections, and digestive complaints, among others. Express Care Clinics are located on the main campus of Weston Hospital and at Martin Health outpatient facilities in Palm City and Port St. Lucie.

As an additional resource for patients with chronic medical conditions, Cleveland Clinic offers access to primary care pharmacists through Pharmaceutical Care Clinics. They assist with medication management and counseling, disease education, and other services.

Morale booster

According to Dr. Khera, the addition of the CAT program and other staffing initiatives has had a positive impact on staff morale. “Our primary care physicians can now return from vacation to find their in-baskets nearly empty, thanks to the in-basket captains, and they know that their patients have had their medical needs met in a timely manner,” he says.

Early caregiver feedback indicates that administrative teams have also benefited from the improved workload management and having greater resources available for assisting patients in need, shares Dr. Khera.

For more information, visit Cleveland Clinic Florida ConsultQD. Subscribe to the Florida Physician Newsletter.
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