Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

Letters - Examiner – Vital Signs
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Questions from
Kevin King
Editor, Beaumont Business Journal
Editor, Vital Signs
The Examiner Corporation

  1. You recently received the inaugural Patient-Centered Medical Home Practice Award in Washington, D.C. Talk about the experience and what the award meant to you.

    One of the things that SETMA has done well, in my opinion, is to let healthcare providers see that they are involved in something larger, that being the transformation of healthcare in America.  This motivates all of us to work hard to improve the care our patients receive.

    This link takes you to an article about the PC-PCC award and a picture of the award itself:  The Patient-Centered Primary Care Collaborative and SETMA

    The following is the text of my acceptance speech which answers this question in detail:

    David Nace, MD Chairman of the Board: This year the PC-PCC will present two new awards that recognize leadership in the area of primary care and the patient center medical home. The patient center medical home practice award recognizes exemplary medical home practice committed to primary care that is patient centered or made it more accessible and which is committed to quality and safety.  The Southeast Texas Medical Home Associates led by Dr. James Holly, the founder of SETMA and chief executive officer today has gone above and beyond to make medical home a reality for all of their patients and family.

    Julie Schilz, Well Point: Our awardee tonight is Larry Holly and I will tell you a lot about him and then I will tell you about how I know him.  Dr. Holly is the founder and chief executive officer of Southeast Texas Medical Associates (SETMA) and always the leader.  In 1998 when EHR’s were coming out he got on the bandwagon and started to implement, and when he implemented the EHR he did not go half way.  SETMA has earned numerous awards, awards from HIMSS, awards from Stories of Success, eHI.   SETMA is a Best Practice Group, associated with the Robert Wood Johnson Foundation LEAP study.  And, because everything is bigger in Texas, Dr. Holly and SETMA has achieved --  and SETMA is the only organization in the country to achieve -- multiple recognitions from multiple organizations around patient-centered medical home.  I think that is worth something.   SETMA not only earned NCQA, PCMH Level 3, but also AAAHC, URAC, and The Joint Commission accreditations in PC-MH and Ambulatory Care. 

    I got to know Dr. Holly the best from his incredible writing.  For sixteen years, he has been writing a weekly article about creating a healthy healthcare delivery system.  I probably saw the first article around 2008 and that’s how I got to know him.  I e-mailed him “Julie from Colorado” and I said, “Can I share this?”  it was such a powerful message of leadership transforming primary care, it had all the elements of being patient and family centered and how to organize care delivery.  Then the next thing he would do is write about the systems and structures that they were putting into place.   So “Julie from Colorado” e-mails him and said, “You’re doing some fantastic work, can I see it? 

    What did he do?  He opened up his website and said, “Here is our link; you can have anything, we are open, we are transparent, we will share everything.”   I think that is such a model for this work.  The collaborative work, the collaborative nature and so on behalf of PC-PCC, I am pleased to present Dr. Holly and Southeast Texas Medical Associates with the PC-PCC’s first Patient Centered Medical Home Practice Award for the exceptional dedication to achieving the Triple Aim.  SETMA focus was on integrating the state of art health technology across all of SETMA’s sites, hospitals, nursing homes, hospice, home health,, physical therapy, etc.  This was a mean for transforming care delivery and for teaching all of us what they have learned along the journey, openly and transparently and collaboratively.

    David Nace, MD Chairman of Board PC-PCC: Holding up the award, Dr. Nace said, “This is very precious, I am going to protect it for him for just a few minutes.”

    Dr. Holly: Thank you very much.  You are very kind and I’m honored to be here.  This honor brings to mind several things; one is that the first chapter in a book I’m writing on the “Developmental history of SETMA” is on  “Team Work” which is the foundation of everything we do.  In my previous career I did a Masters Degree in History and was going to do a PHD in History before I fell upon the evil times and became a doctor.  This developmental history is not a chronological history, but it is an attempt to describe what has taken place in SETMA for us to do the things we have done. 

    Before there was an EMR, before there was electronic patient management, before there was clinical decision support, before there was patient-centered medical home, before there was disease management and tools, and before there was public reporting by provider name on our website, there was a team.  We discovered that the foundational principle of transforming health care is the respect and honor we pay one another and it is when we appreciate the contribution of everyone,  regardless of  academic background.  We attempted to integrate that team in a significant way to create a continuity of care, and a collaborative and collegial team.   We did use terms like physician extenders for nurse practitioners;, we used terms like colleague and healthcare provider.   My wife is sitting here tonight.  Her healthcare provider is a nurse practitioner, as is mine.  They just happened to be the smartest people in our practice. 

    Other than the developmental history and the team concept, this award and this evening also brings to mind the wisdom of a friend of mine that told me once that “flattery must be corrected”.  When somebody says that you’re very bright, or you’re very pretty, or you’re very handsome, or you’re very strong, rather than becoming arrogant or prideful, you should say, “You know I thank you for that compliment, but I didn’t do anything to get those things, God gave them to me, or my parents gave them to me.  We don’t let flattery turn our head because it can change who we are and what we are.

    Secondly, he said, when you are praised, you need to deflect that.  There are many people who have  contributed to our life’s:  our parent’s, our families, my wife of 49 years, 3 months, six  days and 11 hours.  Others have contributed to our lives:  our children, our teachers and particularly my medical school which is the University of Texas Health Science Center in San Antonio.  Dr. Carlos Jaen, who is the Chairman of the Department of Family and Community Medicine under whom I have the pleasure of serving on the adjunct faculty, our colleagues and our partners. 

    These are the people that contribute to what we are and to what we achieve.  they deserve a great deal of the praise, a great deal of the honor and recognition of what we have been able to achieve.  There are also visionaries, that is people that have a unique passion, such as Dr. Paul Grundy, who trots the globe -- I think he uses Santa Clauses sleigh --  to do all the stuff he does.  There are many others that I could mention as well, but I mentioned Paul because he is the genius behind PC-PCC originally.   It was his vision which brought us to this day.  Visionaries are people that have a mental image of the future they want to create.  They have a very honest way of looking at current reality.  And, the difference between reality and vision is what Peter Senge called “creative tension” that makes you get up early in the morning and work hard all day, falling in bed exhausted at night and you just can’t wait to get up the next morning. 

    I get up early but I would get earlier if I didn’t have a wife laying there saying you put one foot on the floor and you are a dead man.  So I spend more time in the bed simply because she won’t let me get up as early as I want to get up and it’s a great partnership.  So the wisdom of sharing the praise is so critical, because yesterday was Veterans Day and my wife and I spent a good part of the day in Arlington National Cemetery.  I remember the lesson about sharing your praise and also being worthy of the sacrifice others make to enable us to do what we do.  Do you remember the movie, Saving Private Ryan?  You  may remember the most poignant part of that movie.  My wife and I visited the American Cemetery in Normandy, it was breathtaking to see the marbled stones saying Here lies a comrade in arms Known but to God.  If that doesn’t take your breath away, I don’t know what will.

    Forty years after D-Day, Private Ryan  visited the grave of Capt. Miller, the man who saved Ryan’s life by giving his own.  Private Ryan stood before Miller’s tombstone.  As he looked, his knees gave way and he crumbled to the ground pleading with his wife, “Tell me that I have been a good man; tell me that have I lived a life worthy of the sacrifice that Captain Miller gave to give me a chance to have a life.”.

    Most of us will never owe a debt of gratitude as dramatic as this but there are many people that have given their professional life’s, their intellect , their emotions, their brilliance, many people that have given their compassion and their hope and their trust, many people have given their encouragement to allow SETMA and me to do the things that we have done.  I have the great honor of having been a physician and there is no greater honor in my judgment on the earth.  But that honor was given to me by others.  I love what SETMA has done, I love that PC-PCC has given the road map to us and others.

     I am grateful for this award and I receive it for all those legions of people that should be here tonight lined up around this room 16 or 17 times, in order to recognize the value of what they have done.  Universal American’s executives are here and I would embarrass myself by to trying to name all of them but these are people that I have worked with for 19 years to provide excellent care to the poorest and the neediest people in our community.  To others who have come to this presentation, I thank you. 

    I am grateful, I wish I had a funny story to tell you but this occasion just seems too solemn to me to be humorous.  SETMA receives this honor with gratitude not with arrogance or pride, but with humility and gratitude.  Out of gratitude comes diligence, discipline and determination to continue to do what we are doing, to do it better next year than we have done it this year, and the year after that to do it better still.  Until I have drawn my last breath upon this earth I shall press forward and  if I do not there will be a still small voice right behind me, the voice of Paul Grundy saying, “Larry get up and do more. “ 

    Thank you and God bless you all; I appreciate this honor.

  1. In March you will be speaking at the Medical Home Summit in Philadelphia as pre-conference chair. What will be the purpose of SETMA’s presence at the summit?

    Many groups have come to SETMA to learn how to do what we have done.  We have had groups from Mainland China, we have a group coming from Australia, Baylor/Scott and White, Kelsey Seybold, multiple Schools of Medicine including University of Texas and Texas A&M.  In addition, SETMA has a Patient-Centered Medical Home Externship for Senior Medical Students and Primary Care Residents where they spend a month at SETMA to learn about PC-MH.

    Because of SETMA’s accomplishments, being the ONLY practice in America which has revived accreditation by all four accrediting organizations - Joint Commission (JACHO), National Committee for Quality Assurance (NCQA), URAC , Accreditation Association for Ambulatory Health Care (AAAHC) - a great deal of interest has come our way.

    I am invited to tell SETMA’s story all over the country. When this invitation came, I thought about taking members of SETMA’s accreditation team   This is unique in healthcare and others are wanting to learn about our approach.  Accreditation by the above has to be renewed every three years.  The only way we can maintain that without it interfering with our practice is to systemize the effort.  SETMA also has a Community Council where patients are invited to meet to discuss healthcare and SETMA; the following link is to an article about the Council:  SETMA's Patient-Centered Medical Home and the Consumer Council.  We will be taking three patients with us to discuss their participation.  The following link is to the faculty for the Philadelphia conference.:

  1. How did the invitation to the summit come about?

    This is a link to the full brochure for the conference.  It is co-hosted by PC-PCC with whom we are involved:  The Seventh National Medical Home Summit 2015.  Also, Raymond Carter is the Conference Coordinator of the Seventh National Medical Home Summit and the Editor of Medical Home News for whom I have written frequently.  He and the CEO of PC-PCC were the ones who invited me to be involved which expanded to our team being involved as I wanted to showcase them.

  1. Is this your first time speaking at the summit?Yes
  1. Talk about the significance of the summit within the medical industry.
    • There is no industry which has more conference than healthcare.  Part of that is our continuing requirement to earn Continuing Medical Education (CME) credits, but also because no industry is changing more rapidly.
    • This link is to a discussion of the penetration of medical home in the United States: Penetration of PC-MH as of September 30, 2014.  There are appropriately 661,400 physicians practicing in the USA.   With 246,090 in primary care and 45,107 working in PC-MH practices, 18.33% of primary care physicians are participating in Patient-Centered Medical Homes.
    • This is one of the principle conferences for the promotion of the PC-MH practice method. 
  1. What topics will you be discussing?

    SETMA’s Team will be conducting a 4-hour Pre-Conference; the sessions will be  titled:

    • SETMA’s Medical Home Journey - the Continuing Pursuit of Excellence. 
    • Unique Billing for PCMH - Transitions of Care/HCC Risk Management Audits for PC-MH
    • PC-MH Community Council - The Staff, Value and Purpose of a Community Council for PC-MH
    • Data Informatics - The Power of Informatics and the Philosophy of Quality Metrics in PCMH
    • PCMH Story Telling - Value and Imperative
    • PCMH Medical Student and Residency Externship
    • Patient-Centered Conversation - Patient Activity, Engagement and Shared Decision Making - Transforming a Patient Encounter into  Real PCMH Visit.
    • Wrap up

    In the Closing Plenary Session, I will be addressing:

    • Recognition/Accreditation is Good but Culture is King
  1.  How might healthcare professionals benefit from attending this summit and specifically from what SETMA plans to share?

    Those who are working in a PC-MH practice can compare their performance to SETMA’s.  Those who have not begun this pilgrimage can learn why they should and how they can proceed.  In such a conference, can address the challenge Abraham Lincoln gave in his 1856 House Divided Speech when he said:  “If we could first know where we are, and whither we are tending, we could better judge what to do, and how to do it.”  This is what is needed in healthcare today.  From SETMA others can learn how to answer the questions posed by Lincoln of:  “where we are”, where we are headed, “what to do,” and “how to do it.”

  1. In what ways can professionals outside the medical industry benefit from attending the summit?

    Employers, health plan administrators, patient advocate representatives, advocates for vulnerable populations, state, local and federal government agencies and others can learn what the most innovative and creative changes taking place in healthcare delivery  are.

  1.  Is there any exciting news that SETMA would like to share with the readers of Vital Signs?

    SETMA is currently working with the American Board of Family Medicine and wit the Robert Wood Johnson Foundation on research projects.  We have recently been invited to consult with The Institute for Healthcare Improvement in Boston and with the Center for Medicare & Medicaid Innovation Centers for Medicare & Medicaid Services
    to help improve healthcare.  The Innovation Centered said:  “Given your expertise and experience, we would welcome the opportunity to discuss with you potential innovations in EHRs for advanced primary care. We are particularly interested in your perspective on the field’s interest in and readiness for innovations.”

    SETMA is delighted to welcome five new physicians now and ten more physicians in the next twelve months.  That will expand the ability of SETMA provide PC-MH services to a larger group of people and to continue to influence healthcare in Southeast Texas for good.

  1. Anything else you’d like to add?  No