Imagine a wellness visit where instead of sitting down with a patient or group of patients in the office, you walk or bike with them while discussing the importance of a healthy diet and exercise.

That idea will become a reality this spring at Sanford Health, where the visits will be rolled out at Sanford-YMCA Wellness Center in Fargo, N.D.

"These group visits will happen on the track," said Dr. Bruce Pitts, president of Sanford Health Clinic North in Fargo. "They will be real visits."

The idea of working out alongside patients as part of a wellness visit came from a couple of young, active primary care physicians at Sanford, said Dr. Pitts, and the health system’s administration is giving the concept their full backing. "I can’t wait to see how it works out, because it has captured people’s imaginations around here," he said.

This type of experimentation in delivering primary care is part of a larger effort that Sanford officials began last October when they convened a two-day summit in Bemidji, Minn., to craft both a long-term agenda and a 100-day plan for revitalizing primary care. Sanford Health is an integrated health system with facilities across Minnesota, North Dakota, South Dakota, Nebraska, and Iowa. The October retreat brought together internists, pediatricians, family physicians, ob.gyns., and psychiatrists from all around the system for the first time.

The primary care summit was so well received that Sanford officials held a second retreat in late January in Fargo, with the same physicians, plus a few additions. The second meeting was a chance to see what progress had been made in the first 100 days and to develop another 100-day action plan.

"We got a lot done, but we have a lot more to do," Dr. Pitts said.

Along with the "walk with your doctor" visits, Sanford officials have also stepped up their focus on the patient-centered medical home. Since the October retreat, several of Sanford’s primary care clinics in Minnesota have achieved state certification as medical homes, and as a result are qualified to earn monthly care coordination fees for certain patients.

During the first retreat, there was also a lot of interest from physicians in learning how to integrate behavioral health services into primary care. Since then, Sanford officials have approved a systemwide plan for doing just that. For example, in the Fargo region, they are decentralizing some of their behavioral health services in an effort to make those services available in each of the primary care centers. In the Sioux Falls, S.D., region, they are recruiting more behavioral health providers.

Sanford officials have also been busy developing service agreements between specialists and primary care. The first one, which included neurologists and primary care physicians in the Fargo area, spells out how primary care physicians should work up specific conditions before referral. In exchange, neurologists pledged to see those patients within 10 days and to report back to the referring physician promptly. "It really is a contract between the specialist and primary care doctors about their roles and their responsibilities to each other," Dr. Pitts said.

While the first retreat produced a lot of big-picture ideas that will serve as ongoing projects, Dr. Pitts said that during the second retreat physicians got more focused on specific goals, such as harnessing motivational interviewing more effectively to better engage patients to make lifestyle changes. With that in mind, Sanford will launch a "train the trainer" program in motivational interviewing that will be open to all clinic staff members, not just physicians.

In the next 100 days, Sanford officials also will aim to devise better ways to add patient-generated data into the electronic health record and on developing an annual internal continuing medical education conference for primary care.

As the Sanford physicians move forward with their plans for primary care, Dr. Pitts said one thing they want to avoid is making primary care the Pontiac Aztec of medicine. Dr. Pitts said one of Sanford’s industrial engineers noted that with the Aztec automobile, Pontiac bolted on every feature that it thought young drivers would want, without redesigning the car. What they ended up with was a car no one wanted.

If health systems just add elements like behavioral health, the medical home, and the electronic health record to practices without redesigning primary care from the ground up, they risk failure, Dr. Pitts said. To address that issue over the long term, Sanford is developing "labs" within its primary care practices to test out new innovations and technology and see how they work best together.

The date for another retreat hasn’t been set yet, but Dr. Pitts said the primary care group may reconvene again this year to review the latest 100-day action plan. Eventually, though, they plan to move to annual meetings, he said.

At Sanford Health, Doctors 'Walk the Walk' With Their Patients