FORT SILL, Okla. -- When the Frontier Medical Home opened its doors in February 2011, Claude Shepperson was uncertain about the clinic's future. As the Group Practice Manager for the new clinic, he knew they would need more than the 11 patients they were starting out with.

"I had three doctors back there and a full staff of nurses, and I only had 11 patients assigned here. I was rather nervous," Shepperson said.

But by May, Medical Home's patient population was up to a couple thousand, and as the volume increased, Shepperson and his staff realized that this job would be tougher than they thought. "Keeping the quality of care as our primary focus was critical," he added.
Quality patient care is the main purpose of the Frontier Medical Home.

It is part of an Armywide program called Patient-Centered Medical Home, whose purpose is to establish small family-centered clinics that are easily accessible and bring a high level of care and communication to the patients in the community. The clinic in Lawton was the second one established by the Army, with the main patient population being family members of active-duty Soldiers.

The clinic is next to Southwestern Medical Center in the southwestern part of Lawton, and that spot wasn't picked by accident.

"The Army discovered that about 85 percent of Fort Sill's active-duty families live in this zip code. So that's why they put the clinic here," Shepperson said.

Now as the medical home approaches its one-year anniversary later this month, the entire program has grown beyond everyone's expectations.

"We are now a little over 6,500 patients," Shepperson said. "Right now I have five primary care managers and a floater. I am in the process of hiring a sixth PCM but that will increase our population as high as 7,000. So we are about where we need to be," he said.

"The thing that's most different from a year ago is how busy we are,"
said David Lynn, Practice Management director for the clinic. "We've made changes along the way but we are now doing pretty well."

Lynn added that they have three new nurses coming in and that gives them a total of 20 -- 16 licensed practical and four registered nurses. The number of nurses is directly related to the unique model that the clinic operates under, that of pairing two nurses with each provider.

"A civilian, Doctor Peter Anderson, came up with the two-nurse concept where one nurse stays with the doctor while he is with a patient, and the second nurse is getting the next patient ready for the doctor to see," Shepperson explained. "There is a third exam room available in case the patient needs to get shots, or have blood drawn by the lab tech."

In addition to six doctors and 20 nurses, the medical home has two lab technicians, a full-time immunizing nurse and a full pharmacy. The staff is currently seeing about 120 patients a day and that doesn't include appointments for immunizations. The goal is to provide as many services in-house as they can, to keep the quality of care high and costs as low as possible.

The clinic has modern medical equipment that can accommodate 90 percent of the tests and procedures performed in a regular family practice. All of the doctors use electronic tablets to enter their reports into the patient's instant records on a network running at 300 megabytes per second. And all of these computer systems are tied back to Reynolds Army Community Hospital on post.

Last October, the clinic began treating Army retirees under age 60 who live in the Lawton area. Adding these patients to the medical home community has shifted the focus of care somewhat, from primarily moms with babies and children to also serving older Army retirees and their spouses. But even though the waiting room now has a different look, the approach remains the same -- providing quality primary care with a personal touch. Many patients will tell you that they like this new approach.

"It means a lot to have this clinic here. It's easier for me to get here because I live close by," said Tommy Sharbutt, an Army retiree.

"I like the staff here because they are very friendly and easy to deal with. I needed to see my doctor really bad and it only took two days for me to get in here. That was awesome," he added.

Sharbutt received a pleasant surprise when he first came to the clinic. "When I came here they told me my doctor would be Doctor Joyce. I said, 'Daniel Joyce?' The nurse said yes; I was so thrilled," Sharbutt said.

It turned out that Sharbutt and Joyce were in the same Army unit when they were active duty years ago, and Joyce was the doctor who treated Sharbutt. "It's great because he knows so much about my medical history and remembers everything about me already," he added with a smile.

The in-house pharmacy stays very busy, averaging around 250 prescriptions filled a day. That's with only one pharmacist and a technician.

"We're doing the same jobs that they do over at Reynolds hospital but with fewer people," said Melody Morris, medical home pharmacist. "We order and stock medicines for the treatment rooms as well as the immunization nurse. My technician does the same jobs of several people. We will probably need to add a second technician, because our patient count is really starting to grow," Morris said.

Shepperson believes that the addition of a behavioral health provider will be a great asset to their community.

"We knew we had patients who needed that type of care, and now that Doctor Susan Lynch is on board she has a full schedule pretty much every day. In between appointments she can consult with the other doctors because she is here," Shepperson stated.

Lynn explained that to provide quality care, the medical home must manage costs and justify the money being spent for the clinic to operate.

"It's a good business model the Army has adopted, because it gives us a picture of whether we are cost-effective or not," Lynn said. "Our funds come through TRICARE, but it still costs money for us to run. This way we can measure the costs and the revenues we are generating to see if we are cost-effective. The idea is that everybody wins," he said.

"I would say to our patients, when you need primary care we want you to come to us. We don't want you to go to an emergency room or urgent care center, or seek care somewhere else. When you are assigned to us, we want you to come see us," Shepperson emphasized.