Overview
Pathways leads a collaborative network of health professionals and companies organized to address health sector challenges by contracting to develop health information technology solutions for healthcare providers, consumers, companies, and government organizations.
Pathways - Five Service Divisions
Pathways Clinical Associates, LLC, is Dr. Nordine’s independent neuromedical (psychiatry) practice. Practicing in West Des Moines since 1985, Doctor Nordine specializes in the diagnosis and treatment of mental health and related medical conditions that cause emotional distress, often interfere with personal relationships, and too often limit employment performance.
His training and experience in neuromedical psychiatry began after he became interested in preventive medicine while attending Northwestern University Medical School in Chicago. Also, while in medical school, he became interested in problems that seemed to interfere with the efficiency and effectiveness of healthcare organization and management.
These interests influenced him to become a Public Health Administration and Preventive Medicine resident at the University of Medicine where he had the privilege of working with health policy and medical system management leaders who developed the 1965 Medicare law and studied ways to improve healthcare operations. He also was privileged to work in Preventive Medicine with a professor studying how stress is related to chronic health conditions.
Preventive medicine research made it clear that many medical conditions start with neurologic responses to stress overload and that the best way to learn about these neuromedical processes would be to return to Northwestern and study psychiatry.
Later, board certified in psychiatry, he chose to practice in Des Moines where it was possible to work in health policy at the State Capitol while also practicing medical psychiatry in new ways that integrate or coordinate medical psychiatry and psychotherapies in settings where physicians and therapists work together.
Dr. Nordine’s approach to coordinated medical psychiatry is to personally engage patients in comprehensive diagnostic considerations followed by treatment recommendations that include both medical and psychotherapeutic interventions.
Over several decades of practice in Des Moines, Dr. Nordine has developed clinical models that integrate the work of physicians and other clinicians. To achieve the best results, physicians, nursing specialists, neuropharmacology specialists, and psychotherapists with different skills need to work together.
He organized Pathways Clinical Associates (PCA) to provide these blended services. Originally the blended model operated as Midwest Clinical Associates. Then Pathways Clinical Associates replaced that model in West Des Moines where it operated for nearly 20 years but as medical neuroscience has advanced rapidly is became necessary to develop a new service integration model.
To make that change, Dr. Nordine has adopted Pathways Clinical Associates (PCA) as the name for his private practice and, through the Pathways corporation, has joined colleagues from many areas to develop a new clinic, Advanced Neuro Solutions Iowa, that combines recently developed magnetic resonance technologies with all the elements of the original Pathways Clinical Associates model.
Meanwhile, as Pathways Clinical Associates, he continues with over 35 years of experience specializing in differential diagnosis, preventive medicine, and helping patients achieve mental health solutions they need to overcome personal, relationship, and employment challenges.
He has clinical expertise based in Internal Medicine oriented Psychiatry and Preventive Medicine support his ability to identify the causes of and treatments for anxiety disorders, emotional distress, mood (depressive) disorders, cognitive (problem solving) conditions, autism, attention deficit disorders, traumatic brain injury, and conditions that disrupt thought processes.
Pathways Business Services
The Pathways Consulting Group (PCG) is organized to serve clients who are unlikely to establish joint ventures or collaborative agreements with other Pathways groups. Clients may be companies and professional organizations, healthcare clinics, healthcare providers, academic institutions, associations, government units, or independent research and development groups.
These clients may also contract with other Pathways Groups. Two PCG client companies that produce medical informatics algorithms have established agreements to embed unstructured Pathways natural language medical interviews in their systems. PCG may help them develop Health IT clinical interviews without a role in their use of Pathways Cybernetics Systems linguistic technologies.
This structure assures that PCG projects do not overlap with other Pathways operations. PCG defines, analyzes, and facilitates IT Solutions without engaging in production or management. If a PCG client wishes to purchase products or services from other Pathways groups, they may submit bids.
For example, a Pathways collaborative enterprise partner, Occupational Health Strategies (OHS), also contracts with PCG for consultation on the development and deployment of cinematic learning systems to enhance OHS services. PCG’s primary goal is health system improvement through the consultative development of more effective health technologies.
Services
PCG accepts consultation requests from health service providers, companies, organizations, and government groups that engage in work related to health policy and strategic management, public health, or healthcare technology. PCG priorities focus on strategically meaningful capabilities to improve resource management and operations.
Organization
Pathways is a network of professionals and companies.
Pathways Consulting Group addresses selected health sector challenges by engaging an internal network of professionals and affiliated companies in project teams that analyze problems, develop strategies, improve IT solutions, and produce Health IT solutions.
PCG business structure is based on strategic affiliations with specialized health systems professionals, companies, and/or government organizations. Pathways manages all network partnerships, collaborative agreements, and service contracts with these affiliates for PCG. Project teams are staffed and directed by PCG.
Pathways is responsible for all operational management support including accounting, marketing, and sales. PCG is responsible for all services including project scheduling, client support, and follow-up. This organizational structure allows PCG project team leaders to focus exclusively on results.
Operations
A five-member PCG management committee coordinates the selection, assignment, and operational management for each project team. The management committee names a director and assistant director for each project and meets with the project leaders regularly to provide strategic perspectives and assist them with operational decisions as necessary. The management committee is responsible for ensuring that PCG projects are properly correlated with the activities of other Pathways business units.
PCG Management Committee
Executive Members
Gaylord Nordine, MD, DPH – Pathways Consulting Group President
Andrew Czuchry, Jr. Chief Operations Officer
Advisory Members
Andrew Nordine, MD, MS – VP; Health Informatics
Jeffrey Nordine, Ph.D. – VP; Educational Strategies
Specialty Members – Selected based on project requirements
Staff
Denise Anderson – Project Team Support
Personal Development Programs (Avante)
Healthcare focuses on diagnoses, procedures, and prescriptions.
General Health and Executive Performance are determined by personal actions that support neuroscientifically established knowledge and judgement as well as strength and energy.
Avante Personal training is needed to develop effective self-regulation and self-management capabilities that prevent problems, promote recovery from illness or injury, and enhance performance.
Healthcare is a professional process. Health related management challenges are personal. Solutions must be client-focused, accessible, reliable, and convenient.
Pathways Personal Development Programs are organized with reference to an INSEAD Health Technology Conference in June 2000 that concluded:
Current health care systems are professionally driven and reactive, problem oriented and concerned with treating disease. This is a broadly interventionist approach to isolated events. An alternative approach argues in favor of seeking, and maintaining wellbeing, health being self-defined and self-driven rather than defined by professionals or government. Inevitably, the solution will lie somewhere between two such approaches.
The consequences of low health self-regulation, self-management capabilities are often excessive healthcare costs, insufficient personal engagement, and decreased economic productivity.
What Pathways Personal Development (PPD) Does
Clinical studies by Kaiser Permanente proved that group-based training programs are effective in lowering healthcare costs. US Government Agency for Healthcare Research and Quality (AHRQ) studies at Stanford in 2002 established that health self-management training lowers chronic disease management costs.
Avante, the conceptual foundation for PPD, produces unique “learning by doing” training that entrains health self-management capabilities. Based on successful European programs, the Avante System engages participants in group processes that "entrain experience" in new behavioral patterns.
For many years American healthcare providers have relied on giving patients reasons to change health behavior. Many admonish patients to do better or flood them with printed material to train them conceptually. Patients do not convert these concepts into sustained actions.
“Learning by doing” systems, originally proven by the Toyota production training system, engage participants in physical practice that leads to new routines. After entrainment for several weeks, interval reinforcement sessions extend the routines and can make them virtually permanent.
The Avante Process
Avante trains twelve to twenty people at a time in activity-based programs based on proprietary “learning by doing” techniques that engage participants in processes that originated in human tribal experience but have only recently been employed in the important work of changing health and work performance behavior. People learn new behaviors physically, somewhat like soldiers first learn military routines by marching. As new routines are entrained, they lead to reliable self-regulation practices.
Avante learning by doing systems are based on neuroscientific knowledge and clinical experience. They produce group engagement proved by German research to be more effective than the more traditional group learning successes reported by Kaiser Permanente and US Agency for Healthcare Research and Quality (AHRQ) research.
Program Content
Health, performance, and productivity gains are based on acquiring physical, resource, and relationship capabilities developed through Avante participation. Avante teaches skills that entrain better physical strength, nutrition, resource management, stress adaptation, and healthcare navigation functions. As these skills are acquired, they are reinforced by the group entrainment process.
Training starts with an open session focused on identifying ideas and attitudes participants have about health self-management and the healthcare system. Participants engage one another in these sessions.
In early human history when the neural system developed its remarkable social capabilities, there was little language. Humans learned through behavioral communication such as posturing, facial expression, limb movement, and intonation.
Primitive gestures and sounds became organized in body language people still use today. Language enhances but does not replace this communication. Publications and conferences will probably never replace shared physical experience.
Business Perspective
Companies, government organizations, and communities need to augment healthcare by adding personal health management training, a low cost solution to improve healthcare outcomes.
Healthcare perspectives are limited by too much focus on professional procedures and verbal prescriptions. Healthcare outcomes will be improved by engaging people in meaningful self-management actions.
Avante focuses on what people can learn to do for themselves and the measurable productivity gains that can result.
Pathways Cybernetic Systems
Knowledge Management Technologies are at the core of all Pathways operations. Healthcare involves six processes – communication, interaction, diagnosis, procedures, prescriptions, and health self-management education.
Three of these processes – diagnosis, procedures, and prescriptions – are professional skills. The others – communication, personal transactions, and education – are interpersonal capabilities shared by healthcare professionals and any person who uses health knowledge.
Both process sets above require sophisticated communication, database, interaction, and outcome measurement technologies.
Professional skills are very important, but interpersonal capabilities determine eighty percent of healthcare outcomes. The best procedures and medicines may be ineffective unless each person follows instructions and independently manages health behaviors.
To personalize health service processes Pathways and Impact AI, LLC joined to create Pathways Cybernetic Systems (PCS,LLC), an independent Pathways group member that produces world-class communication, transaction and evaluation technologies.
Core PCS components are the Impact-AI i-Brain and MedVault database systems.
PCS helps people (consumers and healthcare providers) navigate health services to find the best personal health solutions.
Pathways Cybernetic Systems integrate worldwide multi-channel communication, transaction, and outcomes measurement. These technologies also enhance Pathways healthcare, health self-management, occupational health, and research programs.
PCS Communications
Pathways Communications Systems support interactive voice, text, video, and telemedicine links for anytime-anyplace access. Personal services are staffed by Magellan Global Health professional navigators (physicians and nurses) with access to subscriber personal health records.
The system gives subscribers personal relationships with healthcare professionals who have access to their personal records. 5G Cellular contacts include two-way imaging that makes working relationships more effective. If communication is limited to voice-only connections, Internet appointments are scheduled.
Medicare research has revealed that personal relationships, two-way video images, scheduled appointments, and interpersonal expectations produce better personal health management results.
Personal Health Databases
Pathways health records are based on a partnering relationship with Impact AI and Care Span International (www.carespaceinternational.com) a worldwide Telemedicine Virtual Clinic, health database and analytics company the provides professional healthcare services, person centered healthcare, and analytic services to self-insured employers.
Pathways Linguistics
Pathways linguistics technologies are based on proprietary structured and unstructured automated interactive natural language technologies that gather personal information to be integrated with claims and clinical data. The result is a comprehensive personal health informatics profile from which personal health solutions can be developed.
Pathways Cybernetics is the only health data system that integrates the three essential information sources that fully profile a person with reference to claims, clinical information, and natural language personal history.
Cinematics
High level companies favor video training systems as best employee education process. The traditional services health sector has been slow to adopt interactive video training techniques. Pathways Cybernetics utilizes proprietary owned or shared video training systems.
Many excellent video training products are available in the United States, but it is difficult to deliver them effectively.
Pathways and strategic partners, On Demand Health Media, and Knowledge NRG solve this problem by acquiring the best inventory of health training videos, matching video content to personal health risk appraisal information, delivering video solutions directly from subscriber platforms, and dynamically measuring user progress. The same process serves both healthcare providers and consumers.
Personal Health Solutions
Pathways communication, CareSpan informatics, and video training platforms produce efficient effective, personalized health solutions to individual consumers, families, employers, and service organizations when and where needed. These flexible systems differentiate Pathways Personal Health Information Technology Solutions from all others available.
Pathways Research Group--Human Assets Institute
Overview
Human Assets Institute (HAI) is a not-for-profit research and development group for Pathways.
Other Pathways groups focus on healthcare, personal performance, business services, and Health IT Cybernetics. When new solutions are needed, HAI organizes research and development groups to develop new strategies or research projects.
HAI works independently on new Pathways initiatives, organizes study teams, develops new technologies, and manages funded research. HAI holds Pathways intellectual properties.
Organization and Management
HAI organizes independent project teams as needed to conduct development or research initiatives. As an internal task group, HAI does not maintain its own staff, management system, or marketing, sales, and product support functions. All these services are provided by the Pathways corporate executive group.
Projects and Operations
HAI enters contracts with companies, government, or private clients to develop new products, services, or research projects.
For example, Pathways contracted with the National Library of Medicine Specialized Information Services Division to lead the development of new Information Management Systems to facilitate detection, assessment, and case management of Traumatic Brain Injury and Post Traumatic Brain Disorder problems experienced by soldiers or civilians affected by disasters. HAI supports these initiatives by organizing project management and research teams.
HAI develops new Health Services Research initiatives through collaborative arrangements with internal and external groups. HAI has led Pathways groups engaged in military and civilian stress management, Traumatic Brain Injury recovery, Health IT systems, Accountable Care Organization development, Alternative Dispute Resolution, and innovative executive performance technologies.
HAI has developed mobile stress management programs for CareSpan, The Iowa National Guard, primary healthcare clinics, and behavioral care solutions for rural emergency rooms.
HAI also has internal responsibility for developing and holding Pathways intellectual properties such as automated natural language medical interviews.