1 my nurse call center: providing care for patients outside of the four walls raedean vandenover...
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My Nurse Call Center:
Providing Care For Patients Outside Of The Four Walls
Raedean VanDenoverDirector, Care Management | UnityPoint Health
Dr. Stephanie ReyburnPhysician | Quincy Medical Group
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My Nurse Overview
• My Nurse is a free health information service for the public
• Sponsored by Iowa Health System and it’s affiliate hospitals
• Located in Sioux City, Iowa • My Nurse is staffed by registered nurses
24/7/365 • 24/7 Staffing began in 1999 • Positioned to support the clinical initiatives of
the system
My Nurse Call Center
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Our Services: Triage
• Triage callers to determine appropriate level of care
• Utilize RelayHealth Relay Care software • Triage completed by RN’s only• Medical director oversight and approval of
triage guidelines and call priority
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Our Results: My Nurse Call Center Overall
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Key Performance Indicator
2010 2011 2012URAC
Standards
Call Volume 174,377 156,277 178,709 N/A
Calls Answered 140,768 120,142 131,389
Abandonment Rate
15% 18% 22% Less than 5%
Average Speed of Answer
0:53 0:59 1:03 30 Seconds or less
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Our Results: Physician After Hours Only
My Nurse Call Center
Key Performance Indicator
2010 2011 2012URAC
Standards
Call Volume 51,868 55,552 85,119 N/A
Calls Answered 37,057 37,618 57,291
Abandonment Rate
29% 32% 32% Less than 5%
Average Speed of Answer
0:44 0:48 0:43 30 Seconds or less
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My Nurse Call Center
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Calls Offered, Answered, AbandonedBY HOUR OF DAY
Calls OfferedCalls AnsweredCalls Abandoned
Note: Data range is March 5, 2012 thru March 31, 2013
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My Nurse Staffing
• 17.0 FTE Registered Nurses • 5.9 FTE Licensed Practical Nurses• 4.9 FTE Non-Clinical Support Staff• 0.5 FTE Report Analyst• 1 RN Manager• 1 Director• 1 Medical Director
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Our Services: Physician After-Hours Calls• Provide coverage for physician clinics after
hours• 2012: 48% of all calls are PAH calls• Currently serving 90 clinics and 405 providers • Coverage is 5pm to 8am• Triage calls and page the physician only when
necessary
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Our Services: Triage
• Top Adult Guidelines:• Abdominal pain or discomfort • Post op problems• Chest pain/chest discomfort• Headache• Pregnancy and Pre-term labor (20-37 weeks)
• Top Pediatric Guidelines:• Fever• Cough • Vomiting• Cold symptoms• Trauma to the head
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Physician After-Hours Triage DescriptionOver 80% of Triage calls fall into one of
six dispositions:
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24% Provide self care at home
5% Call provider immediately
17% See the provider within 24 hours (next day appointments)
13% See the provider within four hours(urgent care if available)
20% Go to ED immediately
3% Activate EMS 911
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Our Services: Post-Discharge Call
• Follow up to evaluate understanding of their discharge instructions, pain management, medication management and their need for further health information
• Diagnosis specific questions to assess and reinforce compliance with Evidence Based Practice
• Presented in a “Teachback format”
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Our Services: Post-Discharge Follow up Calls• Post discharge call is made within 24 hours of
discharge• If patient is not able to teach back, My Nurse
will teach back key components from discharge summary
• Second call is made post discharge day 2 to assess understanding of discharge instructions
• If unable to teach back a follow up referral is made
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Post-Discharge Calls
2012 Results
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31,819 Post-discharge calls schedule
67.1% Successfully completed
17.5% Could not teach back their discharge instructions
Monthly reports provided to each affiliate in order to create action plans and drive process improvement
Supports reducing readmission efforts in the regions
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Quality
• 90% benchmark• Quarterly Audits are completed for all staff• 1% of all calls reviewed• Weekly review of all new employees as
needed• QA/QI results for 2012 is 93%
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2012 Progress
• Completed Integrated Chronic Care Disease Management Training for all call center staff
• Trained all staff on use of EHR• Waterloo Triage transitioned to My Nurse• Increased additional clinics to Physician After
Hours by 25%• Focused on staffing and training to prepare for
2013 projects focused on continued clinical integration of the call center
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2013 Progress
• Transitioned 1 additional clinic to Physician After Hour Service• Access to EHR for New Group patients• Training on use of EHR and GPMS• Launched Pilot with Central Iowa to schedule next day
appointments• Implemented Physician After Hours Services for Quincy Medical
Group (26 physicians)• Training and support for Iowa Health Home Care Triage process• Installed new phone system to allow for call recording• Began ED Post Discharge call for Fort Dodge Region
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Looking Ahead
• Continue to support clinical initiatives of the system• Improve call center metrics to industry standards• Capitalize on updated phone system technology and
reporting to drive process improvement and performance
• Continue to expand post discharge calls beyond inpatient discharge
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Looking Ahead
• Move additional clinics to after hours call service • Continue implementation of scheduling next day
appointments• Increase volume and focus of QA/QI program. • Continue to consider additional expansion
opportunities
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New Brand, New Name
My Nurse becomes My UnityPoint Nurse
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New Website
myunitypointnurse.org
Physician-finder resource
Articles about more than 1,000 health-related topics
Customer satisfaction survey
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My Nurse Call Center
Project Innovation Team 3:Value Based Healthcare
Reducing ER Visits and Admissions
Project Champion: Dan Evans, M.D.Project Leader: Stephanie Reyburn, M.D.Project Team:Dan Evans, M.D.Hrishikesh Ghanekar, M.D.Stephanie Reyburn, M.D.
Raymond Smith, M.D.Musab Saeed, M.D.Aric Sharp, CEOPatty Williamson, CFOProject Coach: Mo Kasti
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Quincy Medical Group
• Quincy Population, 40,630 • Service Area 112,000 • Founded in 1937• 135 providers 100/35 (Phys/Midlevel)• 28 Specialties• 50% Primary Care, 50% Specialty Care• All primary care under CRHC• Broad Ancillary Scope• McKesson EHR
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Quincy Medical Group
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Location
Outreach
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Quincy Medical Group Leadership Institute• Focused on Developing Change Agents• Innovation Projects Aligned with the Triple Aim
• Value – Cost of Care• Service – Patient Experience• Quality – Measurement & Improvement
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Scoping Our Project
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Reducing Cost
Imaging Generic RxAdmissions
Readmissions Nursing Home DirectEmergency Room
HP3 ProjectCurrent 9.6%
NP Care ProjectVarious Strategies
Quality
Value
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Selected Project Goals:
• Reduce Avoidable Admissions and Avoidable ER Visits• Increase outpatient services• Increase access to care after clinic hours• Improve coordination of care post-hospital
discharge and for chronic condition patients
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Our Project Plan Approach
1. Narrow Scope
2. Collect Data
3. Educate ourselves and benchmark
4. Pick early wins
5. Develop plans
6. Engage and secure stakeholder buy-in
7. Implement early wins
8. Evaluate what we have learned
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National Data on Admits and ER VisitsPotentially Preventable Admissions & Visits• PPAs: 25% of all initial hospital admissions
• National annual rate -94 per 1,000 beneficiaries • Heart failure most frequent clinical reason
• PPVs: 59% of all ambulatory ED visits (treat and release) • National annual rate -158 per 1,000 beneficiaries• Infections of upper respiratory tract most frequent
clinical reason MEdpAC October 5, 2012
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Other Causes of ED Admissions
1. Lack of after hours nurse triage2. Poor coordination with Home Health Care 3. Limited Ambulatory Care Clinic and/or
primary care hours on weekends4. Culture of taking all admissions from
Emergency Room5. Poor transitions in care between inpatient &
outpatient 6. Lack of community education about
preferred access points
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Benchmarking ResearchWhat Others are Doing to Reduce Cost1. Everett Clinic – Set goal to reduce total healthcare cost by
25% by 2016 through reducing admissions and moving to generic prescribing, etc.
2. Geisinger Health Plan – decreased hospital admissions by approximately 15% by implementing a Medical Home model utilizing nurse case managers targeting specific patient risk panels.
3. Mt. Kisco Medical Group – an on-call physician from the group sees patients presenting to the ER to determine if the patient needs to be admitted.
4. CIGNA Medical Group – is increasing urgent care capacity, implementing a nurse triage line, and educating patients in order to reduce preventable ER visits.
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10 Proposed Initiatives
1. After Hours Nurse Triage Phone Service via Iowa Health System
2. Home Health Care via QMG-Iowa Health System• Home Health Care, Home Medical Equipment, Palliative Care, In-
Home Hospice3. Expand ACC and/or primary care hours
4. Expand infusion center hours
5. Hospitalist assessing patient in Emergency Room
6. Use Nurse Care Coordinator Model – BCBS Int. Medical Home
7. Discharge Nurse to assure good transition to outpatient
8. Nursing Home NP model of care
9. Patient education about preferred access points
10. Educate physicians on preferred ER referral process
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Approach to Securing Buy-in
• Small Family Practice Call group meeting• Large group meeting with Family Practice,
Internal Medicine, and Rural Clinic providers• Presentation at Shareholder meeting• One on One meetings with Physicians
throughout Primary Care
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Nurse Triage
• Nurse Triage call line launched March 4, 2013 for 26 providers
• Provides Better customer Service and access to a health professional
• Reduces avoidable ER visits• Reduces physician after hours call
intensity
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Home Health Care
• Partnering with Iowa Health System • Implementation underway - in process of hiring director• Goals:
• Reduce readmissions• Decrease the overall cost of care• Capture a revenue opportunity for Iowa Health & QMG
• Medicare MSSP data average 406 visits/1000 lives across Iowa Health System.
• Quincy at 127 visits/1000 lives• Opportunity for increased community based services for
our patients
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Home Health MSSP Data
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Visits Per 1000 Lives
0100200300400500600700800900
1000
CedarRapids
QuadCities
Peoria CentralIowa
Waterloo Quincy Muscatine Fort Dodge
Visits
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Expanded Hours
• ACC Hours (Walk In Clinic)• New Physician hired – extending Saturday
hours to all day starting Summer 2013• Primary Care Offices
• Exploring Sunday Hours via Rotation
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Hospitalist in ER
• Dr. Vardaros signed with a start date of October 2013.
• Hospital Call Group to explore engaging with the ER on a routine basis.
• Will reduce avoidable ER admissions.
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BCBS Medical Home Care Model
• Launched January 2013• 37 super visits have been completed with another 10
scheduled• Goal is 200 enrolled patients by August 2013
• Potential next step…• Use MSSP data to identify similar high-risk Medicare
patients for care coordination• Apply Iowa Health Advanced Medical Team Model
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Admission/Discharge Planner
• Launched October 2012
• Better transition of care from hospital to outpatient including scheduled follow-up visits, ancillary capture, med reconciliation and improved communication with provider offices
• Next step – additional staff member has been hired to meet face to face with every patient when admitted and discharged
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Nursing Home Care Model
• Launched April 2012
• NP Onsite at all Nursing Homes in Quincy
• Has led to more satisfied patients, reduced ER visits, and reduced avoidable admissions
• All primary care providers currently utilizing the service
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Consistent Patient Education
• Reviewed Iowa Health System “Red, Yellow, Green” care action plans for utilization with patients
• Implementation Fall ‘13
• Action plans available for wound care, care, stroke, pneumonia, high blood pressure, heart failure, diabetes, depression, and COPD
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Transition Plan - Sustainability
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Action Owner
Nurse Triage Implementation Kathy Harman / Dr. Reyburn
Home Health Carol Lewis / Dr. Noble
ACC Expansion Aric / Dr. Evans
Ancillary Expansion Patty Williamson / Dr. Petty
Hospitalist in ER Aric / Dr. Evans
BCBS Medical Home Kathy Harman / Dr. Leimbach
Discharge Planner Kathy Harman / Dr. Reyburn
Nursing Home Care Model Kathy Harman / Dr. Schlepphorst
Patient & Physician Education The Team
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Leadership Lessons Learned
• Teamwork
• Care Value is Big Work, Narrow the Scope, don’t boil the ocean
• Assign clear roles
• Leverage resources• • Holding each other accountable
• Innovation = Idea + Execution
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Next Steps with My Nurse
• Allow My Nurse Access to EHR
• Begin scheduling next day appointments
• Expand Physician After Hours Service to additional specialties
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Questions?
My Nurse Call Center
“My UnityPoint Nurse, how may I help you?”