enhanced access pcdc dji v2 print - onecity health · computer savvy, the practice was happy to...

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Enhanced Access

PCMH Learning CollaborativeOctober 28 2016

Deborah Johnson Ingram

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What is Access?Patient‐Centered AccessEnhanced Access ‐Why?Purpose of a Policy

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Goal:o Increase access & continuity for all patientso Positively increase patient access experience  o Positively increase staff access experience

Measures:o Number and percentage of same day appointmentso Third next available appointment (TNAA)o No show rate (%)o Daily appointment capacity utilized (%)o Improve patient access experience (survey)o Improve staff access experience (survey)

DSRIP/NCQA Improvement Goals

4Patient Scenario

Mr. M, a patient at Getitgood Medical, was recently discharged from Wawaw Hospital, a local community safety net institution that has served the residents of BlahBlah Brooklyn for over 75 years. Mr. M was told to make an appointment to see his PCP upon discharge. Mr. M contacted the provider on his insurance card. Mr. M had not been to this provider in three years. He was informed by Wawaw hospital that they faxed the discharge summary to the provider.

The practice recently installed an EMR, and the staff was instructed to check the old scheduling system because patients that had not been seen in the past two years were purged from the new system. A new employee was working the phones on this day. Young and computer savvy, the practice was happy to find someone willing to work their unpredictable hours.

The practice has a policy to allow patients to walk in and be seen based on triage. Their predominately immigrant population is used to this process and has been complacent because the practice has early and late hours for availability.

5What Is Access?

The goal of having access is to ensure that patients and family members can get health care when and how they need it

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Who’s responsible for ensuring access?Who determines when and how?

How can you measure:1. Access capacity?2. Patient satisfaction? 

Defining Access in your Practice

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DEFINING & MEASURING ACCESS

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What does  “demand” mean in the context of health care?

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Reflects need for service by a panel of patients for o Clinical care, referrals, advice, condition monitoringo Prescriptions, forms, and resultso Self‐management support, education

Two types of demand:o External: from patients directly, or referral sources on behalf of patients

o Internal: generated by provider‐directed return visits to the clinic or health center.

Demand in Health care 

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What is “capacity” in health care?

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Reflects your ability to accommodate thedemand for needed services for a panel of patientsFactors that influence your capacity:

o Appropriately triaging and matching time slots to appointment types

o Distribution of work among the care team (clinical care, advice, prescription refills, education, self‐management support, etc.)

o Provision of care in alternative ways (phone, electronic communication, group visits, etc.) 

Capacity in Health Care

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Capacity

Demand

Scale

High

Low

Practice Capacity: Scenario 1 

Please describe what you see here

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Capacity

Demand

Scale

High

Low

Please describe what you see here

Practice Capacity: Scenario 2

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Capacity Demand

Scale

High

Low

Please describe what you see here

Practice Capacity: Scenario 3

15A Systems Approach

• Establish panels & care teams

• Pull & do today’s work today

• Exploit technology

Source: Adapted from work completed by Primary Care Development Corporation for the San Francisco DPH “Changing the Way We Care” Collaborative

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Describes how much of a provider’s capacity to see patients was actually used. 

If a provider has: 20 appointment slots and  They see 20 patients Then their capacity used is 100%

Daily Appointment Capacity (Used)

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PATIENT‐CENTERED ACCESS

Looking at efficiency of the visit from the patients perspectiveScenario revisited

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Happy Doc

Frustrated Patients

Provider‐Centered vs. Patient‐Centered Access

The business of health care is effectively set up and efficient to the needs of the provider practice.  

19Patient Scenario … revisited

Mr. M, a patient at Getitgood Medical, was recently discharged from Wawaw Hospital, a local community safety net institution that has served the residents of BlahBlah Brooklyn for over 75 years. Mr. M was told to make an appointment to see his PCP upon discharge. Mr. M contacted the provider on his ins card. Mr. M had not been to this provider in three years. He was informed by Wawaw hospital that they faxed the discharge summary to the provider.

The practice recently installed an EMR, and the staff was instructed to check the old scheduling system because patients that had not been seen in the past two years were purged from the new system. A new employee was working the phones on this day. Young and computer savvy, the practice was happy to find someone willing to work their unpredictable hours.

The practice has a policy to allow patients to walk in and be seen based on triage. Their predominately immigrant population is used to this process and has been complacent because the practice has early and late hours for availability.

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ENHANCED ACCESS ‐WHY?

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1. Improved productivity2. Efficiency in workflow ‐‐ no payment for 

redundant activities3. Satisfied patients4. Satisfied providers and staff5. Health care reform ‐‐ MACRA‐ value‐based 

payment

Why Improve Access?

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Confirmation calls ‐ not reminder callsSame day access w/ capacity 24/7 electronic accessAfter‐hours availabilityGroup visits

Methods of Enhanced Access as Per NCQA

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Don’t think about it as a reminder call – it’s much more

Make calls no more than two to three days aheadCall until you reach the patient and record results on the schedule

Confirm demographics and financial informationBest done by a member of the patient’s care teamCan leverage technology Make interaction patient‐centered to build relationship between the patient and care team

Train staff to do them well and use a script; shadow to coach, support, and train

How to Make Confirmation Calls That Work

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Schedules have slots for same day requests that are pre‐determinedo Not just walk‐ins… and wait and wait and wait

Same day visits don’t delay patients with scheduled appointments from being seen on timeSame day slots should vary based on season/reason

Same Day Access with Capacity

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Implementing patient portal accessMarketing to patients the ease of seamless communication with the providerYes we know YOUR patients won’t do it… try anyway!o Please disregard if you treat:

• Developmental disabled population• 100% non‐English speaking/ reading/ communicating populations   

• 100% geriatric populations

24/7 Electronic Access

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Provide patients evening and weekend optionsAdjust your schedule to begin sessions mid‐day and extend services to mid eveningo 9PM‐5PM will become 1PM‐8PM Tuesday’s Only

After Hours Availability

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Patients are grouped according to disease, acuity or circumstanceEncounters are scheduled so that common issues, barriers, self‐management goals are addressed as a groupo Evidence shows benefits for:

• Pregnant women w/gestational diabetes mellitus• Smoking (cessation)• Harm reduction related to drug use• Diabetes

Group Visits

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PURPOSE OF A POLICY

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They are a set of documents that describe an organization’s objectives for operationalizing a procedure. Procedures (written process) are not only required for NCQA recognition, but are also directly related to the consistency and quality of care patients receive. 

What Are Policies?

Source:  Robin VeltKamp, Health Services Associates, Inc. 

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1. Retain and transfer knowledge2. Fulfill compliance requirements3. Communicate effectiveness measures4. Document improvement and change5. Increase consistency6. Decrease training time7. Present risks, hazards, and lessons learned8. Decrease error rate9. Simplify access to information10.Ease replication and growth

Benefits of Having Written P&Ps

Source:  Robin VeltKamp, Health Services Associates, Inc. 

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Policies & Procedures = Decreased Process Variability

Management Control

Process Control

Internal Controls 

Reduced process variability

P&P’s

Source:  Robin VeltKamp, Health Services Associates, Inc. 

Benefits of Having Written P&Ps (cont.)

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To get to the reason of why we need procedures we need to look at what needs to be in control. 

What are areas of variability in your practice?o How staff answer the phoneo What patients get told regarding same day visitso How to explain group visitso Visit cycle (encounter time)

What Procedures do I Need for Access?

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PURPOSE IN A POLICY ACTIVITY

34Purpose Driven P&Ps

Management wants to improve the outcome of their patient experience scores as they relate to ease of getting an appointment and care quickly. They want to establish a new P & P. The only problem is that the procedure they commission to write stems from a policy that doesn’t describe the expected goal.

You are commissioned to provide feedback on a current policy that describes a current condition and no goals.

35Considerations When Drafting Procedures 

If you have been tasked to write a procedure, break the process into four partso Discovery ‐ understand the problem o Design ‐ process mapping (inputs and outputs)o Development ‐ know the users of the procedureo Deployment ‐ training, auditing of procedure

Source:  Robin VeltKamp, Health Services Associates, Inc. 

36Discovery

During discovery we need to understand:o Who are the sources/resources and what do they supply to the process?

o What are the inputs, and what outputs are they transformed into?

o Who are the customers and what do they receive from the process?

o What are the effectiveness criteria or how do we know if the process is working correctly?

o What corrective action is taken when the process does not work correctly?

Source:  Robin VeltKamp, Health Services Associates, Inc. 

37Design

Given the discovery information you should create a process map 

38Development & Deployment

Development of the written procedureo Who are the users (novices, occasional users, or frequent users)

o Write the procedure based on the user

Deployment of the information in the procedureo Mail, email, physical training, memo

o Auditing of usage and relevance

39Drafting a Policy – Style Tips

All policies should be drafted in MS Word, using Arial 12 point font and 1″ margins.

Policies should be clear and concise and written in the third person.

Words should be selected carefully. Words such as should and may imply choice.

Try to avoid information that may quickly become outdated such as employee names or web addresses.

When using acronyms, spell out the words the first time, then indicate the acronym in parentheses, e.g., American Academy of Family Practitioners (AAFP).

Source:  Robin VeltKamp, Health Services Associates, Inc. 

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Contact:Deborah Johnson Ingram

djingram@pcdc.org212.437.3935

http://pcdc.org

Questions?