bridge 2 excellence: patient centered medical home implementation a joint venture with gim and rise
Post on 21-Dec-2015
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Bridge 2 Excellence: Patient Centered Medical Home
Implementation A joint venture with GIM and RISE
Patient Perspective
Wait!Wait!
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Patient Acute Service Utilization
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No Show Impact
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61% of patients arrive for scheduled appointments
~20% are materially late
Impact not planned for and used effectively
Results in average of 20 minute gap in schedules in nearly 1 of 4 appointments
BMC GIM Physician Productivity
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Productivity higher than expected at 8 visits / session
Significant process barriers prevent higher productivity
Patient no-show and reschedule rates are material
Low average sessions per provider per week result in limited access for patients
All identified barriers are addressable, and expect 12 visits per session is attainable
Future State of Primary Care
Key Drivers Payor Consolidation Continued downward pressure on
costs Payment Reform
Move from transaction based payment to payment based on outcomes
Global payment demonstrations, ACOs
Penalties for readmissions, admissions for ambulatory sensitive conditions
Accountability for health of population Fewer publicly insured patients in
FFS arrangements Once insured, patients have choices
and vote with their feet Clout matters – volume brings scale
and negotiating leverage
Future Requirements Primary care should be “front door” to
system; must be welcoming and responsive to patient needs
Practices should be patient-centric Need capacity in practices to see new
patients and existing patients with urgent needs
Patients need continuity when their physician is not available; care teams become critical
Teams can be accountable for a panel of patients; they have to be a size that people know one another and patients know who to call
Need short cycle information and metrics
Need system of leadership and accountability that is supported by training, tools and measurement
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Transforming Primary CareA Comprehensive Approach
What Is Needed
Create Capacity
Measure and improve clinical quality and enhance patient experience
Design and organize care to improve outcomes and lower costs
How Is It Achieved
Extend the physician through allied professionals and “virtual visits”
Move tasks to the most appropriate member of the care team
Use technology to eliminate work
Continuous data analysis leading to proactive patient outreach
Consolidated data leads to more effective and focused visit
Focus on patient experience at every point of contact
Create and manage to a customer-specific Medical Cost Action Plan
Build evidence-based protocols into the process
Inform patients so they are active participants in care decisions
What does all this mean?
First emphasis should be on unleashing capacity Improvements in quality and cost will follow Improvements occur primarily as a result of focusing on process and
accountability Unwarranted variability must be eliminated to support effective flow
Will require a fundamentally different process Incremental change will not yield the transformation needed Leadership development is key to transformation and sustainability May need to evaluate reward and incentive structures In this unique environment, patient panels must be owned by care teams, not
individual physicians
Possible to substantially increase visit and patient volume Double capacity of visits and 50% increase in patients not inconceivable Of value today and in ACO environment
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Two initial areas of focus
Create a dedicated care team with clear accountability and goals
Team means more than group of people sharing rooms
Team is accountable for a panel of patients
Each team a has part-time medical director, full-time practice manager, practice assistants, check in-check out, and nursing resources available
Team held accountable for clearly identified metrics
Create technology-enabled team designed to contribute to the care experience and support the practice
Emphasis on completing as much as possible in advance of visit
Optimized scheduling
Pre-visit prep including eligibility and insurance verification, history of present illness, and med rec
Most of the follow through and care planning activities completed by this team
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Proposed Scorecard
Stop Light Version
Operationalize Decision• Order Entry • Prescriptions• Pt education
• Letters• Calls• Refill Rx• Results Management
15 min 5 min
• Daily Huddle• Arrive Patient• Collect Copay• Manage Patient Wait• Vital Signs• Room according to Protocol
• Optimized Schedule• Verify Eligibility• Verify Insurance• Med Reconciliation• History of Present Illness• Select Family and Social History• Care Gaps (TBD)• Wellness Gaps (TBD)• Virtual Visits (TBD)
Operationalize Decision• Prior Authorization• Referrals
EMR Optimization• Clinical Protocols (Initial)Existing
support roleNew
extender rolePhysician
Operationalize Decision• Order Entry • Prescriptions• Prior Authorization• Referrals• Pt education
Documentation• Complete Note• Coding
• Letters• Calls• Check Labs• Refill Rx
PatientVisit
20 min 4 min (Est)9 min (Est)
• Presenting issue• Med Reconciliation• History• Physical Exam• Plan• Decide• Update EMR• Begin Referrals
• Verify Eligibility• Verify Insurance• Collect Copay• Arrive Patient• Vital Signs
CarePlanning
Follow-Through
Registration& Room
Pre-visitPrep
• Schedule• Transfer to Practice
15 min 4 min9 minPatientVisit
CarePlanning
Follow-Through
Check-in& Room
Pre-visitPrep
CarePlanning
AFTER Hands on and
dedicated care team focused on efficient patient flow
New Patient Coordinator role takes work off rest of care team
Predictable provider process more readily accommodates patient fluctuations
Provider able to complete “today’s work today”
BEFORE Support team not
focused on effective patient flow
Provider process unpredictable
Provider schedules not flexible to daily patient fluctuations
Provider has significant work carryover beyond scheduled session
A Day in the Life of the Practice (Phase 1)7 min4 min
15 min
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The Extended Care Team
Project Timeline
The Case for Transformational Change
TRAINING KICK-OFF
• 28 New Rise Employees Trained