person first health care process-technology integration

September 14, 2009 | James Hereford

story lineOur story did not start with a vision that was followed by a neat, linear and sequential set of actions that put in place that vision.

It started with an idea, that people want something from the health care system that they are not getting. A focus on them as people. Not as a patient, or a number, or a disease, but as people. And the way we met those needs must be integrated. That is core to who we are.

We started with the web, and built our web portal. We saw that it could not meet the needs unless we had an EMR, so we implemented EPIC.

That created both a problem and an opportunity. The technology wasn’t fully integrated into the care processes of the clinical teams, which led to the work of the medical home. It also created opportunities for new capabilities, so we integrated a health profile into both the web and the emr.

This is a story that continues to unfold, but the focus on people and meeting their needs in an integrated way has remained constant.

mygrouphealth

some numbersFor the Week of August 17, 2009

55% Adult Enrollees Verified

179,666 Adult Enrollees Verified

30,000 Secure Messages Sent

44,000 AVS’s Viewed

313,000 Labs Viewed

the electronic medical record

secure messages

automated results sharing

online test results and information therapy

the after visit summary

the health profile

the health profile

decision support tools

integration into lab result

risk calculator on the web

web accessibility of sdm content

integration into patient instructions

60%24%

10%6%

Phone the clinic to discuss thehealth concern

Schedule a clinic appointment

Schedule a phone appointment

I would not have contacted myhealthcare team

“How would you have contacted your health care team if

secure email were not available?” (n = 846; 212 blank)

Extremely valuable

Very valuable

Fairly valuable

Sometimes valuable

Not valuable at all

28%

45%

18%

8%1%

“How would you rate the value of secure email in enhancing your visits to your health

care team?” (n = 962; 96 blank & N/A)

0%

20%

40%

60%

80%

100%

Would strongly

recommend

Would recommend

93.6%

“Would you recommend MyGroupHealth to a friend or colleague?”

(n = 1,039; 19 blank)

0%

20%

40%

60%

80%

100%Not importantSomewhat important

Fairly important

Very important

Extremely important

41%

39%

13%5%3%

“If you were to be given a choice of health plans, how important would MyGroupHealth’s services be in your

decision?” (n = 1,016; 42 blank)

medical home pilot: the premise

In In relationshiprelationshipwithwith

==

Patient (in the purple sweater) surrounded

by her health care team.

medical home pilot: design components

Point -of-care tactics & tools

Outreach tactics & tools

Group Health Medical Home Model

Email visits

*Medication reconciliation , adjustments , conversions by

care team pharmacist

*Online health risk assessment

*New patient outreach

*Scheduled time for provider email and phone call management24-h telephone nurse

consulting

Best practice provider alerts

Health maintenance provider reminders

*MD-MA 1:1 huddles

Abnormal test result flags

*Scripted care team member introductions

*30-min standard appointments

*Direct routing of patient telephone calls to care team

Mailed reminders for patient care needs

Care team RN management of complex cases

Group visits

*Outreach for preventive & chronic disease services

Peer -led self -management support workshops

Health coaching for lifestyle concerns

*Predictive risk modeling

*Motivational interviewing & brief negotiation

*Collaborative care planning

*Next-day follow -up to discharges , urgent care & ER visits

Team-based rapid cycle process improvement

Performance feedback reporting

*Visual display systems

*Pre-visit chart review & outreach

Rapid online specialist consults

*Team huddles

*Pre-visit chart review & outreach

Disease registries

Patient Website & online medical record

Patient Website & online medical record

Online appointmentsMedication refillsVisit summaries

Vetted health literatureTest results trendingVisit summaries

QualityPatient satisfactionUtilization

Telephone visits

LPN as care team communications hub

* - developed for the demonstration clinic

results – adjusted utilization analyses

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Primary CareVisits

Secure MsgThreads

TelephoneEncounters

Specialty CareVisits

ConsultingNurse Calls

ED/UC Visits Inpatient Stays

# v

isit

s p

er

pa

tie

nt

pe

r y

ea

r

Medical Home Non-Medical Home

Thank you.