Transcript Leadership Symposium

Leadership Symposium
SETTING THE COURSE FOR
CHANGE
PATIENT CENTERED MEDICAL HOME
4.17.2012
Objectives
•
Recognize how creating the Medical Home
through Care Model Redesign supports the IHS
strategic vision
•
Identify the guiding principles of a team-based
care model
•
Understand the components of the care model and
implementation strategies
•
Describe how care packages based on evidencebased medicine improve the quality of patient care
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Medical Home
Redesign care to create the ideal Iowa Health System experience that
focuses on the “Best Outcome for Every Patient Every Time”
Iowa Health System
“The road to the future is constantly under
construction.” ~ A Wise Man
Changes to the Future of Healthcare
Payment Model
Innovative Quality Systems
Population Management
Clinical Integration
Electronic Heath Record / CPOE
Meaningful Use Measures
Structure of the Health Care Delivery System
Iowa Health System
Commitment to the Future
Physician Alignment (NewGroup)
Clinical Integration
PCMH (Patient Centered Medical Home)
Integrated Health Management
Advanced Medical Team
Hospice / Palliative Care
ACO/ICO Development
Physician Leadership Academy
Iowa Health System
“For tomorrow belongs to the people who prepare for
it today.” ~ African Proverb
Value-Based Strategy
Physician Alignment
Delivering Value
Demonstrating Value
Value-Based Contracting
4
Prototype Clinics
Grimes Family Physicians
• Dr. Dennis Bussey
• Carin Bejarno, ARNP
• Janell Schlosser, MHA Clinic Administrator
• Cora Duncan, RN
• Donna Starck, CDE
• Kate LaFollette, RN Project Coordinator
Prototype Clinics
Lakeview Internal Medicine
• Dr Heather Roberts
• Dr Tyler Casey
• Dr Dan Allen
• Dr Ailey Brehmer
• Dr Katie Burns
• Heath Hill, MHA Clinic Administrator
• Renea Seagren RN
• Carrie Leiran RD, LD
• Carrie Koenigsfeld, PharmD
• Kate LaFollette, RN Project Coordinator
Care Model Redesign / Care Packaging
• Redesign care and align incentives to produce quality care
with a reduction in total cost of care based on defined
metrics
• Improve clinical quality outcomes aligned with evidence
based guidelines
• Improve employee, physician, and patient / family
satisfaction with care provided through the new model
• Implement a team based care model
• Identify, prioritize and sequence five Care Packages that
provide enhanced quality with effective cost efficiencies at
the identified prototype clinics
Care Model Redesign & Care Packaging
Team Based Care Models
The fundamental structure or the
“track” in which quality care will
run
Care Packages
Quality Care will be designed
through the use of Care
Packages or “cars” that will run
on the track
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Team Based Care Model
Guiding Principles
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Team Based Care
 A Multi-Disciplinary Team – Top of Licensure
 Physicians
 Mid-Level Providers
 RNs
 RDs
 CDEs
 Pharm D
 CMAs
 Schedulers
Team Model
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Care Model Basics
 Co-location


Huddles
Task management
 Phone tree

First call resolution
 Standardization




Standardized Room Set Up
Standardized Rooming Process / Family Team Care
BP protocol
Medication conciliation
 Change management

PDSA
 Health literacy


Made materials health literate
Teach back
Co-Location
Co-Location
Team Huddles
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Phone Tree
Goal: 1st Call Resolution
Reduced call abandonment rate: -11%
Overall task reduction: -31%
Reduction in tasks assigned to providers: -15%
Room Standardization
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Care Model Basics
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Previsit Call Text Template
Care Package Goals
 Functional and Risk Status
 Improve functional status and sense of well being
 Reduce and manage co-morbidities
 Satisfaction and Perceived Health Benefits
 Improve overall service satisfaction – staff / patients
 Cost
 Reduce overall cost
 Reduce office visits / Increase phone calls and RN visits
 Reduce Pharmacy / Indirect cost
 Reduce redundant lab costs
Care Packaging
It is when care is redesigned and incentives are aligned to produce
quality care with a reduction in total cost of care
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Adult Preventive
Adult Preventive
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Hypertension
 Hypertension Goals
 RN Care Package
 BP protocol/competencies
 Patient education and teach back
 Standing orders
Hypertension Goals
Goal
Metric
Accurate Measurement of blood pressure
100% of the time
Educate patients regarding lifestyle
modification and self management of HTN
Hypertensive patients reach/maintain goal:
Educate HTN patients in each visit
Increase control
140/90 All patients (except for diabetes,
CKD, patients that require an individual goal
based on their specific condition)
OR
130/80 Diabetes and Chronic Kidney
Disease
Reduce cost
None at this time
Hypertension
 Accurate BP Measurements at all visits

Staff / Provider Competencies Completed

Net Learning / Skill competencies
 Educate HTN Patients at every office visit


Teach Back Education Methodology
Health Literate Education Materials

EHR order set / Web Based tools
 HTN Patients reach / maintain goal


130/80 – DM / CKD
140/90 – All other patients
 Reduce Cost

RN HTN Care Program
RN Hypertension Care Program
 Provider Referral for entry into the Program
 RN Schedules / EHR Note Types
 Verification of EKG / Labs being UTD
 Education
 Diagnosis / Management
 Lifestyle Modifications
 Standing Orders
 Medication titration / Lab monitoring
 Office / Phone follow ups
Hyperlipidemia
 Hyperlipidemia
 EHR changes/flow sheet
Hyperlipidemia Goals
 Evaluate/Classify New Patients with Hyperlipidemia
 Framingham Score (CoQ Measure)
 Assess Lifestyle Risk / Other Risk Factors
 Lab Evaluation to R/O Secondary Hyperlipidemia
 FBS / TSH / Cr / LFTs / UA
 Initiate Lifestyle Modifications
 RN Care Program

Diet / Weight Management / Exercise / Smoking / EtOH
 Initiate Lipid Lowering Rx per guidelines
 ATP III Classification / Treatment Goals
 Monitoring of Lipids / LFTs while on Therapy
Hyperlipidemia Flow Sheet
Diabetes Care Package
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Well Child
 Multiple screenings needed in first five years
 Lead, TB screening
 Social and developmental screenings
 Autism screening
 Using Ages and Stages Questionnaire on-line
 Parents complete questions on line before Well Child
appointment
 Returned and scored electronically
 Results available at visit, referrals made as needed
 Software can run reports, reminders, provide education
Data
 CoQ – year end for LVIM and Grimes
 Quality Metrics for beginning 2012
 Employee satisfaction survey
 Patient satisfaction
Year End CoQ Data - LVIM
Employee Satisfaction Survey
90
The following changes have improved my ability to
care for patients
80
70
60
Strongly disagree
50
disagree
agree
40
strongly agree
30
20
10
0
Huddles
med rec
co-location
Room standarization
pre-visit calls
Patient Satisfaction
95
94.5
94
93.5
93
92.5
Grimes
LVIM
92
91.5
91
Q4 09
Q4 10
Overall likelihood to recommend practice
Q4 11
Next Steps
 Improving care coordination
 Communication across settings
 Coordinating care across settings
 Interdisciplinary Team
 Adding mental health counselor (Grimes)
 Increased coordinator role for RN (LVIM)
 Deployment plan
Stories
 Patients
 Staff perspective
 Physician perspective
Contact Information
Kate LaFollette
[email protected]
515-471-9292