Transcript [Poster title]

PATIENT ALIGNED CARE TEAM AT The va sierra nevada health care system
Uche S. Uchendu, MD. Associate Chief of Staff, Ambulatory Care
Patient Aligned Care Team
Medical Home + VHA = PACT
 Background
VASNHCS has 69,000 square miles of mostly rural area of 31 counties
With 116,000 veteran residents and 26,000 unique patients
Primary care provided at the main facility is in Reno Nevada and
Four CBOC’s : Auburn & Susanville CA; Minden & Fallon NV
Outreach clinic in Winnemucca, NV
Access
Care Mgt & Coordination
Focus on high-risk patients
Offer same day
appointments
^ shared medical
appointments
^ non-appointment care
Resources: Tech, Staff, Space, Community
Identify your behavioral “comfort zone
Capitalize on your behavioral strengths
Increase your appreciation of others’
behavioral “comfort zones” and
behavioral strengths
Be more effective when working with others

ACP Home builder
Facility Total
Voice of the Customer
People are always courteous
You Guys are good to me
Good People
No complaints
In reality all PACT items should be standard
operations : Plan, operation, directive ,execution =
success. Phone calls should be returned timely.
PACT Recognition for 5 Teams 2011!
FEB 2012
≥ 10
TEACH trainingAll PACT staff
Overall Medical Home Builder Survey
Response
Redesign team:
oRoles & Tasks
Improve care for:
Enhance:
oPrevention & Chronic disease
oCommunication& Team
Improve transitions between PACT Improve Processes:
&: Inpatient ; Specialty; Broader Team
oVisit & Non-visit work
Patient Centeredness: Mindset and Tools
Improvement: Systems Redesign, VA TAMMCS
The DiSC will help you:
D OMINANCE
I
NFLUENCE
S TEADINESS
C ONSCIENTIOUSNESS
Practice Redesign
PACT COMPASS 2 day
Contact Post Hospital
<10 and ≥ 5
Module 7 - Quality Improvement
Performance
<5
TOTAL
POINTS (MAX
14)
Facility 10
Module 6 - Population Management
Module 5 - Use of Technology
2011
2009
Module 4 - Care Coordination Transitions of
Care
Module 1 - Patient Centered Care
Communication
0
20
40
60
80
100
Identify • Facility Gap analysis done February 2010
current • Funding allocation and spending plan 15 teamlets in Reno, Auburn -4 Minden-3,
Primary Fallon-2 & Susanville -1 with Extended Team gap deferred to next fiscal year
Care • Partnering with HR to reach hiring goals
staffing

PACT
Fairs
at
all
sites
gaps
•Financial :Staffing sustainment analysis discussion with leadership February 2010
•Operational: Space and support gap analysis - March 2010
Plan for • PACT Home team – involving all services and other key stake holders
Impleme •Education- plan for staff and veterans to lay the foundation
ntation •Vigorous HR recruitment of teamlet staff started
• Space redesign Plans mapped , approved and in progress
Approval of • Other Key PACT Implementation staff recruitment in progress
New PACT • VA PCMH launch in LasVegas April 2010 and birth of Collaborative Team thereafter
positions • Sprung into action with goals and timelines from education to staffing and dissemination
HBC, HPDP,
•
Committed
to
6
regional
collaboarative
sessions
with
interim
reports
and
projects
MHV
•
Training •
Process •
changes •
resource •
allocation
Auburn 12
Module 2 - Access Scheduling
• ACP MHB Results reviewed January 2010
Medical • Primary Care Module Management Staffing and Room Utilization review
Home • PACT readiness assessment
Builder
Coordinator 
Reno PC 9
Module 3 - Organization of Practice
• *Patient Driven
*Team based,
•
*Efficient
*Comprehensive
*Continuous
PACT
Principles • *Communication
*Coordination
ACP scoring methodology
Minden3
Fallon 14
on 127 questions:
Susanville 8
0-33%: Weak Performance
34%-67%:Average performance
67%-100%: Strong Performance
Training
Goals set at the PACT Summit - Met
DiSC tool June – July 2010 for team building - 100%
Motivational interview with MINT certified trainer July 2010- all PC staff on board
Discussions at weekly meetings, National fireside charts and PC Current Happenings materials
Primary Care meetings with expanded team members 2x monthly,
PACT/PCMH related Journal reviews and Local presentations by ACOS AC

PACT collaborative Goals – Met/Exceeded
• Whole teamlet PACT learning centers training
• Travel team engage in 6 learning sessions over 18 months-July 2010 through January 2012
Champion • Pilot team used to iron out kink then spread to all teams
•
All
teams
assigned
as
of
February
2011
at
all
sites
Pilot >
spread
PACT COMPASS PCP Continuity
10/8/2010
LS 2: Oct
2010
Care
Coordination
PACT
West
Collabo
rative
LS 1: July
2010
Access
PACT COMPASS Ratio of
Telephone to all Encounters
Auburn CBOC
Minden CBOC
To all the Veterans, we hear you
and we salute you!
LS 3: Jan.
2010
Practice
Redesign
Susanville CBOC
LPN
RN
LS 5: July
2011
Team Roles
Challenges
PACT COMPASS Same Day Appt. with PCP
Fallon
CBOC
LS 6: Jan 2012
PACT + specialty
PACT+ Teleheath
PACT Sustainment
LS 4: April
2011
PACT
Principles
Staff turnover Buy-in
Winnemucca
Competing demands
Continuity and Space
MSA
PCP

Future Plans
Sustain
Specialty spread
Stay Tuned…