Transcript My Nurse Call Center
My Nurse Call Center:
Providing Care For Patients Outside Of The Four Walls
Raedean VanDenover
Director, Care Management | UnityPoint Health
Dr. Stephanie Reyburn
Physician | Quincy Medical Group 1
My Nurse Call Center
My Nurse Overview
• My Nurse is a free health information service for the public • Sponsored by Iowa Health System and it’s affiliate hospitals • Located in Sioux City, Iowa • My Nurse is staffed by registered nurses 24/7/365 • 24/7 Staffing began in 1999 • Positioned to support the clinical initiatives of the system 2
My Nurse Call Center
Our Services: Triage
• Triage callers to determine appropriate level of care • Utilize RelayHealth Relay Care software • Triage completed by RN’s only • Medical director oversight and approval of triage guidelines and call priority 3
My Nurse Call Center
Our Results: My Nurse Call Center Overall
Key Performance Indicator Call Volume 2010 174,377 Calls Answered Abandonment Rate 140,768 15% Average Speed of Answer 0:53 2011 156,277 120,142 18% 0:59 2012 178,709 URAC Standards N/A 131,389 22% 1:03 Less than 5% 30 Seconds or less
4
My Nurse Call Center
Our Results: Physician After Hours Only
Key Performance Indicator Call Volume 2010 51,868 Calls Answered Abandonment Rate Average Speed of Answer 37,057 29% 0:44 2011 55,552 37,618 32% 0:48 2012 85,119 57,291 32% 0:43 URAC Standards N/A Less than 5% 30 Seconds or less
5
My Nurse Call Center
25 000
Calls Offered, Answered, Abandoned BY HOUR OF DAY
20 000 15 000 10 000 5 000 Calls Offered Calls Answered Calls Abandoned
Note: Data range is March 5, 2012 thru March 31, 2013
6
My Nurse Call Center
My Nurse Staffing
• 17.0 FTE Registered Nurses • 5.9 FTE Licensed Practical Nurses • 4.9 FTE Non-Clinical Support Staff • 0.5 FTE Report Analyst • 1 RN Manager • 1 Director • 1 Medical Director 7
My Nurse Call Center
Our Services: Physician After-Hours Calls
• Provide coverage for physician clinics after hours • 2012: 48% of all calls are PAH calls • Currently serving 90 clinics and 405 providers • Coverage is 5pm to 8am • Triage calls and page the physician only when necessary 8
My Nurse Call Center
Our Services: Triage
• • • • • • • Top Adult Guidelines: Abdominal pain or discomfort Post op problems Chest pain/chest discomfort Headache Pregnancy and Pre-term labor (20-37 weeks) • • • • • Top Pediatric Guidelines: Fever Cough Vomiting Cold symptoms Trauma to the head 9
My Nurse Call Center
Physician After-Hours Triage Description
Over 80% of Triage calls fall into one of six dispositions: 24%
Provide self care at home
5% 17% 13% 20% 3%
Call provider immediately See the provider within 24 hours (next day appointments) See the provider within four hours (urgent care if available) Go to ED immediately Activate EMS 911 10
My Nurse Call Center
Our Services: Post-Discharge Call
• Follow up to evaluate understanding of their discharge instructions, pain management, medication management and their need for further health information • Diagnosis specific questions to assess and reinforce compliance with Evidence Based Practice • Presented in a “Teachback format” 11
My Nurse Call Center
Our Services: Post-Discharge Follow up Calls
• Post discharge call is made within 24 hours of discharge • If patient is not able to teach back, My Nurse will teach back key components from discharge summary • Second call is made post discharge day 2 to assess understanding of discharge instructions • If unable to teach back a follow up referral is made 12
My Nurse Call Center
Post-Discharge Calls
2012 Results 31,819
Post-discharge calls schedule
67.1%
Successfully completed
17.5%
Could not teach back their discharge instructions Monthly reports provided to each affiliate in order to create action plans and drive process improvement Supports reducing readmission efforts in the regions 13
My Nurse Call Center
Quality
• 90% benchmark • Quarterly Audits are completed for all staff • 1% of all calls reviewed • Weekly review of all new employees as needed • QA/QI results for 2012 is 93% 14
My Nurse Call Center
2012 Progress
• Completed Integrated Chronic Care Disease Management Training for all call center staff • Trained all staff on use of EHR • Waterloo Triage transitioned to My Nurse • Increased additional clinics to Physician After Hours by 25% • Focused on staffing and training to prepare for 2013 projects focused on continued clinical integration of the call center 15
My Nurse Call Center
2013 Progress
• Transitioned 1 additional clinic to Physician After Hour Service • Access to EHR for New Group patients • Training on use of EHR and GPMS • Launched Pilot with Central Iowa to schedule next day appointments • Implemented Physician After Hours Services for Quincy Medical Group (26 physicians) • Training and support for Iowa Health Home Care Triage process • Installed new phone system to allow for call recording • Began ED Post Discharge call for Fort Dodge Region 16
My Nurse Call Center
Looking Ahead
• Continue to support clinical initiatives of the system • Improve call center metrics to industry standards • Capitalize on updated phone system technology and reporting to drive process improvement and performance • Continue to expand post discharge calls beyond inpatient discharge 17
My Nurse Call Center
Looking Ahead
• Move additional clinics to after hours call service • Continue implementation of scheduling next day appointments • Increase volume and focus of QA/QI program. • Continue to consider additional expansion opportunities 18
My Nurse Call Center
New Brand, New Name
My Nurse becomes My UnityPoint Nurse
19
My Nurse Call Center
New Website
myunitypointnurse.org
Physician-finder resource Articles about more than 1,000 health-related topics Customer satisfaction survey 20
My Nurse Call Center
Project Innovation Team 3: Value Based Healthcare
Reducing ER Visits and Admissions
Project Champion: Dan Evans, M.D.
Project Leader: Stephanie Reyburn, M.D.
Project Team: Dan Evans, M.D.
Hrishikesh Ghanekar, M.D.
Stephanie Reyburn, M.D.
Raymond Smith, M.D.
Musab Saeed, M.D.
Aric Sharp, CEO Patty Williamson, CFO Project Coach: Mo Kasti 21
My Nurse Call Center
• • • • • • • • •
Quincy Medical Group
Quincy Population, 40,630 Service Area 112,000 Founded in 1937 135 providers 100/35 (Phys/Midlevel) 28 Specialties 50% Primary Care, 50% Specialty Care All primary care under CRHC Broad Ancillary Scope McKesson EHR 22
My Nurse Call Center
Quincy Medical Group
Location Outreach 23
My Nurse Call Center
Quincy Medical Group Leadership Institute
• Focused on Developing Change Agents • Innovation Projects Aligned with the Triple Aim • Value – Cost of Care • Service – Patient Experience • Quality – Measurement & Improvement 24
My Nurse Call Center
Scoping Our Project
Value Reducing Cost Quality Imaging Admissions Readmissions Emergency Room Nursing Home HP3 Project Current 9.6% Various Strategies NP Care Project Generic Rx Direct 25
My Nurse Call Center
Selected Project Goals:
•
Reduce Avoidable Admissions and Avoidable ER Visits
• Increase outpatient services • Increase access to care after clinic hours • Improve coordination of care post-hospital discharge and for chronic condition patients 26
My Nurse Call Center
Our Project Plan Approach
1. Narrow Scope 2. Collect Data 3. Educate ourselves and benchmark 4. Pick early wins 5. Develop plans 6. Engage and secure stakeholder buy-in 7. Implement early wins 8. Evaluate what we have learned 27
My Nurse Call Center
National Data on Admits and ER Visits Potentially Preventable Admissions & Visits
• PPAs: 25% of all initial hospital admissions • • National annual rate -94 per 1,000 beneficiaries Heart failure most frequent clinical reason • PPVs: 59% of all ambulatory ED visits (treat and release) • National annual rate -158 per 1,000 beneficiaries • Infections of upper respiratory tract most frequent clinical reason MEdpAC October 5, 2012 28
My Nurse Call Center
Other Causes of ED Admissions
1. Lack of after hours nurse triage 2. Poor coordination with Home Health Care 3. Limited Ambulatory Care Clinic and/or primary care hours on weekends 4. Culture of taking all admissions from Emergency Room 5. Poor transitions in care between inpatient & outpatient 6. Lack of community education about preferred access points 29
My Nurse Call Center
Benchmarking Research What Others are Doing to Reduce Cost
1.
Everett Clinic –
Set goal to reduce total healthcare cost by 25% by 2016 through reducing admissions and moving to generic prescribing, etc.
2.
3.
4.
Geisinger Health Plan
panels.
–
decreased hospital admissions by approximately 15% by implementing a Medical Home model utilizing nurse case managers targeting specific patient risk
Mt. Kisco Medical Group
– an on-call physician from the group sees patients presenting to the ER to determine if the patient needs to be admitted.
CIGNA Medical Group –
is increasing urgent care capacity, implementing a nurse triage line, and educating patients in order to reduce preventable ER visits.
30
My Nurse Call Center
10 Proposed Initiatives
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
After Hours Nurse Triage Phone Service via Iowa Health System • Home Health Care via QMG-Iowa Health System Home Health Care, Home Medical Equipment, Palliative Care, In Home Hospice Expand ACC and/or primary care hours Expand infusion center hours Hospitalist assessing patient in Emergency Room Use Nurse Care Coordinator Model – BCBS Int. Medical Home Discharge Nurse to assure good transition to outpatient Nursing Home NP model of care Patient education about preferred access points Educate physicians on preferred ER referral process 31
My Nurse Call Center
Approach to Securing Buy-in
• Small Family Practice Call group meeting • Large group meeting with Family Practice, Internal Medicine, and Rural Clinic providers • Presentation at Shareholder meeting • One on One meetings with Physicians throughout Primary Care 32
My Nurse Call Center
Nurse Triage
• Nurse Triage call line launched March 4, 2013 for 26 providers • Provides Better customer Service and access to a health professional • Reduces avoidable ER visits • Reduces physician after hours call intensity 33
My Nurse Call Center
Home Health Care
• Partnering with Iowa Health System • Implementation underway - in process of hiring director • Goals: • Reduce readmissions • • Decrease the overall cost of care Capture a revenue opportunity for Iowa Health & QMG • Medicare MSSP data average 406 visits/1000 lives across Iowa Health System.
• Quincy at 127 visits/1000 lives • Opportunity for increased community based services for our patients 34
My Nurse Call Center
Home Health MSSP Data
Visits Per 1000 Lives
1000 900 800 700 600 500 400 300 200 100 0 Cedar Rapids Quad Cities Peoria Central Iowa Waterloo Quincy Muscatine Fort Dodge Visits 35
My Nurse Call Center
Expanded Hours
• ACC Hours (Walk In Clinic) • New Physician hired – extending Saturday hours to all day starting Summer 2013 • Primary Care Offices • Exploring Sunday Hours via Rotation 36
My Nurse Call Center
Hospitalist in ER
• Dr. Vardaros signed with a start date of October 2013.
• Hospital Call Group to explore engaging with the ER on a routine basis.
• Will reduce avoidable ER admissions.
37
My Nurse Call Center
BCBS Medical Home Care Model
• Launched January 2013 • 37 super visits have been completed with another 10 scheduled • Goal is 200 enrolled patients by August 2013 • Potential next step… • Use MSSP data to identify similar high-risk Medicare patients for care coordination • Apply Iowa Health Advanced Medical Team Model 38
My Nurse Call Center
Admission/Discharge Planner
• Launched October 2012 • Better transition of care from hospital to outpatient including scheduled follow-up visits, ancillary capture, med reconciliation and improved communication with provider offices • Next step – additional staff member has been hired to meet face to face with every patient when admitted and discharged 39
My Nurse Call Center
Nursing Home Care Model
• Launched April 2012 • NP Onsite at all Nursing Homes in Quincy • Has led to more satisfied patients, reduced ER visits, and reduced avoidable admissions • All primary care providers currently utilizing the service 40
My Nurse Call Center
Consistent Patient Education
• Reviewed Iowa Health System “Red, Yellow, Green” care action plans for utilization with patients • Implementation Fall ‘13 • Action plans available for wound care, care, stroke, pneumonia, high blood pressure, heart failure, diabetes, depression, and COPD 41
My Nurse Call Center
Transition Plan - Sustainability
Action Nurse Triage Implementation Owner
Kathy Harman / Dr. Reyburn
Home Health ACC Expansion Ancillary Expansion Hospitalist in ER BCBS Medical Home Discharge Planner
Carol Lewis / Dr. Noble Aric / Dr. Evans Patty Williamson / Dr. Petty Aric / Dr. Evans Kathy Harman / Dr. Leimbach Kathy Harman / Dr. Reyburn
Nursing Home Care Model
Kathy Harman / Dr. Schlepphorst
Patient & Physician Education
The Team 42
My Nurse Call Center
Leadership Lessons Learned
• Teamwork • Care Value is Big Work, Narrow the Scope, don’t boil the ocean • Assign clear roles • • Leverage resources • Holding each other accountable • Innovation = Idea + Execution 43
My Nurse Call Center
Next Steps with My Nurse
• Allow My Nurse Access to EHR • Begin scheduling next day appointments • Expand Physician After Hours Service to additional specialties 44
My Nurse Call Center
Questions?
“My UnityPoint Nurse, how may I help you?”
45