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Welcome

Mark MasselliPresident and CEOCommunity Health Center, Inc.Connecticut

Board Chair, NIMAA

Team-Based Care Model The Curriculum Host Clinics Role of Preceptors A Students Perspective Strategic Steps

What We Will Cover

Ed Wagner, MD, MPH MacColl CenterWashington

Tom Bodenheimer, MD, MPH UCSF School of MedicineCalifornia

Why does NIMAA Matter?

Tom Bodenheimer, MDCenter for Excellence in Primary CareUniversity of California, San Francisco

Well-trained MAs are essential for

primary care teams

Competence

• I want my physician to have the knowledge needed to help me

Empathy

• I want my physician to care about me

Familiarity

• I want to know my physician; I want my physician to know me

Continuity

• I want to see my personal physician when I need help

It doesn’t have to be a physician. It could be a NP, PA, RN, behaviorist, pharmacist, physical therapist, or medical assistant.

What do patients want from physicians?Detsky AS, JAMA 2011;306:2500; Safran DG, Ann Intern Med 2003;138:248

Stable team structure: teamlets

Patientpanel

1 team, 3 teamlets

Clinician + MAteamlet

Patientpanel

Clinician + MAteamlet

Patientpanel

Clinician + MAteamlet

RN, behavioral health professional, social worker, pharmacist, complex care manager

Definition: stable team/teamlets

1• The same people always work together

2

• Patients empaneled to a teamlet are always cared for by that teamlet

3

• The teamlet is responsible for the health of its patient panel and only sees patients on its panel

Why should teams be stable?

1• Patients: “I want to know the people caring for me”

and “I want the people caring for me to know me”

2

• Clinicians working with the same MA every day tend to have lower levels of burnout than clinicians working with different people on different days [Willard- Grace et al, J Am Board Fam Med 2014;27:229].

3

• Research shows that patients prefer small practices. A stable team/teamlet divides a large, impersonal practice into small, comfortable units that feel like small practices [Rubin et al, JAMA 1993;270:835].

Patientpanel

Clinician + MAteamlet

Patientpanel

Clinician + MAteamlet

Patientpanel

Clinician + MAteamlet

Panel management and health coaching

MAs taking responsibilityfor panels of patients

Sharing the care with MAs:Panel Management

• Preventive care: immunizations, cancer screening (cervical, breast, colorectal)

• Chronic care: e.g. diabetes: all lab tests are done in a timely fashion

Medical assistants identify patients overdue for routine services and arrange for those services to be performed

Physician-written standing orders are needed to empower the medical assistants

Quality of preventive services improves [Chen and Bodenheimer, Arch Intern Med 2011;171:1558]

An estimated 50% of all preventive care activities could be performed by medical assistants [Altschuler et al, Ann Fam Med 2012;10:396-400]

Sharing the care with MAs:Health Coaching

Health coaching: assisting patients develop the knowledge, skills and confidence to become informed, active participants in their care [Ghorob, Family Practice Management, May/June 2013]

In RCT, patients with MA health coaches had significant drop in A1c and LDL-cholesterol compared with controls [Willard-Grace et al, Ann Fam Med 2015;13:130]

Estimated 25-30% of chronic care activities could be performed by MA health coaches [Altschuler et al, Annals of Family Medicine 2012;10:396]

For health coaching curriculum and 4 videos, see the Center for Excellence in Primary Care website, cepc.ucsf.edu, Tools for Transformation, Health Coaching

Primary Care Team

Team Structure:Major Findings from Site Visits

MA Involvement inKey Functions or Competencies

http://www.improvingprimarycare.org

Improving Primary Care

Mary Blankson, DNP, APRN, FNPChief Nursing OfficerCommunity Health Center, Inc.

Mark Splaine, MD, MSEducation DirectorWeitzman Institute

The Curriculum

Traditional ContentMedical career workforce skillsHealth, disease processes, and preventionPractice in a community health centerCore skills & Externship

NIMAA-specific ContentThe health system and communityTeam-based care (health coaching, panel mgmt)Quality improvementDeveloping as a professionalNIMAA skills

What is the content?

National CurriculumEveryone does same online workExperience at sites is also coordinated

Site-based LearningLearning specific skillsParticipating in clinic setting from Day 1Close work with preceptors and mentors

How does the curriculum work?

NIMAA ParticipantIncremental learning with hands-on clinical

application Socialization to the MA role on the care teamExplore possibilities for academic progression

What is the impact?

Host Clinic SiteOpportunity for existing staff to solidify

commitment to train the next generationEnhances current QI activityEnhances current staff development

programming

What is the impact?

NationallyCreates a knowledge network between centersPromotes a new standard for MA educationEnhances the interprofessional collaborative

practice team

What is the impact?

Tillman Farley, MDChief Medical Officer Salud Family Health Center

Teri Brogdon, M.Ed.Education and Training Design DirectorSalud Family Health Center

The Role of the Host Site

Train students to your center Hire students that you knowReduce training costsIncrease efficiencyImprove care to your patientsImprove the health of your community

What are the benefits for a host site?

Commitment to the PCMH team-based healthcare delivery model

Recruit and select students Identify staff to be trained as preceptors Support the training model Communicate with NIMAA Help graduating students find a job

In the communities you serve!

Key Expectations of Host Site

Skills based learning

– students are helpful from day 1 Students are assigned a weekly skill to practice Students are not assigned to an individual MA Every skill is taught, then repeated until

mastery No lost opportunities for practice

NIMAA Additive Skills Training Model

Productive

Effective

Limited

Graduation

Orientation

NIMAA Additive Skills Model

Provide curriculum and content Provide on-line training Playbook to guide the host clinic Preceptor trainings and support Technical assistance

NIMAA Role in Supporting The Host Clinic

Recruitment of students Identifying a NIMAA liaison/Site directorReleasing preceptor time for trainingInvolvement in skills training each weekProviding evaluations and feedback to NIMAAHelping students find a job after graduation

What are the costs for a host site?

NIMAA host clinics transform health care, one MA at a time!

Natasha Quinn Senior Medical AssistantCommunity Health Center, Inc.

The Role of Preceptors

Role of the Preceptor

Training NIMAA Participants

Benefits of being a Preceptor

The Role of the Preceptor

Jenn DepreyNIMAA’s Pioneer ClassCommunity Health Center, Inc.

A Participant’s Perspective

Differences between NIMAA and standard MA education models

NIMAA provides a better way of learning

Working in Team-Based Care

A Participant’s Perspective

David AylwardNIMAA Project Lead

What’s Next?

Characteristics of a NIMAA Host Clinic: Strong support and involvement of top leadership Share NIMAA’s dual goals: better care through trained workforce; better student

careers Implementing model of care where MAs are becoming key members of the PCMH

team

NIMAA Provides to Host Clinics: Experienced faculty and Instructional staff: regular live, taped lectures and discussions Complete online curriculum and program with textbooks, supporting IT systems Preceptor training program, with guidance for teaching and measuring specific

traditional and PCMH skills; available to all staff during Phase II Support for host clinic leader and preceptors Manage all enrollment, grading, certification and grievance issues.

Phase II “Get”

Responsibilities of a NIMAA Host Clinic: Interview, help select, host MA candidates for the 7 month training

session Appoint a NIMAA program leader Select qualified preceptor for each medical assistant candidate Host candidates 4 hours daily as they assist a care team and learn

from preceptors Organize weekly coordination and feedback meeting for candidates Support NIMAA in obtaining state teaching licensure Provide feedback Pay tuition

Phase II “Give”

Survey for all of you What are your pain points? Interests in workforce development?

NIMAA Host clinic for full Phase II program (9/17) Host clinic for full Phase III program (4/18) Contributor to program content Upskill existing staff: apprentice programs

Other workforce development/transformation training

Next Steps Pathways

February: Fill out survey February: Conversations Early March: Virtual workshop April and May: Selection of Phase II partners June and July: Recruit and qualify students Summer: Host clinic selects, NIMAA trains site lead

and preceptors July and August: Select students September: Training begins

NIMAA Full Program Phase II

Any Questions?

Contact us:nimaa@chc1.comwww.nimaa1.org

Thank you for attending!