KEEPING PRIMARY Changing our focus to population CARE ... · CARE RELEVANT Changing our focus to...

KEEPING PRIMARY CARE RELEVANT

Changing our focus to population management

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LEARNING OBJECTIVES Understand a framework through which primary care can deliver patient centered care to support population health Identify opportunities for enhanced pharmacist involvement in population driven care Understand how the tools of design thinking can be applied to solving complex healthcare problems

SPECIFIC TAKE AWAY As community care moves towards a population health framework that emphasizes value over volume, the contributions of non-physician team members become more and more important.

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DISCLOSURES None

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28% of patients could list their medications 37% could state the purpose of their medication

14% could state common side effects

42% could state their diagnosis

50% of all prescriptions went unfilled

50% of filled prescriptions were taken improperly

AFTER A CLINICAL INTERACTION:

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Cost Insurance Too Busy

Not sure what to do

REASONS FOR NOT SEEKING CARE

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The system doesn’t support us understanding the real reasons people come to see us

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The health care system cannot respond to the needs of the patient without talking to them first

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What we thought we knew about what patients wanted wasn’t really what they wanted

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Consumers define health not as the absence of disease but as the ability to function in their daily lives

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Communities look to healthcare as a service that supports their health rather than a system that rids them of disease

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Of every 5 patients seen in the clinic today

1 needs to see a provider

1 could be served with non-visit care

3 could be served by a care team

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HEALTHCARE COSTS

COMPENSATION

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Fee-for-service

Episode care

Condition-based care

Partial population care

Full population care

0%

20%

40%

60%

80%

100%

2010 2015 2020 Source: “The View from Healthcare’s Front Lines: An Oliver Wyman CEO Survey”

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Health care organizations will be responsible for keeping a population healthy instead of being rewarded for caring for individuals only when they get sick

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We need to transform our delivery model to one that eliminates waste and rewards value

A Population Health Management model is the framework through which we can build out this new model of care.

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New models of primary care must be practical and transformative, create standardization with reasonable localization, enable the shift from fee for service to fee for value and create a customer/patient service driven culture that consistently improves outcomes and experience at decreased cost

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To remain relevant, primary care will require health systems to move beyond the inpatient core business model to invest in the complete arc of care The most successful future requires shifting investments away from acute care assets and towards primary and community-based care

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At the heart of a successful primary care redesign is a comprehensive care management infrastructure that delivers coordinated, integrated care Effective care management will require significant investment in non-physician clinical workforce and workflow

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The challenge for Primary Care is to attract and retain new patients through compelling service offerings and meaningful access to trusted relationships

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ADDRESSING HEALTHCARE WASTE

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Self Care

Treatment

Assessment / Detection

Management

COMMUNITY CARE DOMAINS

A construct based on patient experience. Patients move back and forth within the four domains. Community Care needs to provide the most appropriate service at the right time and place.

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COMMUNITY CARE DOMAINS

The goal is to help people remain within or return to the Self-Care domain as much as possible. This means the healthcare system will need to offer support and knowledge in a different, less intensive and more effective way.

Self Care

Treatment


Management

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Self Care

•  People maintaining a stable level of health •  Reaching out to the healthcare system to answer

specific questions or get reassurance •  Best served by non-visit services

•  Patients who need preventive screening services (detection)

•  Patients who need diagnostics- acute illness, new chronic condition (assessment)

•  Combination of visit, non-visit and drop in services


•  Patients with a diagnosis and plan of care •  Leverage the entire care team to monitor and adjust

treatment Treatment

•  Patients with an established plan of care •  Best served by services that increase the patient’s

capacity and ability to return to self care

Management

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Self Care

•  How can we better support populations at home? •  What NVC services do patients want to engage with?

•  How do we ensure that primary care providers see the patients that need diagnostic assessment?

•  How do we skill up primary care to practice at full licensure?


•  How do we leverage the full care team? •  Can we protocolize care for more diseases? Treatment

•  How do we skill up patients so they can get back to self-care?

•  How do we increase patient and caregiver capacity?

Management

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Self Care

•  E-visits •  Concierge Apps •  24/7 availability for questions and support

•  POC Decision Support •  Microconsults Assessment /

Detection

•  Adding/Enhancing care process models •  Nursing Protocols •  Collaborative Visits

Treatment

•  Intensive education programs for new chronic disease diagnoses

•  Understanding/measuring/enhancing patient capacity

Management

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KEY THEMES

Organizing for team based care

Improving communication Preparing for and streamlining complex visits

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KEY THEMES

Using data to improve quality and experience Skilling team members up to support patient centric outcomes and relationship based care

Supporting health and wellness in the community

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KEY BENEFITS OF THIS MODEL

Improved personal and systemic resiliency Increased market share growth without dependency on providers as focal point of care Position clinics to thrive in a total cost of care environment

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WHY DOES OPTIMIZING THE TEAM MATTER?

*Estimates that increased demand will double panel sizes and influx of patients from specialty will weight panels towards the higher tier end.

INCREASED DEMAND FOR PRIMARY CARE ACCESS

CURRENT PRACTICE LEVERAGING THE TEAM INCREASES CAPACITY FOR

PATIENT CARE

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WHY DOES OPTIMIZING THE TEAM MATTER?

We’re leveraging previously under-utilized roles to deliver the right care, to the right patients, at the right time. Sharing care responsibilities across the team means: + Increasing nurse driven visits + Improving the integration of allied staff members providing specialized services. + Daily communication and coordination of patient care across the team. + Increasing non-visit care options. WORKING WITH THE PHYSICIAN,

NOT FOR THE PHYSICIAN

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FROM CONVEYOR BELT CARE TO WRAP-AROUND CARE

A co-located, multi-disciplinary group that works together to meet the needs of a shared team patient panel. + Conveyor Belt = disconnected, overly structured, single purpose visits. + Wrap-Around Care = flexible, timely, collaborative, responsive to anticipated and emergent needs

WHAT IS THE OPTIMIZED CARE TEAM?

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We are not simply emphasizing physician efficiency and maximizing individual physician productivity. The Optimized Care Team: + Establishes how each member of the team can add the most value to direct patient care. + Emphasizes the delegation of care across disciplines. + Diversifies the relationships patient’s have with their clinic. + Diversifies the access touch points patients have with their clinic.

HOW IS THIS DIFFERENT FROM OTHER CARE TEAM MODELS?

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Referral rates Spring 2013

Including all team members in Care Team huddles increases awareness and discussion of non-medical needs.

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HOW DOES IT FEEL FROM A PRACTICE PERSPECTIVE?

“We should not live and work in silos and lob inboxes at each other. Seeing patients and interacting with the team is rewarding. I don’t want to go back to my silo.” – Care Team M.D. “When we first started, I hated it. Now, I love it!” – Resident M.D. “Co-location, that has really transformed the relationship between pharmacy and clinic.” – Care Team Pharmacist “Small efficiencies add up- I’m not always running around trying to find people anymore.” – Care Team L.P.N.

“What’s in it for me? 5 years ago our diabetes all or none was 8% , now it’s 38%. Our group takes care of about 600 patients with diabetes, our panel has grown 500 in the last 4 months since we’ve started doing this. That’s what we need to do, take better care of patients, take care of more patients, and take care of more complex patients.” – Care Team M.D.

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HOW DID IT FEEL FROM A PATIENT PERSPECTIVE? “I’d rather come in for one very thorough 45min appointment where I see the whole team, than come back 3 times in 3 months.” — Patient interview “Today we saw [the new provider] instead because she has a background in cardiology. Is that because you guys are back there looking ahead and discussing my husband’s visit? I love that!” — Patient Interview “I’m sitting here jealous. I wish it had been my visit!” — Caregiver accompanying patient to appointment

PATIENT QUOTES FROM OPTIMIZED CARE TEAM EXPERIMENTS “It seemed continuous even though there were three people coming in. They knew what I said to the others.” “It was nice because the nurse could provide more education. It didn’t feel rushed.” “Seeing the pharmacist was great. I pick up the meds for the family and I got to ask questions I otherwise would have forgotten.” “I liked that everyone seemed to know about me” “Before, you had to make an appointment just for one thing, it’s nice to have everything taken care of.”

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HOW MUCH CAPACITY WAS GAINED?

Self-reported data from Mayo Clinic Austin, Orange Care Team Data collected from Baldwin Family Medicine Care Team

WHO SAW THE PATIENT?

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THE PATIENT EXPERIENCE

Were you more or less satisfied with a team based visit as compared to previous visits?

More The same Less

n=276

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Was the quality of care you received in a team based visit comparable or better than previous visits?

Yes No

n=183

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How would you rate the timeliness and efficiency of team based visits as compared to previous visits?

Below Average Average Above Average Excellent

n=259

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PHARMACIST ROLE IN THE CARE TEAM

Participation in team huddles Anticoagulation Clinic Participation in care coordination intake Medication assessment and conversion Chronic disease management Post hospital discharge medication reconciliation and assessment

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QUALITY OF CARE RECEIVED FROM THE PHARMACIST

Excellent Very Good Good Fair Poor

63%

26%

11%

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PATIENT SATISFACTION

Agree Disagree

89%

My clinical pharmacist helped me to understand why I am taking each of my medicines

11%

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Agree Disagree

100%

My clinical pharmacist is working as a team member with my other health care providers

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Agree Disagree

100%

After talking with my clinical pharmacist, I feel more confident to manage my medicines

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“Humans are allergic to change. The most dangerous phrase in the English language is ‘We’ve always done it that way’”

-Grace Hopper

KEEPING PRIMARY Changing our focus to population CARE ... · CARE RELEVANT Changing our focus to...

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