Patient Engagement: The Key to Care Transformation · • Shift from physician-centered care to...

blueshieldcafoundation.org

blueshieldcafoundation.org November 15, 2016

Patient Engagement:

The Key to Care Transformation

Presenters:

Carolyn Wang Kong, Blue Shield of California Foundation Giovanna Giuliani, California Health Care Safety Net Institute (SNI) Nia Johar, San Mateo Medical Center Lucia Angel, San Francisco Health Network - Primary Care Shunling Tsang, M.D., M.P.H., Riverside University Health System – Medical Center


today‘s speakers

Lucia Angel

San Francisco Health

Network - Primary Care

Nia Johar

San Mateo Medical

Center

Giovanna Giuliani

California Health Care

Safety Net Institute (SNI)

Carolyn Wang Kong

Blue Shield of

California Foundation

page 2

Shunling Tsang, M.D., M.P.H.

Riverside University Health

System – Medical Center


patient engagement research

page 3


gains in satisfaction

page 4


gains in satisfaction

page 5


available resources

page 6


recommendations categories

page 7


available resources

page 8


Giovanna Giuliani,

Executive Director,

California Health Care Safety Net

Institute (SNI)

page 9

Ambulatory Care Redesign

Data-Driven Organizations

Social Determinants

of Health

Performance Excellence

Value-Based Strategy

PHS 2020 Vision & Sustainability

• PRIME required

project webinars

• Foundation-

strengthening

webinars, in-person

meeting

• In development • In development

Waiver

integration

teams

(WITs)

Global Payment Program

• Data for

Improvement

program

• CMIO/CIO peer

group

PRIME

Whole Person Care

Waiver Implementation and Delivery System Reform Framework

Models of integrated care that are high value, high quality, patient-centered, efficient and equitable, with great patient experience and a demonstrated ability to improve health care and the health status of populations.

• Closely linked to

Whole Person

Care

• Reporting guide and support, Q&A • Care delivery transformation

• Reporting guide and support, Q&A • Support state learning collaborative; wrap-around

offerings

• Reporting support, guide and portal • Metric specifications and Q&A • Innovative metrics testing

• PRIME manager webinars (technical) • Implementation webinars (care delivery)

page 10

Wa

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featured speakers

Lucia Angel

San Francisco Health

Network - Primary Care

Nia Johar

San Mateo Medical

Center

page 11

Shunling Tsang, M.D., M.P.H.

Riverside University Health

System – Medical Center


Nia Johar, Patient Centered Medical Home

Coordinator, San Mateo Medical Center

page 12


care teams

• What is a care team?

• A structure around how a clinic team works together to

effectively and efficiently take care of a panel of patients

page 13


why transform care teams

• Primary Care trends at SMMC and across the U.S.

• Shortage of primary care physicians

• Increase in patient demand for primary care

• Shift from physician-centered care to patient-

centered care

• Coordinating treatment, tests, and prescriptions across

providers & healthcare settings

• Focus on preventative care

• Changing payment structures

• Shift from Fee-for-service (based on volume of services)

capitation and value-based payment (based on quality of

patient outcomes)

page 14


planning process

• Conduct a 3P in order

to build the care team

model

• Review roles and

responsibilities of each

position

• Choose set of in-reach

and outreach activities

to plan and manage

care

page 15


implementation strategies

• Hold Improvement event with frontline staff and

Patient Improvement Partners

• Informational presentations

• Train and validate staff on operator standard work

page 16


spread

• Site by site implementation (still in the works)

• Identify Pilot site as 1.0 slowly integrate other

clinics

• Take all Operator Standard Work and see where each

medical home is currently standing

• Use model from pilot site and allow each medical home to

PDSA it to best fit their regions needs

page 17


skills needed

• Champions

• Change agents

• Natural Leaders

• Good communication/

trying different

strategies

COWBOY MENTALITY PITCREW MENTALITY

page 18


challenges

• Medical homes each currently have their own

flavor of care teams

• Not a standard care team

• Transformation seen as a project and not a culture

shift

• Spread to clinics of different sizes

• Resistance to change

• “What’s in it for me?”


patient engagement

• The core goal of team-based care is continuity

• Every time a patient comes in the see a member of their

own care team

• Empowers patient to collaborate with care team

members

page 20


Lucia Angel, Care Experience Team Lead,

San Francisco Health Network - Primary Care

page 21


background

• A system of 14 community and hospital-based health centers across the city (4 had developed PACs)

• Value of the patient voice in helping identify what matters most to those we serve

• 2015- Primary Care Leadership identified Patient Experience as a strategic priority (True North Metric)

SFHN Primary Care Network

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objective

• Goal is to transform from being the provider of

last resort to the provider of choice for patients

and families.

• Patient loyalty is directly connected to

satisfaction and patient experience in the safety

net

• We must understand gaps between patients

expectations and services they receive

The Blue Shield of California Foundation’s Pathway to Patient Loyalty

page 23


starting with patient advisory councils (PACs) • PACs - the Patient Experience Intervention

• Building a platform to hear and elevate the patient voice

• Patient Advisors would help identify the areas for

improvement and partners in the improvement

• Patient Advisory Council Collaborative

• Staff and Resources were identified

• Plan to establish PACs at all SFHN Primary Care Health

Centers was communicated

• Patient Engagement Assessment Survey

page 24


building capacity

• PAC Seminar Series

• Seminar 1: Group Facilitation

• Seminar 2: Storytelling

• Seminar 3: Quality Improvement

• Central Support

• Patient Experience Lead (tactical)

• PAC coordinators (logistical)

page 25


• Network Level

• Access

• Team-based care

• Customer service

• Network communications

• Health Centers

• Call Center transitions

• Mammogram screening outreach

• Tablet-based timely feedback

patient advisor partnerships

page 26


key learnings and areas for growth

• Clearly defining roles and expectations

• Managers, staff, patient advisors

• Patient Advisors would help identify the areas for

improvement and partners in the improvement

• Dedicated resources

• Committed leadership

• PAC staff member

• Patient incentive funds

• Make work visible!

• Develop standards processes

• Metrics for success

page 27


Shunling Tsang, M.D., M.P.H, PCMH Lead Physician,

Riverside University Health System – Medical Center

page 28


goals of project

• Increase access for patients via telephone visits

• Improve patient satisfaction

• Provide patients options for care

• Capture provider indirect work as it relates to direct

patient care

• Improve provider satisfaction

page 29


desired accomplishments

• Create alternative options for patients seeking care

• Decrease access issues

• Decrease unnecessary emergency room visits

• Decrease hospitalization rates

• Decrease overall costs of care

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key activities • Partner with marketing to develop materials for

patient education to increase awareness of

telephone visits

• Train our scheduling center to determine which

patients are appropriate for telephone visits

• Train our registration staff and back office staff on

the process of telephone visits

• Train our providers on how to utilize and document

telephone visits

page 31


challenges

• Engaging stakeholders – patients, administration,

scheduling, registration, nursing, providers, IT

• Patient engagement and education

• Process changes with implementation of new EMR

• Scheduling challenges

• Data challenges

page 32


achievements to date

• Over 8,000 telephone visits in 2014-2015

• Average of 5-7 telephone visits/hour/provider

• Increased number of patient “touches” or

“encounters” in a resource neutral manner

page 33


lessons learned

• 1/3 to 1/2 of all clinic visits can be substituted with a

telephone visit

• Lack of reimbursement is a major barrier to

widespread implementation

• Education of telephone visits with patients during a

traditional face to face visit helps with engagement

and “no-show” rate

• Importance of confirming a reliable telephone

number and alternative number

page 34


Q&A

page 35


today's webinar was recorded and will be available online in the coming weeks.

Thank you!

For more information, visit:

www.BlueShieldCAFoundation.org

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