The Harvard Vanguard Medical Associates LEAD Story

Continuously Building Upon Innovation….

Pt. Centered Med. Home Shared Med. Appts. Leadership Academy

Lean Process Clinical Innovation

EngagementCell Med

LEAD  

   

Patient Centered    

Care

   

Model Clinical      

Unit     

Since HCHP opened the doors in 1969, we have a strong history and culture of innovation…with an emphasis on thedelivery of highquality care

Hypothesis for Health Care Transformation

Payment & Coverage Reform (Finances/Economics)

Redesign Clinical Care Delivery (Care Model Paradigm)

Transformational Change in Health Care

Engagement of Multiple Stakeholders

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Clinical Outcomes Goals

Measurably improve outcomes of our patients with:

(1) Obesity

(2) Cardiovascular Risk

– Hypertension / Diabetes / Dyslipidemia /Tobacco Use

(3) Depression

The Case for Redesigning Ambulatory Care

Schroeder S. N Engl J Med 2007;357:1221-1228

The Case for Redesigning Ambulatory Care

Pre-visitPost-VisitVisit

Between Visits

Between Visits

Patients’ behaviors are most critical determinant of health.Patients’ behaviors are most costly determinant of health care.

Engage patients in healthful behaviors

The ‘3rd Paradigm’ of Care & Between Visit Care Hospital Clinic Home/Work/Play

(1st Paradigm) (2nd Paradigm) (3rd Paradigm)

Late Stage & Acute Care

High Complexity

High Cost

Less patient participation

Early & Mid Stage of Care

Less Complexity

Less Cost

Moderate patient participation

LEAD

Changes in Pre-Visit, Visit & Post-Visit• Pre-Visit

– Labs

– Demographic & PCP Verification

– Medication Reconciliation & Health Maintenance Update

• Streamlined & Service-oriented Check-in Process

– Included improvements to the “late patient” process, printed receipts, insurance

card scanning, welcome packets for new patients, kiosks…

• Visit

– Medical Assistant Medication Reconciliation & Allergy Verification

– Use of “walkie talkies” for clinician-MA handoffs

• Post-Visit

– After Visit Summary (also available on MyHealth)

– Care Coordinator Role

– Cross-booking into specialty appointments & radiology

Health Risk Assessment Tool

• Administer behavioral risk assessment at all physicals

– Physical Activity 58% sedentary

– Depression 33% dysthymic or depressed

– Nutrition 74% risky nutritional behavior

• Provide EPIC supports to document plan of care

• Deliver personalized, written instructions after patient visit

• Match patient to appropriate treatment option

• Monitor progress between visits

Clinical Outcomes Interventions

• Prescriptions for Healthy Living

• Health Coach

• Virtual Nutritionist

Use of the After Visit Summary: 2008AVS use: CHE, MFD & HVMA

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10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

SEP OCT JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC

Months

% o

f FTF

Enc

ount

ers

CHE IM-A CHE IM CHE MFD IM MFD HVMA

MyHealth Enrollment

0.0%

5.0%

10.0%

15.0%

20.0%

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30.0%

35.0%

40.0%

SEP OCT NOV DEC JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC

Month

Perc

ent E

nrol

lmen

t

CHE IM-A CHE IM CHE MFD IM MFD HVMA

13

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10111213

Weight LDL SBP DBP A1c

Team ATeam C

LEAD Clinical Outcomes

0.420.170.091 0.0420.5P Value =

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LEAD principles, approaches to change,

operational processes and clinical tools

have become integrated and infused into

Harvard Vanguard Medical Associates . . .

Transformation & Sustainability

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LEAD and HVMA 2009 Strategic Goal Development

· Engagement Process

· Rapid Prototyping Process Improvement

Approach

· Improvement and Innovation

LEAD Initiatives HVMA 2009 TacticsApproach

New Care TeamCheck-in / Check-outClinical OutcomesAgreements of Belonging

Patient Centered Medical Home

Check-in / Check-outQuick FixLean process Improvement

Shared Medical Appointments Pilot

Agreements of BelongingEngagementLeadership Academy/ Training

Site-based Councils

Shared Medical Appointments Program

Team and Lean Process Improvement

Check-in / Check-outVisit Efficiency

Epic Optimization and Workflow Efficiencies

Lean Process ImprovementCheck-In / Check-OutAgreements of Belonging

Rescue and Re-allocate

Charles HandyThe Age of Unreason

The future we predict today is not inevitable. We can influence it, if we know

what we want it to be…

We can and should be in charge of our own destinies in a time of change.

Reflections . . .