CPAR Uncovered: A closer look at the
Central Patient Attachment Registry
PCN Strategic Leads Forum – September 9, 2017
Dr. Tobias Gelber, Chinook PCN, President Section of Rural Medicine Barbra McCaffrey, EMR Lead, Toward Optimized Practice Chris Diamant, EMR Advisor Toward Optimized Practice
Presenter Disclosure
• Presenter: Dr. Tobias Gelber Chris Diamant Barbra McCaffrey
• Relationships that may introduce potential bias and/or conflict of interest: – No relationships to declare.
Introductions
Where did the Central Patient Attachment Registry come from?
• Part of the amending agreement between AMA and AH
• Need for greater continuity in Alberta
• Desire to have primary provider information appear in Netcare
• Joint initiative with AHS and AH
Panel ID, Maintenance and CPAR
Current State of Panel Maintenance
At every interaction ask who the patient identifies as their primary provider Record it in the EMR & Date Stamp It Maintain & Review the panel List Utilize the panel list to plan care delivery starting with ASaP
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Current State of Panel Maintenance
• Patients seen for primary care (panel) are distinguished from patients seen for episodic care (caseload)
• Clinic can produce a file/list of each primary provider’s panel
Panel Maintenance with CPAR
At every interaction ask who the patient identifies as their primary provider Record it in the EMR & Date Stamp It Maintain & Review the panel List Utilize the panel list to plan care delivery Submit the Panel List to CPAR
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Three Panel Conflict Signs
03.04J
Rx Test
Result
CPAR – Phase One
CPAR - Phase One
• December 2017 • Blended Capitation clinics will be required to
participate • CPAR will be the source of truth in Alberta for
roster management and compensation for all blended cap programs (currently 3 programs)
CPAR – Phase One
• April 2018 • Limited production rollout? • Clinics must meet readiness criteria (handout) • Registration process will proceed participation
– Panel Access Administrator – Panel Administrator – Panels
• Participants will export panel lists from their EMRs and upload to CPAR quarterly
• Name, DOB, PHN, Gender, Last Visit Date, Last Confirmation Date
How Will CPAR Work for Panel?
Clinics confirm panel at practice
Produce confirmed panel list at practice for each primary provider
Save list as csv file and submit to registry via
secure portal
Registry receives the list and looks for duplicates and mismatches to PCR
Provider receives list of panel conflicts and
mismatch notifications
Clinics are already doing this: • Name • PHN/ULI • DOB • Gender • Date of last visit • Date last confirmed
CPAR Registration for Panel Access
Administrator, Panel Administrator &
Panels
START
CPAR – Phase One
• Panel Administrator will receive two reports: – Panel conflict report by provider – Mismatch notifications report
Panel Conflict Report MOCK REPORT FOR DR. TEST IN EDMONTON
Panel Conflict Report MOCK REPORT FOR DR. TEST IN EDMONTON
John Doe – was paneled to Dr. Y 9 days after being paneled at my clinic 3 months ago. Joan Chan – was paneled at my clinic and 2 others, all in April 2016 Chris Lee – was paneled by Dr. V in St. Albert last but was paneled at my clinic and 3 others over 1.5y Manish Padwal – was paneled last at my clinic by 11 months Fredrick Caron – was paneled at Dr. K in Sherwood Park 11 months after he was paneled at my clinic
Mismatch Notification
Clinic EMR does not match Patient Client Registry (PCR) for PHN/ULI, Name, Date of Birth, Gender or is Deceased. • In some cases the clinic EMR may be correct
• E.g., Patient changed name, informed clinic and didn’t complete the paperwork for Alberta Health
• In some cases the PCR data may be correct • E.g., A team member made a typo when entering the patient’s date of
birth
How Will it Work for Panel?
Clinics confirm panel at practice
Produce confirmed panel list at practice for each primary provider
Save list as csv file and submit to registry via
secure portal
Registry receives the list and looks for duplicates and mismatches to PCR
Provider receives list of panel conflicts and
mismatch notifications
Clinic team acts on panel conflicts and
mismatch notifications. CPAR verifies panel
Repeat Quarterly
Who Should Upload Panels?
Panel • Provide comprehensive
longitudinal primary care
• Include long-term care patients in panel (may be separate panel)
Caseload/Episodic Care • Specialty services
– Vasectomies – Maternity Care – Sports Med – Pap clinic – Aesthetic services
• Patients seen for episodic care
Questions?
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The Value Proposition
CPAR – Phase One
• Learning from those who went before…
With cross referenced lists of patients that are paneled at other clinics in our PCN, we have been forced to create a clear concise script to facilitate our staff starting these conversations with patients. The conversations are often awkward and uncomfortable for the patient and the panel manager but ultimately a better common ground is found, where the patient feels supported not attacked and recognizes the behind the scenes work we do on their behalf even when they don’t come to the clinic regularly.
Dr. Christine Luelo MD CCFP & Margo McMillan, RN, Panel Manager
Testimonial from South Calgary
Why CPAR?
Relational Continuity
Informational Continuity
Data & Information
System Enablers
• Better health outcomes • Better quality of care • Better coordination of
care • Reduced overall health
cost to the system
• Potential Reports • Provider/Clinic • PCN • System
• Provincial level attachment data & information for secondary use
• Unattached patients • Provincial level planning of
care services delivery • Foundation for chronic
disease registry
• Better handoffs • Better
communication • Less duplication
• Enabler for potential new compensation models for
• Physicians • PCNs
Value – Patient
With increased continuity, patients: • Healthier • More satisfied • Receive better care • Take better care of
themselves • Have better outcomes
Value – Initial Phase
Physician and Team • Identify panel conflicts • Manage panel conflicts • Create VERIFIED panel
– Use for panel management – Patient value of improved
continuity • Clarify demographic
mismatches • Be in position for future
continuity of care incentives
PCN • Additional phase of panel
supports • Verified panels for panel
management • Identify panel conflicts • Population data on attached
& unattached patients • Be in position for future
population health data reporting
Value - Future Phase
Physicians and Team • Receive clinical panel-based
data reports on verified patients
• Use reports for pro-active panel-based care
PCN • Data based on attached and
unattached patients in the PCN will inform planning and service delivery – population health and
business intelligence reports from registry data
– clinical and health system utilization population reports
• Be in position for new PCN funding models
Questions?
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CPAR – Next Steps
CPAR – Next Steps - Tools
Developed • Key Messages • FAQ’s for Physicians and EDs • EMR Panel Guidance
– How to panel – How to produce panel list
• IF and Panel Manager training (phase appropriate)
• Readiness checklist • Roles and responsibilities of
Panel Administrator
In Development • Leader Slide Decks • Registration Package • EMR – csv file generation • How to use Registry • Managing Panel Conflicts
– Guide – Scripts
• Patient Communications
CPAR – Next Steps
Training Tools • IF training, Panel in Action Training • Incorporate into Panel Management (screening
care, disease management, care planning) • Strategies for panel conflict management How can the AMA help? • Training videos • Full suite of supports, resources and tools for
PCNs, Teams and Providers
CPAR – Next Steps
Handouts: • Glossary • Readiness Checklist • Roles and
Responsibilities of a Panel Administrator
CPAR – Next Steps
• Patient Consultation (Alberta Health) – Consultation is initiated and ongoing – AH has engaged with IMAGINE Citizens
Collaborating for Health on Panel and Continuity – Patient input – Results have potential to influence
• Patient communication materials • Physician office scripts
CPAR – Next Steps
We’re all on board! What do we do next? • Decide on a strategy for your PCN • Start talking to your members • Encourage Panel ID & Maintenance Processes
– Use the STEP documents – Use the Checklist for Panel and CPAR Readiness
• Discuss your plans with your AMA (TOP/PMP) contact
Questions?
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CPAR – Future State
CPAR – Future State
CPAR Attachments in Netcare: • Once the registry is populated and conflicts
managed: – The patient’s Netcare record will include the name of
their primary provider and practice contact information
– Clinic can be contacted in urgent care situations – Enable hospital/ER reports to reach primary provider – Increased integration
CPAR – Future State
Community Information Integration (CII): • Registry automatically
populated from provider’s EMRs: – CII team currently in talks
with EMR providers
CPAR – Future State
Patient Portal: • CPAR information linked to the patient portal? • When a patient is paneled to more than one
provider, they could select the provider they want to be paneled to?
• See their primary provider in the portal?
CPAR – Future State
Consolidation of data from multiple databases • Patient Client Registry • Provider, Panel ID • Panel elements (Name, PHN, DOB, Gender, Last
visit, last date confirmed) • Unattached patients • PCN membership of providers – via AH PCN
Membership • Provider Registry • HQCA
CPAR – Future State
Future PCN Reporting: • What would PCN Executive Directors, Boards,
Medical Directors and team members find of most value?
Thank You!
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