Honoring Choices Wisconsin. About GHC-SWC

Transcription

1 Honoring Choices Wisconsin Group Health Cooperative of South Central WI Initial Pilot March 1, August 31, 2013 About GHC-SWC Began operation in 1976 as health care cooperative-both the clinical provider and the insurer Currently have six primary care clinics in Dane County-just opened new clinic at Madison College to serve students, staff and in January of 2014 will open to all patients 1

2 GHC-SCW Approximately 50 primary care providers including nurse practitioners, physician assistants and clinical nurse educators Also provide PT/OT, dermatology, podiatry, optometry, chiropractic and complementary medicine GHC-SCW Serving 75,000 patients/members Approximately 3,000 Medicaid or BadgerCare and 2,500 Medicare In 2014 will provide insurance coverage outside of Dane County In 2014 will also partner with a Medicare Advantage plan 2

3 How we got started Innovation Grant in 2011 to pilot the use of the Five Wishes Started with 2 busy practices-1 Internal Medicine and 2 Family Practice Physician referrals to one social worker Less than 10% of all patients had a completed advance directive on file Found out about the HCW and increased scope of project The planning team Pilot Leader Project Coordinator Facilitators-nursing and social work Project Manager Clinic Manager Physician Champion/Sponsor Epic Team HIM Coding 3

4 The Focus Focused on patients over the age of 60 who were scheduled for a Welcome to Medicare Visit, Annual Wellness Visit (Medicare) or a general routine physical Selected Internal Medicine practices at three sites, busy Family Practice practices at two sites for a total of 5 physicians 4

5 Pre-Pilot Training Met with all clinical staff at all five clinics to introduce advance care planning and the plan for the pilot All staff received the HCW tri-fold brochure and our own handout with pilot details Articles were placed in organizational newsletters to clinical and general staff Presentation to GHC Board of Directors 5

6 Execution Facilitators were each assigned to a clinic Facilitators were given 4 hours a week for pilot They pulled the list of patients scheduled a week or two out Calls were made to target group offering the conversation The goal was to meet with them prior to or after their appointment Scripted Intro for ACP to Patients Good morning, Mr./Ms.. My name is and I am a nurse/social worker & advance care planning facilitator at GHC. Dr. is recommending that his/her patients meet with me to discuss a new service we are providing called Advance Care Planning. Are you familiar with what an Advance Directive/POAHC is? Advance care planning is a process for you to: Understand possible future healthcare choices Reflect on those choices in light of the values and goals important to you Discuss your choices with those close to you and the health professionals who care for you Make a plan for future healthcare situations This process may only take a short period of time or it may take many months. What is most important is that you begin now and take the time you need to understand, reflect, discuss, and make a plan that will work best for you and those closest to you. [Mary found it helpful to explain the 2 meetings/times so that pts understand what they are getting into time-wise. Also that we prefer that pt s selected agent come to the second meeting.] An Advance Directive is the plan you make for future healthcare. In this plan, you may simply provide instructions about the choices you would prefer for future healthcare, or you may appoint another person or persons who would make your healthcare decisions if you were unable to make them yourself. Making an advance directive is optional and the healthcare you receive will not be affected if you decide against making one. As long as you are capable, you may change or revoke your advance directive at any time. Having these discussions isn t easy, but having them provides a real gift to families. When families have discussions about how they want to be treated, it reduces stress, anxiety, depression, and even anger among family members because they know what kind of care you want. It is about helping your family honor your choices not make choices for you 6

7 Reactions Overwhelmingly the majority of those contacted were interested in meeting with the Facilitators Of those that declined, the majority already had a document completed and agreed to either bring it in or allowed us to retrieve it from another organization Documentation Reason for Call: Advance Care Planning Facilitation Synonym: ACP SmartPhrase for Outreach Call 7

8 Documentation Place Order for Facilitation 8

9 ACP Outreach from the scheduled PHE, AWV, WTM Add to Appointment Note for scheduled PHE, AWV, WTM ACP scheduled with [facilitator name] for [date/time]. ACP offered and declined. ACP offered and pt already has POAHC. [Did they bring a copy?] 9

10 Route Encounter to PCP as an FYI Consider using <dot>afutappts to pull in the appointment information. Results At the beginning of the pilot the five selected physicians had a completion rate of 13.5% At the end of the pilot the rate was 16.3% Total of new (HCW) documents collected was 21 The balance were sent from other organizations or the patients brought them in to be scanned 10

11 Results Over 100 patients had an initial conversation Two additional physicians were added per their request Finding witnesses Challenges Consistent follow-up after first visit Getting people back for second visit Making time for pilot work One physician was out on medical leave for several weeks Added physician did not have many over 60yo on her panel 11

12 Next Steps Continue with same physicians Expand offering to all patients over 60, regardless of visit type Offer to new SSI members that will be in managed care in 2014 Include rooming staff in the process Increase number of Facilitators Request for HCW Coordinator staff person Committed to Success 12