Objectives and Implementation Plan for a Managed Care Curriculum

Transcription

1 Objectives and Implementation Plan for a Managed Care Curriculum Elizabeth Krajic Kachur, PhD;* Karen S. Edwards, MD. MPH;* Eliot Moshman, MD;** Barney D. Newman, MD;** Martin Klein, MPH;* Martha S. Grayson, MD* From the Center for Primary Care Education and Research and the Departments of Pediatrics and Medicine, New York Medical College, Valhalla, NY (*) and Kaiser Permanente - New York, White Plains, NY (**). Corresponding author: E. K. Kachur, PhD; Center for Primary Care Education and Research, New York Medical College; Munger Pavilion, Suite 600; Valhalla, New York Tel: (914) , Fax: (914) , Elizabeth_Kachur@NYMC.edu Introduction To provide primary care residents with the knowledge, skills and attitudes necessary to work effectively in today s managed care (MC) world, a curriculum was developed for a one-month rotation to a group model HMO and a complementing lecture series. The objectives outlined in Table 1. are meant to yield to a basic understanding of MC principles. The focus is on learning about the system rather than on adding an extra ambulatory patient care rotation. The eighteen core goals are kept sufficiently generic to permit an application to multiple specialties. The implementation matrix in Table 2. relates each goal to each of the 12 planned learning activities: 1. A monthly lecture serieswhich is offered before, during and after the rotation 2. An orientation sessionat the beginning of the rotation 3. A quality management projecthat requires the in-depth analysis of one provision issue (e.g., adherence to guidelines for breast cancer screening) 4. Supervised patient care sessions, each focusing on a separate MC topic (e.g., referral practices) 5. Patient education sessionsconsisting of attendance at group programs as well as individual tutoring by patient education staff 6. Telephone management sessionswhere residents work with advice nurses who assist patients over the phone with the help of a physician-developed manual 7. Specialty and subspecialty sessions which address clinical as well as managerial aspects of 8. Attendance at MC hospital rounds 9. Visits to selected departments(i.e., pharmacy, membership relations, quality management) 10. Attendance at selected committee meetings(i.e., quality and resource management, pharmacy and therapeutics, ethics) 1

2 11. A syllabus which is designed as a workbook companion for the rotation 12. Regularly scheduled supervision sessionswith HMO faculty and the rotation director Care has been given to maximize the potential of each program element and to assure that each goal is covered multiple times, via multiple pathways. Such tight structuring affords the opportunity to eliminate some educational offerings (e.g., due to scheduling problems or preferences of individual learners) without jeopardizing an overall coverage of the educational goals. 2

3 Table 1. Educational Objectives At the end of the training program, residents should be able to... GOALS KNOWLEDGE OBJECTIVES SKILLS OBJECTIVES ATTITUDE OBJECTIVES I. MC Principles a. Distinguish MC from other forms of b. Contrast different types of MC c. Trace the history of MC in the US and elsewhere d. Explain benefits and limitations of MC e. Identify the forces driving the current debate and developments II. Population-based Medicine a. Describe the principles of populationbased medicine III. Ethical Considerations a. Identify ethical and legal issues related to MC b. Juxtapose ethics concerns in MC with those of other systems IV. Career Decisions a. Describe MC career opportunities and limitations b. List elements pertinent to work contracts with MC organizations V. Quality Management a. Discuss the principles of quality management b. Describe quality of care assessment methods VI. Cost/Utilization Management a. Explain the principles of cost containment and utilization management b. Compare and contrast cost and benefit distributions in MC with those of other systems Managed Care Fundamentals a. Use MC terminology effectively a. Demonstrate an openness to MC principles a. Analyze the risks/needs of a patient population a. Apply ethical principles to MC patient situations a. Secure further information concerning MC options Systems within Managed Care a. Perform a QM chart review b. Assess the effectiveness of selected practices c. Utilize QM terminology effectively a. Analyze the cost factors applicable to the care of a particular case b. Incorporate cost in clinical decision making a. Develop a community orientation for prevention and treatment b. Balance an individual (1:1) with a population approach (N:1) a. Demonstrate sensitivity to ethical and legal concerns a. Exhibit comfort in making an informed choice concerning MC career decisions a. Reflect a commitment to continuous quality management a. Support cost conscious approaches to 3

4 GOALS KNOWLEDGE OBJECTIVES SKILLS OBJECTIVES ATTITUDE OBJECTIVES VII. Continuity of Care a. List the benefits of continuity of care b. Describe the mechanics involved in maintaining continuity VIII. Primary Care Physicians as Coordinators of Care a. Delineate the tasks involved in the coordination of care b. Discuss the role of Primary Care physicians in a variety of MC settings IX. Referral and Consultation a. Describe methodologies for incorporating specialists into a MC system b. Discuss the trade-offs between internal and external specialists c. Explain what happens during a MC consultation with a specialist X. Hospital Care a. Describe the relationship between MC agencies and hospitals b. Distinguish the MC approach from other systems XI. Performance Evaluation a. Summarize methods for assessing physician performance b. Explain how MC organizations utilize performance reports to change provider behaviors XII. Patient-Physician Relationship a. Discuss the concept of membership b. Examine the coordinator role c. Explain the use of patient satisfaction measures d. Contrast relationship issues in MC to those of other systems e. Describe how patients select PCPs in MC systems XIII. Team Work a. Describe the contributions different workers can make to the care of a patient b. Identify the responsibilities of team leaders and team members a. Diagnose continuity problems in a plan b. Design organizational measures to enhance continuity a. Coordinate comprehensive more effectively and efficiently a. Initiate appropriate referrals b. Collaborate effectively with consultants a. Apply quality improvement and cost containment principles to the care of hospitalized patients b. Consult the Milliman and Robertson Hospital Utilization Guidelines a. Interpret performance reports accurately Interpersonal Skills a. Effectively involve patients in decision making processes b. Utilize the patient-physician relationship for maximizing c. Take on an appropriate coordinator role a. Collaborate more effectively with other physician and non-physician providers b. Engage in participatory decision making a. Endorse a patient care approach that emphasizes continuity of care a. Reflect on the value of Primary Care physicians as coordinators of care and patient advocates a. Acknowledge the importance of a careful consultant selection process b. View specialists as true consultants a. Value MC criteria for hospitalization b. Acknowledge that much care can be transferred to outpatient settings a. Endorse the need for performance evaluation a. Value the closeness of a continuous and long-term patient-primary Care physician relationship b. Strive towards improving and maintaining high quality patientphysician relationships a. Recognize the efficiency, added value and cost effectiveness of team collaboration 4

5 XIV. Managed Care Approach to Common Outpatient Conditions XV. Prevention and Health Maintenance GOALS KNOWLEDGE OBJECTIVES SKILLS OBJECTIVES ATTITUDE OBJECTIVES a. Discuss the MC approach to the 10 most common disorders b. Contrast MC patient care models to those of other systems c. Recognize what procedures can be safely done in a Primary Care office setting d. Describe practice guidelines a. Describe guidelines for primary, secondary and tertiary prevention b. Recall how they are developed and what their limitations are c. Explain the mechanics of communitybased preventive efforts XVI. Patient Education a. Identify the factors involved in effective patient education b. Select effective videos, pamphlets and other patient education aids c. Describe how patient education classes work XVII. Telephone Medicine a. List problems and issues patients present during telephone consultations b. Explain guidelines for medical decision making during telephone encounters c. Identify the proper place for telephone management d. Discuss the relationship between telephone medicine and emergency room use Diagnosis and Treatment a. Utilize outcome research for medical decision making b. Apply practice guidelines to individual cases a. Take an efficient risk factor history b. Counsel patients appropriately c. Utilize patient education materials effectively d. Perform appropriate screening exams e. Design a personalized health maintenance plan and negotiate it with a patient a. Frame medical knowledge in layperson s terms to increase understanding b. Utilize patient education materials effectively c. Assess patient comprehension a. Establish rapport with a patient on the telephone b. Assess patient s problems over the phone c. Utilize advice guidelines in a telephone encounter a. Acknowledge the benefits of the MC approach to patient care b. Reflect an appreciation of the value and appropriate role of practice guidelines a. Value prevention as intricate part of b. Acknowledge prevention as a cost containment measure a. Acknowledge the importance of patient education as core element of the encounter b. Recognize the contributions patient educators make to the provision of a. Reflect on the challenges and opportunities of telephone medicine 5

6 XVIII. (to be determined jointly by resident and faculty) GOALS KNOWLEDGE OBJECTIVES SKILLS OBJECTIVES ATTITUDE OBJECTIVES Personal Learning Goal 6

7 Table 2. Implementation Matrix Educational Goals (I-XVIII) and MC Learning Activities (1-12) - shaded areas indicate coverage I MC Principles II Population Based Med. XII Ethics 1 Lectures 2 Orient at. 3 QM Proj. 4 Pt. Care 5 Pt. Educ. 6 Telephone 7 Specialties 8 Hosp. Rounds 9 Select Depts. 10 Committ ees 11 Syllabus 12 Supervision XV Career Decisions V Quality Management VI Cost/ Utilization VII Continuity of Care VIII PCP as Coordinator IX Referrals in MC X Hospital Care XI Performance Evaluation XII Patient-MD Relationship XIII Team Work XIV Common Conditions XV Prevention/ Health Prom. XVI Patient Education XVII Telephone Medicine XVIII Personal Goal Abbreviations Depts. = Departments Orientat.= Orientation Educ.= Education PCP = Primary Care Physician Hosp.= Hospital Proj.= Project MC= Managed Care Prom. = Promotion MD = Physician Pt.= Patient Med. = Medicine Q M = Quality Management 7