Expanding Access Through. Team Care. Carolyn Shepherd, M.D.

Transcription

1 Expanding Access Through Team Care Carolyn Shepherd, M.D.

2 Clinica Family Health Services ,000 Patients 206,000 Ambulatory visits 5 Clinical sites

3 Clinica Family Health Services 50% uninsured 40% Medicaid until 1/1/ % < Poverty 98% < 200% of poverty 1041 deliveries in % prefer to speak in a language other than English

4 Clinica Family Health Services 46 physical health providers 14 behavioral health providers 8 dental providers Clinic in the Homeless Shelter, Mental Health Center 2 full pharmacies, 2 pharmacy outlets, 2 schools of pharmacy Total staff of 408 Admit to 2 community hospitals Faculty, Family Practice Residency

5 Big 6 for Clinica Transformation 1. Continuity 2. Access 3. Team Based Care 4. Alternative Visits 5. Information Technology 6. Patient Engagement

6 What is a team Patient and family (3600) 3 MA and provider teamlets per team Team members: 3 FTE provider 3.5 FTE MA 1 RN/LPN 1 behavioral health professional 1 case manager 2 front office staff 1 medical records 1 call center attendant Shared-pharmacy, hygienist, nutritionist

7 Clinica Team Based Care 1998 Profession-centered, integrated team based care Medical Behavioral health care Referrals Clinical pharmacy services Nutrition services Dental 2014 Patient-centered, cross- functional team based care Patient and family Clinical Providers (physicians, NPs, PAs, dentists, DH, EDDA, behavioral health, pharmacists) Nursing Health Support (MAs, front office staff, case managers, health coaches, referral coordinators) Community Support

8 Clinica Team Based Care Today Help the patient understand the team Team speak with patient, color branding, co-location Algorithm driven care done at front desk Plan for contingencies-questions they can t answer, permission to refer to clinical staff Warm hand-offs for follow up visits with staff Warm hand-ins for MA, pharmacy & nurse visits Team continuity across job descriptions Med recs, telephone #s, names of team on visit summary

9 Clinica Team Based Care Today Continuity and access groups managed by staff Nurses and pharmacists see patients by protocol and ahead of providers when S<D Immunization management is done by MA Developmental and SBIRT screening managed by front office, MA and case manager Med records reviews incoming reports first Accountability for clerical and clinical paperwork

10 Clinica Team Based Care Today Front desk writes work excuses during winter Providers set time limits, and MA manage refills MAs checkout w/ teach back on visit summaries Career ladders support expanded duties

11 Clinica Team Based Care Today Provider can focus on patient needs Provider needs to care for their patients who want care today Alternative visits, hand offs, hand ins, double books

12 Clinica Family Health Services UDS Outcomes:

13 Access Measures Pecos Red Pod-May 2014

14 Clinica Family Health Services NCQA Diabetes 2011/2014 NCQA PCMH Level /2013 Joint Commission Accredited since 2002 Nominated by staff, awarded: 2012/2013/2014

15 Team Care Lessons Learned Its about the patient, its about the patient, its about the patient, its about the patient, its about the patient, its about the patient Fairy Dust doesn t work Time Physical space Effective meeting skills Coaching Support Team continuity is essential Trust

16 Team Care Lessons Learned Reframe productivity into access to care Explicitly link team support with provider access expectations Providers must share the authority-coaching Clinical leadership must get provide buy-in on protocols Report outcomes by team Address resistance with small tests of change Teams often gel around adversity (muffler sign)

17 Team Care Lessons Learned Agree on ground rules Roles and expectations should be written Train teams at the same time whenever possible Co-location helps the patient understand the concept of the care team Co-location facilitates handoffs and trust

18 Team Space Matters Click to add