Patient and Caregiver Engagement

Transcription

1 Patient and Caregiver Engagement March 16, 2017 Bryant Campbell, Amy Gibson, Barbara Doyle

2 Continuing Education To receive Continuing Medical Education/Continuing Education Unit credit: Go to Enter your login ID and password and then click "Log In." NOTE: You may need to create an account if you have not done so in the past. Specific instructions are available for download during the webinar or from CPC+ Connect. For questions regarding the continuing education credit, please contact via . 2

3 Introductions Bryant Campbell National Learning Team for CPC+ Amy Gibson National Learning Team for CPC+ Barbara Doyle National Learning Team for CPC+ 3

4 Objectives At the end of this session, you will be able to: Identify effective strategies to partner with patients and caregivers to improve quality Describe strategies to integrate self-management support into your practice Describe ways to engage patients and caregivers through shared decision making 4

5 CPC+ Driver Diagram 5

6 Function 4: Patient and Caregiver Engagement Engage patients and caregivers to guide improvement in the system of care Integrate self-management support into usual care across conditions Engage patients in shared decision making 6

7 Key Questions Your work to enhance Patient and Caregiver Engagement starts by asking: How can we can effectively engage patients, families, and caregivers in improving the system of care? What roles, responsibilities, and activities can my staff take on to help patients achieve their health goals? How can we balance risks and expected outcomes with patients preferences and values? 7

8 Care Delivery Requirements: Patient and Caregiver Engagement Requirements for Track 1 Requirements for Track 2 Convene a Patient and Family Advisory Council at least once in PY2017, and integrate recommendations into care as appropriate Convene a Patient and Family Advisory Council in at least two quarters in PY2017 and integrate recommendations into care as appropriate Assess practice capability and plan for support of patients self-management Implement self-management support for at least 3 high risk conditions Track 2 capabilities are inclusive of and build upon Track 1 requirements. 8

9 Polling Question At what stage are you in developing your PFAC? a. Not started yet b. Started planning with practice staff c. Have a identified a few potential patients to serve on PFAC d. Planning for first PFAC meeting e. PFAC meets regularly and involved in making practice improvements 9

10 Patients as Partners in Improvement Our patients and their families are an abundant source of wisdom as we navigate the stormy seas of healthcare delivery. To go it alone without their partnership is foolish and unwise. Joseph Bianco, MD, FAAFP Director of Primary Care, Essential Health. 10

11 Benefits of Patient and Family Advisory Council (PFAC) Bring patient and family perspective to practice operations Improve patient safety, quality and care delivery Provide insight about community resources and supports Share unique patient experiences influenced by culture and environment 11

12 Starting your PFAC Collaborate Identify Identify a staff liaison Composition Determine the composition of your PFAC Meeting Recruit and invite patients and family caregivers to the meetings Work with members to determine best day and time to meet Get to know one another Provide orientation to practice and goals of PFAC Work collaboratively to develop agenda and goals going forward Key Steps for Creating PFACS in CPC Practices document is available for download 12

13 Western Wayne Physicians Located in: Allen Park, MI Physician-owned, primary care practice Robert Jackson, MD Primary Care Physician EHR: Allscripts/KPN Laurie Groesbeck Complex Care Manager 13

14 Providence Medical Group North Portland Located in: Portland, OR Large health system Chantell Fitz-Amado Program Coordinator Patients: 9,336 EHR: EPIC/Healthy Planet Bryant Campbell PFAC Member 14

15 What is Self-Management Support? Self-management support gives your patients with chronic conditions the tools to manage their health on a day-to-day basis and take an active role in their health care 15

16 Shift in the Process of Care 16

17 Essential Activities in Self-Management Support Collaborating with patients Negotiating healthy behavior change Assisting with the emotional impact of having a chronic condition Teaching disease-specific skills Providing training in problem-solving skills Providing regular and sustained follow-up 17

18 Utica Park Clinic Owasso Located in: Oklahoma Large Multi-specialty practice EHR: Next Gen and IBM Watson Health for population management Jeffrey Galles, D.O. Chief Medical Officer Primary Care Physician 18

19 Shared Decision Making Identify preference sensitive conditions Determine the process for the care team to support shared decision making Decide on a uniform approach to shared decision making including the use of decision aids 19

20 Additional Learning Support CPC+ Roadmap CPC+ Requirements CPC+ Change Package 20

21 Engage with the CPC+ Learning Community Review the Change Package and Care Delivery Requirements Find tools and resources in your Implementation Guide Join Action Groups Ask questions and share best practices on CPC+ Connect Join Affinity Groups 21

22 Upcoming CPC+ Learning Events Check the CPC+ Community s Weekly Update for registration details as they become available. Learning Event Scheduled Date Refer to the CPC+ Master Calendar on CPC+ Connect for the latest information and details! CPC+ Monthly Office Hour Access & Continuity on demand webinar series Action Group 001 Implementing Risk Stratification and Longitudinal Care Management Action Group 002 Implementing Risk Stratification and Longitudinal Care Management Using Your Comprehensive Primary Care Payment for Non-Visit Based Care webinar Action Group 003 Two-Step Risk Stratification and Enhanced Longitudinal Care Management Action Group 004 Two-Step Risk Stratification and Enhanced Longitudinal Care Management Financial Forecasting and Reconciliation on-demand webinar CPC+ Monthly Office Hour April 27 at 4:00 PM ET Coming in April Session 1: April 11 at 12:00 PM ET Session 2: April 25 at 12:00 PM ET Session 3: May 9 at 12:00 PM ET Session 1: April 11 at 3:00 PM ET Session 2: April 25 at 3:00 PM ET Session 3: May 9 at 3:00 PM ET May 3 at 4:00 PM ET Session 1: April 27 at 12:00 PM ET Session 2: May 11 at 12:00 PM ET Session 3: May 25 at 12:00 PM ET Session 1: April 27 at 3:00 PM ET Session 2: May 11 at 3:00 PM ET Session 3: May 25 at 3:00 PM ET Coming in May May 25 at 4:00 PM ET 22

23 Question & Answer Additional Questions? Contact CPC+ Support at or

24 Thank You We appreciate your feedback on this learning event. Please take a minute to complete our survey. 24