NMCP Referral Guideline and Feedback Loop Implementation

Transcription

1 NMCP Referral Guideline and Feedback Loop Implementation LCDR Tuberson Latica Lewis Referral Management 4 May 187 1

2 Referral Guideline Working Group Team Members Lt. Col Alderson (DMS) CDR Walters (DSS) CDR Gentry (DPC) LCDR Boggs-Wilkerson (DPC) LCDR Tuberson (DHBO) 2

3 Referral Guideline Guiding Premise DHA-IPM : Primary Care providers will: Collaborate with MTF specialty care leaders to enhance the referral guidelines in the Tri-Service Workflow Form (TSWF-Madigan Guidelines) based on local capabilities to maximize direct care bookings of the first specialty appointment. Use specialty care referral guidelines in the TSWF when referring a patient for specialty or behavioral health care appointment. 1. Provide pre-referral management suggestions at PCM point of care. 2. Improve quality and completeness of referrals to reduce unnecessary consultation. 3. Encourage communication between Primary Care Providers and Specialists. 4. Improve Patient Experience through more efficient referral process, communication and downstream access. 5. Provide basis for central review by utilization management (eg put the specialists basic decision processes on paper). 6. Decrease purchased care costs. 3

4 Current State Referral Process 1 Business Day 1 Business Day 2-14 Business Days Consult Generated by PCM Specialist Review of Referral (1 Day) Accept or Reject Referral Accept Book to MTF Defer to Network Reject 1. Functional Dead End: Only feedback if consulting provider reads CHCS mail and many Primary Care providers may only work a couple times per week or month. No incentive to use existing guidelines. 2. Patients and PCM do not know status and often calling RMC or PCM to check on status of consult Info Needed or No Appointment Required 3. Specialist feel consults unnecessary or incomplete with growing number of consults despite relatively stable enrollment

5 Future State Referral Flow Chart 1 Business Day 1 Business Day 2-14 Business Days All referrals will be reviewed and either appointed to MTF or deferred to network within (1) business day of written referral. Specialist Review of Book to MTF Consult Generated by PCM Referral (1 Day) Accept or Reject Referral Accept Defer to Network Med Home Team Review all returned consults. Coordinate INFO Needed Close No Appt. Required Inform patient within 24hrs. Referral Guidelines = Shared Mental Model VIA CHCS Bidirectional Queue INFO NEEDED Return to Med Home Team for clarifying info Reject Info Needed or No Appointment Required No Appointment Required Return to MHP for closure Via CHCS Bidirectional Queue

6 Referral Guideline Desktop Icon Link Currently maintained within the Referral Management SharePoint site. Stored in PDF format Printable Savable to other locations or ed Accessible through all NMCP Desktops via The Blue Button 6

7 NMCP Referral Guidelines SharePoint Intranet Site 7

8 Complete Guidlines Adolescent Med Adolescent Med Allergy Allergy Allergy Allergy Allergy Allergy Allergy Cardiology PEDS Cardiology PEDS Cardiology PEDS Cardiology PEDS Cardiology PEDS Cardiology PEDS Dermatology Endo PEDS Endo PEDS Endo PEDS Endo PEDS Endo PEDS Endo PEDS Endo PEDS GI HEM/ONC HEM/ONC HEM/ONC HEM/ONC Sexual health Mental/Behavioral Health Urticaria Rhinitis Asthma Dematitis Immunotherapy Food/Drug Anaphylaxis Murmur Hyperlipidemia Hypertension Marfan Syndrome Syncope Chest Pain Extensive Short Stature Obisity Hypo/hyperthyroid Pubertal Disorders Diabetes mellitus/hyperclycemia/polydipsia/uria Calcium & Vitamin D Metabolism Disorders Failure to thrive Dysphagia Anemia Cancer Spenomegaly Venous Thrombocytosis Inf. Disease Inf. Disease Inf. Disease Inf. Disease Inf. Disease Inf. Disease Inf. Disease Neuro Surg Neuro Surg Ortho Ortho Ortho Ortho Ortho Ortho Pulmonary Pulmonary PEDS Pulmonary PEDS Pulmonary PEDS Pulmonary PEDS Pulmonary PEDS Pulmonary PEDS Pulmonary PEDS Vascular Vascular Vascular HIV STI Hepatitis Travel TB Ulcers Lyme Latent TB Cervical Lymphadentitis Recurrent HSV Recurrent MRSA Immunodeficiency Lyme/Rickettsail Fevers periodic Bone/joint infections Lumbar Radiculopathies Cervical radiculopathies Emergent Ortho Referrals Foot Knee Spine Hip Elbow & Wrist Injuries Chronic Pain Asthma Cystic Fibrosis Bronchopulmonary Dysplasia Restrictive/interstitial lung disease Thoractic Scoliosis Recurrent Pneumonia Muscular Dystrophies AAA AI Carotid Stenosis 8

9 The Feedback Loop- The missing piece from 2014 initiative 61,929 Referral Written Jan-Mar 2018 More Info Needed % of total or avg 7 per day No Appointment Required- 3, % of total or avg 50 per day Anticipate initial increase in More Information Needed once feedback loop process working. emsm concerned with impact on review within 24 hours metric this process will have related to No Appointment Required if returned to MHP team in this process for closure. NMCP intent to improve communication despite the metric but will need close monitoring. 9

10 Specialist Sending Back to PCM 10

11 PCM Queue managed by MHP team to get required information to send back to specialist 11

12 Next Steps Continue deployment of referral guidelines on SharePoint site. NMCP Staff smartphone deployment. DMH and DCSS (MRI) to be added to Guideline group. May- Training at MHP clinics on using CHCS referral queues. 7 May 18 -Test referral guideline functionality and feedback loop at Boone Clinic (has used preliminary loop in past already) 14 May 18 Adjust based on feedback from Boone Providers 30 May 2018 Full deployment across all specialties/mhp Website Metrics to assess use of Blue button and specific guidelines. 1 May 19 - Annual review and adjustment to all guidelines. Centralization of consult review process with RMC utilization management RNs 12

13 Info Needed/No Appt. Required Report 13

14 Referral Management Team Assignments 14