Empowering Medical Assistants Improves Primary Care

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1 Empowering Medical Assistants Improves Primary Care By: Jessica Langley, MS, Executive Director of Education and Provider Markets, National Healthcareer Association Running a healthcare practice presents unique challenges managers seek efficiency and productivity, while employees value career advancement, fulfillment and work-life balance. Most importantly, patients expect (and deserve) a high quality of care. Emerging healthcare trends focus on empowering the medical assistant (MAs) oftentimes the most underutilized and unrecognized direct patient care provider. Positioning the medical assistant as the heart of the care team can significantly improve productivity, quality of care and cost efficiency, while creating a compelling career ladder for allied healthcare professionals. A FOCUS ON MEDICAL ASSISTANTS Healthcare organizations across the country are finding new ways to provide improved patient care. One approach is to elevate the role of MAs as part of the care team. For example, the Hitachi Foundation s Care Team Redesign Initiative 1 seeks to spark primary care improvement through the career development of MAs at several large primary care centers. A third-party evaluation by Georgia State University is examining the relationship between MA advancement, patient care metrics and the financial performance of clinics. 2 Health systems and insurers must simultaneously boost patient outcomes and control costs. When given training, medical assistants can play a more vital role as part of the care team and can yield tremendous value to patients and healthcare providers, says Tom Strong, Senior Program Officer at the Hitachi Foundation.

2 NORTH SHORE PHYSICIAN GROUP LEADS THE CHARGE As MAs take on additional responsibilities, their roles and titles are transforming. For example, newer titles such as patient navigator, health coach and facilitator have emerged to differentiate job functions. When MAs gain the trust of their providers and are trained to perform at the top of their license, elevating their roles can benefit the entire organization. The case study of North Shore Physicians Group (NSPG) highlights an organization that has made significant investments in its MAs, with impressive results. In 2009, the group was faced with a diverse patient population and an influx of patients, resulting in a workload that was overwhelming to both physicians and patients. In 2010, NSPG launched its journey toward the Patient Centered Medical Home (PCMH) and looked at improving a number of core operational areas such as patient and employee satisfaction, lack of standardization and quality of care. We knew our care team was feeling overwhelmed with the amount of work that needed to be accomplished on a daily basis, says Lindsay Gainer, Director of Clinical Services and Innovation at NSPG. Additionally, patients were also impacted by long wait times and decreased levels of service. We wanted to deliver care in a new and more efficient way, and we knew we needed to make big changes to accomplish that goal. Senior leaders at NSPG knew that the transformation required redesigning the role and utilization of MAs. But they faced some hurdles: A standard education and training requirement for onboarding new MAs did not exist, translating to discrepancies in skills across their team. Professionals with the title of MA had varying roles from department to department. The changing role of the MA impacted outpatient practices, with physicians requesting more assistance. Without consistency in education or roles, they were faced with answering how to empower each MA for sustainable, repeatable success. STEP 1: STANDARDIZE MEDICAL ASSISTANTS EDUCATION NSPG s leadership team recognized a need to standardize education and requirements for all its MAs. In 2010, the organization launched a Clinical Redesign curriculum that provided consistent, high-caliber training for MAs across the entire organization. This effort was designed to accomplish the following: Utilize MAs more effectively in patient care delivery models. Empower MAs to be critical members of the care team. Improve MA job satisfaction and retention. Enhance MA quality and performance. Improve provider work-life balance. The results were astounding. In fact, the curriculum was so successful it gained national attention and was ultimately purchased for use in a six-state PCMH demonstration project in safety-net community health centers. 3 STEP 2: REFINE THE ROLE OF THE MEDICAL ASSISTANT After all current NSPG MAs completed the training in 2010, the organization began making changes to the roles and responsibilities designated to the MA. First, MAs shared space with providers in order to act as flow managers. Using Lean methodology, developed at the Virginia Mason Institute to improve office flow, NSPG levelloaded the work across the care team.

3 This change led to MAs taking on new and expanded tasks. MAs are now charged with tasks such as agenda setting, medication review and routine screenings, better utilizing their skill set. patients needs are met without delays is essential. This is greatly improved by the MA and provider sitting side-byside, allowing easy communication and smooth flow of patient requests. The MAs also now proactively perform immunizations and point-of-care testing using standing orders. For example, for a diabetes follow-up visit, the MA performs an HbA1c and microalbumin and addresses an overdue eye exam before the provider even enters the team room. When we see the medical assistant as a valued member of the care team, they are empowered to address issues around chronic disease management. Functioning as a health coach in this manner helps patients feel comfortable and know they are receiving high-quality care, Gainer says. Additionally, NSPG MAs assist with the management of indirect work, all of the behind-the-scenes tasks required to care for a panel of patients. In the new world of population management, using a team-based approach to ensure all Elevating the role of MAs, particularly in the areas of health coaching and population management, has made them a critical and extremely valued part of the NSPG care team. STEP 3: OFFER PROFESSIONAL DEVELOPMENT OPPORTUNITIES As the MA transformed into a more vital role at NSPG, the organization created a number of leadership and professional development opportunities such as a MA Council, an Employee Education Assistance Program, recognition of national certification and a robust career ladder promoting growth within the group. Descriptions of each program are listed below. NSPG Professional Development Opportunities Medical Assistant Council The council was launched in 2010 with MAs from each NSPG site meeting bi-monthly to focus on standardizing and improving clinical processes. The council members also serve as Process Advocates at their sites to communicate new standards of work. Employee Education Assistance Program The Employee Education Assistance Program (EAP) was launched in 2011 from funds raised by the MA clinical curriculum redesign. Individuals may use the funds for a variety of jobrelated professional development or continuing education activities. There is a lifetime maximum of $2,500 and the employee must commit to two years of employment. NSPG physicians contribute to the fund annually, demonstrating their investment in the team. National Certification Recognition MAs were required to become nationally credentialed as part of NSPG s professional development process. Credentialing serves as a quality care assurance indicator as well as a personal investment in their profession. As there is no universal curriculum, education, training requirements or scope of practice for MAs, employers rely on a nationally recognized credential to validate an individual s base knowledge.* Medical Assistant Career Ladder NSPG created a four-tiered career ladder allowing MAs to advance into higher, more specialized roles. To qualify for movement within the career ladder, MAs had to provide documentation of an NCCA national certification, compose an essay describing their accomplishments, and show dedication to the organization and future goals along with five letters of recommendations.** *There are four notable allied health professional certificate organizations that maintain accreditation from the National Commission for Certifying Agencies (NCCA) - an organization that serves as a third-party evaluation of exam development. **For more information about NSPGs four-tiered career ladder, please refer to National Healthcareer Association s (NHA) 2015 publication, T.E.A.M.- Based Care: Trust, Educate, Advocate for and Maximize on the Abilities of the Medical Assistant.

4 I saw the professional development opportunities as accomplishments for medical assistants and a breakthrough for the profession, says Laura Nichols, an NSPG medical assistant. In her seven years with NSPG, Laura has capitalized on her strengths, moved up the career ladder and currently holds a position as a clinic supervisor. She s well on her way to pursuing her dream of becoming a registered nurse and sees her certification and the opportunities made available by NSPG as the catalysts for her success. THE RESULTS NSPG solved operational challenges by implementing innovative strategies and evolving a traditional, decades-old care model. In doing so, they opened the doors not only for the medical assisting profession but also their organization by offering a ladder of opportunities for allied health professionals, resulting in overall success for the care team. T.E.A.M.-Based Care in Action: Laura Nichols, CCMA Laura Nichols, Certified Clinical Medical Assistant (CCMA), has experienced first-hand the evolution of the medical assistant (MA). Her role has changed for the better, and she has taken full advantage of professional development and career opportunities offered to her by North Shore Physician Group (NSPG). Nichols has always had a passion for caring for others and a dream of becoming a registered nurse. In 2008, she took the first step toward achieving that dream: she enrolled in and completed a MA training program. She launched her MA career with experience in her training programs and an internship at a family medical clinic. She transitioned to a position at Boston s Brigham and Women s Hospital, where she gained a great deal of real-world knowledge in a large facility with a fast-paced environment and diverse patient population. Nichols transitioned to NSPG where she was promptly integrated into the practice s care model redesign initiative. The initiative focused on expanding the role of the MA, with the primary goal of highlighting them as key members of the healthcare team. Because of NSPG s redesign model, Nichols feels highly valued in her position as a MA. Nichols urged NSPG to think bigger about opportunities for MAs and provided feedback to the administration as they began to develop an internal career laddering and professional development program. I saw this as an accomplishment for the MAs and a breakthrough for the profession, says Nichols. NSPG was committed to supporting its frontline staff and empowering them to grow professionally in order to gain national certification and higher-level positions within the organization. Obtaining a national credential is key - it shows dedication to our careers. National Healthcareer Association s (NHA) CCMA credential made that possible for me, Nichols says. Credentialing is not only important to obtain -- it s important to maintain, as it s transferable from one employer to another. I see it as a badge of honor and a huge accomplishment. In her seven years with NSPG, Nichols has capitalized on her strengths, moved up the career ladder and she currently holds a position as a clinic supervisor. She is still pursuing her dream of becoming a registered nurse. With collaboration and innovative support from NSPG, Nichols is a testament to the many successes that come with incorporating the teambased care approach within a practice.

5 REDUCED MEDICAL ASSISTANT TURNOVER Because of the increased level of investment and recognition for MAs, the organization experienced a reduction in staff turnover, dropping from 25% in 2007 to 11% in Employees say they feel valued and supported by the organization a sentiment that s reflected in higher employee satisfaction scores and improved teamwork. PHYSICIAN SATISFACTION A focus on developing a standardized clinical curriculum has paid off for NSPG, giving physicians and nurses more confidence in the skills of MAs, and the ability to level load in order to achieve workflow efficiencies that helped not only the MA but also the physician resulting in a 14% increase in primary care physician satisfaction scores. INCREASED CERTIFICATION The push for career laddering and national certification for MAs exemplified the organization s support for professional growth and development. Achieving national certification is seen as an accomplishment within the profession and with the opportunity to climb the career ladder, MAs feel motivated to succeed. A credential is also a valuable asset that is transferable from position to position or across multiple locations. NSPG has seen an increase in the number of MAs seeking a national credential jumping from just 14% in December 2010 to 62% in March In conjunction, formal education completion rates have increased as well. IMPROVED PATIENT SATISFACTION According to NSPG, empowering the MA has helped patients feel comfortable and as if they have a dedicated health coach to help them throughout their journey. Patients have one trusted point of contact who knows their history and needs and can serve as their guide. The 2015 Massachusetts Health Quality Partners Patient Experience Survey in adult primary care shows the NSPG mean score for Office Staff is 90 out of 100, and exceeds the statewide mean. NATIONAL RECOGNITION NSPG s changes have caught national attention from the Annals of Family Medicine, which featured the organization in its report of High-Functioning Primary Care Practices. The article highlights facilities that foster a positive work environment and prevent physician burnout. 5 These efforts were also highlighted in Thomas Bodenheimer, MD s report: The 10 Building Blocks of High-Performing Primary Care, which studied successful models to determine innovative efforts that lead to improved patient care.

6 NSPG investments Standard training for all staff Expanded role for MAs Team-based care model Clinical curriculum redesign Baseline standardized competencies All team members practice to top of license MA council Employee EAP Recognition of national certification Development of career ladder NSPG outcomes All staff trained on standardized clinical competencies Increased confidence in skills Employee retention/reduced turnover** Improved patient care Reduced physician daily work flow Increased MA national certification Improved teamwork Increased employee engagement/satisfaction** Greater workflow efficiencies** Improved patient satisfaction** Strengthened professionalism Patient Safety improvements** PCMH industry recognition** In summary, with NSPG and various case studies, there is a valid business case for training and elevating the role of the MA. In doing so, practices support positive clinical and patient outcomes while promoting innovation within the care team -- ultimately working to improve the quality of patient care. nhanow.com

7 AUTHOR: JESSICA LANGLEY, MS, EXECUTIVE DIRECTOR OF EDUCATION AND PROVIDER MARKETS, NATIONAL HEALTHCAREER ASSOCIATION Jessica Langley has been at the forefront of the national effort leading the charge to elevate the quality of patient care by empowering allied healthcare professionals. Her role at NHA puts her at the forefront of the national effort to influence allied health certification acceptance and regulation throughout the United States. Prior to joining the NHA team, Langley spent the past 12 years pursuing her passion for allied health education as program director, clinical coordinator and Radiography instructor. Additionally, she held administrative titles such as Allied Health Department Chair and, more recently, Director of Education/Academics. Langley is a clinician by trade and has held national certifications as a Registered Radiologic Technologist and a Computed Tomography Technologist for the past 15 years. Working alongside physicians and healthcare professionals, Langley is committed to delivering quality patient care in various clinic and hospital settings. She received her A.A.S. degree in Radiography, was awarded a Bachelors of Science degree in Medical Diagnostic Imaging from Fort Hays State University and earned a Master of Science in Educational Leadership from Pittsburg State University. Langley has published multiple articles about, and is regularly invited to speak, on topics such as trends in medical assisting, Meaningful Use implications, and the impact of certification in allied health professions. CONTRIBUTOR: LINDSAY GAINER, RN, MSN, NORTH SHORE PHYSICIANS GROUP Lindsay Gainer received her Bachelors of Science in Nursing and her Masters of Science in Nursing, specializing in Health Care Systems, from The University of North Carolina at Chapel Hill. She has varied professional experience in clinical, academic and leadership settings. Lindsay s areas of expertise are in quality and safety, process improvement, leadership and health policy.

8 RESOURCES 1 Hitachi Foundation Strong, Tom. Care Team Redesign: Transforming Medical Assistant Roles in Primary Care. 11 Mar healthaffairs.org/blog/2015/03/11/care-team-redesign-transforming-medical-assistant-roles-in-primary-care/ 3 Qualis Health and the MacColl Center for Health Care Innovation at the Group Health Research Institute. Safety Net Medical Home Initiative. 4 Sinsky, Christine A., MD et al. Annals of Family Medicine. In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices. June Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. Annals of Family Medicine. The 10 building blocks of high-performing primary care. Apr Learn more about NHA at nhanow.com This communication is provided for informational and promotional purposes only and is not intended to be a legally binding contract. The information contained herein, which is subject to change without notice, is provided for general use and, while ATI is committed to providing accurate information, ATI assumes no liability for the accuracy or completeness of this information or your reliance there upon. AHMARK10177 EMP