BUILDING RELATIONSHIPS: PANEL

BUILDING RELATIONSHIPS: PANEL

True or False The majority of Physicians already have panel processes in place If you answered True sit down If you answered False remain standing

True or False Electronic Medical Records support Panel Identification If you answered True remain standing If you answered False sit down

True or False Patients do not want to a relationship with their family physician. If you answered True sit down If you answered False remain standing

True or False You can make measureable clinical improvements in practice without knowing your panel? If you answered True sit down If you answered False remain standing

Yes or No Do you still have wood paneling in your basement? If you answered Yes stay standing If you answered No sit down

PANEL AS FOUNDATIONAL STEP TOWARD MEDICAL HOME 7

PANEL AS FOUNDATIONAL STEP TOWARD MEDICAL HOME 8

PCN EVOLUTION IMPLEMENTATION ACTIVITIES 2014-2015 Governance Panel Measures Goal for 2014-15: Each PCN will have 80 % of their physicians with panel identification processes in use. 9

PANEL WHAT? Panel identification = know who an MD s patients are, and be able to create a list. Teamwork not physician work. Panel management = plan care services with the clinic team so to meet the needs of your specific panel priorities; screening, chronic care, complex care, etc.

PANEL IDENTIFICATION 2 Components to Panel Identification: 1. Patient identifies physician The patient record accurately indicates the most responsible physician. This should be confirmed by the patient on a regular basis. 2. A Physician s panel list is reviewed The team can generate a list of active patients attached to the provider. The panel list should be reviewed and updated on a regular basis.

PANEL MANAGEMENT 2 Components to Panel Management: 1. Registries that support care planning: Patient disease/registries are available to support care planning activities 2. Reports on how well things are going: Reports on care processes, or outcomes of care, are regularly provided as feedback to practice teams for their review.

KEEP CALM AND PANEL ON 13

SUPPORTS FOR PANEL Physician-led Panel Workshops Panel Manager Training Training for Improvement Facilitators Tools and Resources Guide to Panel Identification EMR Tip Sheets and Videos

Building Relationships: Panel Examples in Action Dr. Nadine Letwin Edmonton North David MacDonald Calgary West Central Brian Match / Lindsay Dallyn Kalyna PCN

FACULTY/PRESENTER DISCLOSURE Faculty: Dr. Peter McKernan; Dr. Nadine Letwin; David MacDonald; Lindsay Dallyn; Brian Match Relationships with commercial interests: None

DISCLOSURE OF COMMERCIAL SUPPORT This program has received no commercial support or in-kind funding from commercial organizations. Potential for conflict(s) of interest: None

MITIGATING POTENTIAL BIAS This program has received no commercial support or in-kind funding from commercial organizations, therefore there are no sources of potential bias to mitigate All sessions were planned specifically for a general practitioner audience based on input from a planning committee of physicians

Edmonton North PCN s Approach to Panel Identification & Screening 2014/15 fiscal year

Our context 150 member doctors, in 50 clinics, who see 187,000 patients PCN programs are largely centralized, although with growing support in our member s clinics 65 PCN staff with another 55 working in member clinics in our Resource in Clinic program (we reimburse doctors 80% of the cost)

Supporting our doctors In 2013, formally established a department dedicated to assisting our doctors in their clinics Physician Practice Supports (PPS) Includes three Clinic Liaisons who work directly with our doctors in their clinics and is the PCN s key conduit of information Also offer a participation payment

Last Year We started down the path of panel, putting screening protocols into action, and tracking third next available (TNA) Panel payment was earned if doctor could produce a number from EMR, charts or HQCA report 83% earned this component Inconsistent and variable results Was not verified by the patient Upside was it started the conversation

More about last year Doctors also identified a minimum of 5 maneuvers they wanted to track and needed to achieve a minimum 50% consistency to earn their payment 70% earned this component Intention last year was that the next step would be to go to 6 at 60% Artificial number, rather than recognizing improvements regardless of starting point

Then this year started Manager of dept left in April; hired June Austin in the month of June Spent summer refocusing and retooling; changes are rolling out now Support and assistance from TOP has been key; they have been very helpful, supportive and adaptive to our needs

Our focus for the rest of the year Build a solid foundation that all else is built off of based on best practices and a common language across our PCN Ensuring panel identification processes in place in interested member clinics Screening baseline established for participating doctors Ensure our TNA processes are accurate

Our panel identification plans 1. Member doctors, and their key staff, attend a two hour info workshop starting in November Define terms (12 and 36 month panels) and concepts so we speak the same language Emphasis on team, standardization and documentation of process Small on theory - big on practical and interactive Delivered by TOP initially with PCN s CLs taking over. All content reviewed and approved by PCN and branded as such.

Panel identification cont d 2. Clinic staff (doctor optional, but encouraged) to attend a four hour working session to define and agree upon processes Panel maintenance tool completed Analysis of current state Begin to build skills on how to move to standardized processes Sessions will also start running in November.

Panel id, cont d 3. Follow up meeting with designated Clinic Liaison and each clinic team Process committed to and have in place by March 31, 2015 Teams submit documentation and various data points of the standardized processes for panel identification (includes validation and maintenance) Continue to support and reinforce beyond engagement period

How in the heck do we hope to make this happen? Members know this is coming Workshops are being set up to be engaging, fast paced, interactive, and interesting Various workshop times offered to minimize impact / providing flexibility Teambuilding opportunity for clinics Good food and swag bags

And money talks Pay the doctors to attend $500 for the two hour session Hourly rate for the four hours workshop Reimburse the doctor (or clinic) for their staff to attend Flat hourly rates set for various roles Opportunity to earn 25% of their participation payment ($2,500) for completing the process

Next year and beyond in panels Use panel data to move into access/efficiency work Seek to identify patients that are on more than one panel Leverage off work done in more advanced PCNs (and other groups like CPCSSN) for opportunities to mine meaningful data

Screening process this year & next Clinic Liaisons to visit each interested doctor and establish baseline (via chart audits) for all maneuvers each doctor wants to track. Identify QI opportunities, link to ASaP. Next year focus on, and reward, improvements from baseline and link the denominator to the panel number

It s been a crazy, busy few months and is only going to get busier for the rest of the year. Other bits: Communication plan and program roll out in full on Monday Getting upwards of 25 workshops scheduled and run over the next few months Enhancing our partnerships with other key support teams (TOP, AIM) Planning to start for the next fiscal year

Calgary West Central PCN Physician Engagement Panel Management David MacDonald BSc.P.T.,MBA Senior Manager Practice Effectiveness October 3, 2014

Calgary West Central PCN

Calgary West Central PCN 380 Physicians 118 locations 76 team members in 72 clinics 306,000 patients 13 Different EMR s 9% of Physicians use paper files.

Physician Engagement CWC actively seeks feedback from Physicians through Annual and periodic surveys Town Halls Virtual Town Halls Feedback solicited from the Examiner Physician Leads Many other informal methods

Physician Engagement We had an physician survey set to go out in August 2014 Decided to repurpose it to focus on panel identification, disease registries, and EMR s. Used Survey Monkey to administrate the survey. Open 8 days

Physician Engagement Survey link was emailed to 355 physicians 104 Physicians started the survey. 95 physicians completed the survey (26%) 63 responded with the first 48 hours.

Preliminary Survey Results We are just starting to analyze data. There are some General Things that we can take away and get started on.

Q2: In my practice, there is a panel identification process in place. Answered: 94 Skipped: 1

Q6: I review/validate a list of my patients for accuracy on a regular basis Answered: 95 Skipped: 0

Q7: My review includes identifying all those I deem to be "active" (as defined by you) Answered: 95 Skipped: 0

Q8: My team creates patient/disease registries (i.e., patients selected by different criteria such as disease or health problem, medications, lab result, etc.)

Q9: Have you participated in any structured improvement program to create a patient panel or to support panel management activities?

Q11: Do you use an EMR? Answered: 95 Skipped: 0

Q14: EMR users could benefit from help to achieve greater standardization of patient data entry (e.g., codes)

Q15: Do you have a team member who is the recognized EMR "super user"?

Q16: If you answered yes to the previous question, what role does the super user have in the clinic?

Q17: We do not use an EMR but are planning to transition my practice to an EMR system

Q10: I and/or someone from my team would like to attend a CWC PCN Panel Management information meeting Answered: 94 Skipped: 1

Next Steps We were considering different ways to start paneling: By Geography By Size of Clinic By EMR Type

Next Steps Based upon survey results of 45% feel they have a panel in place We will start with those that feel that they have a paneling process in place already.

Next Steps Based upon 36% would like to attend a panel management workshop Develop a Physician Education Series First one is October 28 th Follow up in January Virtual Town Hall November 1, 2014

Next Steps Based on Survey result of 79% believe they would benefit from help to achieve greater standardization. We are hiring an EMR Specialist We are hiring 4 Panel Coordinators

Thank You

Panel Management

Preparing for Panel Management ED and Physician Lead/Board members have had representation at all of the AMA forums over the past 2 years. Evaluation consultant attended PMO forum. A presentation was made to Board on AIM and ASAP in September 2013 by Dr. Bahler. It was agreed that Viking site would participate in ASAP and that Vermilion Midtown Clinic and Vegreville PCN clinic would participate in AIM collaborative.

Preparing for Panel Management Another presentation was made to NPC Board by ED and Board member on Panel Management, Community membership on Board and evaluation done in April 2014 Newsletter sent out to staff by email and any documentation forward also sent out. ED discusses panel management with staff at any opportunity Panel Management guide provided to all physicians via email and also as hard copy. ED has discussed with about 50% of physicians.

Preparing for Panel Management 9 physicians have requested AH and HQCA panel information, process supported by AIM Viking CDM RN has been trained by TOP for ASAP program which includes a requirement for panel management. Lead Physician in Viking provided information from TOP about Panel identification and management, request POET position 1FTE Clinic Receptionist/MOA position hired for Viking to research and establish Panel Management position/roles and responsibilities. CDM program reviewed to include panel management as part of program

Panel Management Going Forward Based on 1 FTE to 4 physicians PCN will hire LPN and Clinic Receptionist in Vegreville Family Physician Clinic, Vermilion Midtown Clinic and Killam as Panel Managers AMA roving team to present at AGM on Panel Identification and management in October 2014

Panel Management Challenges Presently increase in Panel Management positions are funded due to surplus money, need to have sustainable source of funding EMR training costs are high and no longer supported Panel Managers need dedicated computers, phone lines, office space Continue to develop understanding amongst all physicians

Patient Panel Manager Presented by: Lindsay Dallyn

What is the role of a Panel Manager? The Panel Manager plays an important role in helping clinics utilize panel data to optimize patient care. Areas of focus: panel identification and management supporting screening and clinical care processes utilization of the EMR system to capture and create panel related reports use of strategies such as scripting to communicate with patients about screening care.

Benefits of a Patient Panel Manager Improved efficiency and full utilization of the Clinic EMR. Streamlining appointments and eliminating duplication of appointments. Conducting opportunistic and outreach programs to patients to free up physician time spent with patient.

Why is Panel Identification Important? Leads to improvement to both patient and provider satisfaction and improved clinical care outcomes. Allows for equitable distribution of work across a group of providers. Assigns accountability, thereby allowing for reliable follow-up. Helps define the workload for your clinic/pcn. The panel size and demographics determines the total demand for services that must be matched by clinical supply in order to achieve good access to services.

Teamwork is key to success! Identification of a patient panel is ongoing maintenance and is optimally achieved when all team members, including all clinical and non-clinical staff are involved in the process. By having everyone working as a group, you generate ideas and identify clear measurable goals that allow you to develop and test changes that will define and improve the overall process.

What have I done so far? Began clean-up of the EMR Worked with Med Access to set up the ASaP Goals Met with the physicians and staff to see how I could assist them in streamlining their patient s appointments. Began entering completed SF12 forms as well as prepping the forms for the Nurse s complex care/chronic disease patients to complete. Worked with front staff to implement a system that was effective and efficient to take the patient s height, weight, BP and smoking status and have the information entered prior to the doctor seeing the patient for their complete medical. Continuously working with Med Access to make improvements to the EMR and set up CDS triggers (pop-up notifications) to improve the care for our patients. Implemented a new system with the help of the physicians and staff to assign all patients a primary provider.

What are we working towards? Ensuring every patient has a primary physician assigned. Offering all patients screening maneuvers through outreach and opportunistic programs while continuing lab requisition offers. Maintaining up-to-date electronic medical records. Improving data entry to allow for consistent accurate reports to be generated.

We currently do Not screen for the following below: Exercise Assessment Alcohol Use Assessment Influenza Vaccination

Example of ASaP Goals in Use

How do we track to see if our efforts are effective? Patient Panel Manager Lab Requisition Offers July 29 - September 25 By creating a template in the patient s profile, you are able to show whether you have contacted the patient, what you have offered, and what response you have received from the patient. Labs Completed Offered No Contact Declined Pick-up

Are your efforts making a difference? 1. Any improvement is increasing the patient s quality of care (quality improvement). 2. Positive patient feedback. 3. More initiative to go for their lab since they will get their results all within one visit.

Training to get Started Panel Management Training (provided by Towards Optimized Practice) Shadowing of a POET (Proactive Office Encounter Technician) Tip sheets and YouTube videos from TOPS website (http://www.topalbertadoctors.org/asap/resourcestools/emrkt/#4) Training sessions with Med Access

Challenges from a Panel Manager s Point of View Maintaining communication between staff, physicians and panel manager. Manpower to carry-out screening maneuvers. Electronic Medical Records (EMR) Inconsistent data placement Standardization Full utilization of the EMR functions (ex: customized templates, electronic lab requisitions, etc.) Number of diagnosis Patient demographic categorization

References ALBERTA AIM, ALBERTA COLLEGE OF FAMILY PHYSICIANS, ALBERTA HEALTH SERVICES, ALBERTA MEDICAL ASSOCIATION, UNIVERSITY OF ALBERTA, HEALTH QUALITY COUNCIL OF ALBERTA, PHYSICIAN LEARNING PROGRAM, TOWARD OPTIMIZED PRACTICE, PRIMARY CARE NETWORKS PROGRAM MANAGEMENT OFFICE. GUIDE TO PANEL IDENTIFICATION; FOR ALBERTA PRIMARY CARE. 2014, APRIL; 2-8. ALBERTA SCREENING AND PREVENTION. IMPROVEMENT FACILITATION SESSION 2013-14; FOR PRIMARY CARE PROVIDERS. 2013, JULY. TOWARD OPTIMIZED PRACTICE. QUALITY IMPROVEMENT INFORMATION FOR: THE PANEL MANAGER; FOUND AT: HTTP://WWW.TOPALBERTADOCTORS.ORG/QUALITY- IMPROVEMENT-INFORMATION-FOR/PANELMANAGEMENTSTAFF/ABOUTTHISROLE. Kalyna Country Primary Care Network 5241-43 rd Street Vegreville, Alberta T9C 1R5 780.603.4455 www.kalynapcn.ca

Thank you for your time! Improving patient care, one patient at a time