Creating Team Based Proactive Office Encounters
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1 Better Health Greater Cleveland relies on the presenter to obtain all rights to use and display copyright-protected information. Anyone claiming a right or interest in or to any posted information should contact Better Health immediately by calling Creating Team Based Proactive Office Encounters Connie Barath, RN Neighborhood Family Practice John Jason, BA Neighborhood Family Practice Marianella Napolitano, RN, MBA Neighborhood Family Practice Ann Reichsman, MD Neighborhood Family Practice Faith Walsh, MA, CPT Neighborhood Family Practice Michelle Mencke, Operations Consultant - Kaiser Permanente 1
2 Disclosure Presenters reported no financial interest relevant to this presentation 2
3 Our Make Up 3 Community Health Centers all providing Primary Care Health services Membership as of YE 2011 = 13, Medical Office locations all with Primary Care Teams (additional admin. offices) Current membership = 91,000 3
4 Objectives 1. Participants will learn the primary concepts of Proactive Office Encounters (POE) and the importance of team work in accomplishing these concepts. 2. Participants will learn how team formation has enhanced communication, increased efficiency and provided better patient care. 3. Participants will learn how technology is used to support care teams in ensuring patient care is addressed via a POE, as well as the importance of staff engagement in the process. 4
5 What is a Proactive Office Encounter? All the processes, tools and workflows supporting both patient preventive and chronic care as well as the healthcare team in the Primary Care Team setting Patient ready, room ready, provider ready Prior to, during and after a member initiated patient encounter Includes face-to-face office visits and telephone visits 5
6 Why Team Building? To get ready for the 21 st Century Care utilizing: Patient Centered Teams Pre-Visit preparation Implementation of Huddles
7 Care Team Re-Design Team Training provided to all members From a provider centered team to a team based approach Increased efficiency and more clear Source: Bruce Tuckman Group Development Model communication
8 Pre-Visit: Patient Advocate (PA) Reviews Patient Chart, Identifies Chronic Disease Patients using Problem List
9 Pre-Visit: PA Identifies Care Gaps
10 Pre-Visit: PA Enters Recommended Routine Orders
11 Pre-Visit: PA Documents Identified Care Gaps
12 Day of Visit: PA Documents Identified Care Gaps
13 Day of Visit: Medical Assistant Chart Scrubbing Review patient list Release pre-orders Circle CPEs to identify which health history form is needed & whether PAPs are due Alert the provider to the 10 minute visits
14 Day of the Visit: Nurse Contribution During Huddles Participate in the huddle Provide OARRS reports Anticipate nurse visit needs such as DM teaching, foot examinations Brief discussion of pertinent patient concerns Apprise of future nurse visits
15 Day of Visit: Huddle Process Inefficient vs. Efficient INEFFICIENT HUDDLE PROCESS 20 Minutes EFFICIENT HUDDLE PROCESS 5 Minutes or Less MA Provider Role Play Prints List Uses EMR Review information with Provider: Writes down orders needed Opens each chart: Reviews information
16 The Proactive Office Encounter Outcomes Data 100% Diabetes Care Standards 80% 85% 86% 60% 63% 65% 56% 56% 54% 49% 71% 66% 66% 63% 58% 54% 55% 51% LDL Checked yearly *** LDL < 100 or on Statin ** M-alb or ACE/ARB Rx ** 40% 33% 42% 31% Foot Exam/Pod referral (yr)*** Eye Exam Done annually ** 20% 12% 0% Mar-12 Apr-12 May-12 Jun-12
17 What is different at Kaiser Permanente Ohio? PreEncounter or PreVisit Encounter via POINT Identify missing labs, screening procedures ~ care gaps Communicate care gaps to our member(s) 17
18 What is different at Kaiser Permanente Ohio? PreEncounter or PreVisit Encounter via EMR Check for concurrent communication(s) Health Alerts Letters Check for open orders Labs X-rays Initiate a telephone encounter Utilize SmartSets and phrases as designed 18
19 What is different at Kaiser Permanente Ohio? Office / Telephone Encounter or Day of Encounter via POINT and EMR Room ready Patient s electronic chart is open Does the provider have everything he/she needs for the visit Patient ready Identify and flag alerts for providers (addressing when possible) Visit/vital sign collection (rooming standards) PreEncounter follow-up Proactive Office Encounter SmartSet Dressed per exam Provider ready Reviewed electronic medical record 19
20 What is different at Kaiser Permanente Ohio? Post Encounter After visit summary/after care instructions Follow-up (future) appointments Health education materials 20
21 What is different at Kaiser Permanente Ohio? Proactive Office Encounter & Team Composition Providers RN Leads LPNs CMAs 21
22 The Proactive Office Encounter Teamwork It takes a team and communication!! 22
23 The Proactive Office Encounter Teamwork In our teams Must fit in to the team s workflow and habits Start of day procedures Familiar processes Maximize our systems Permanente Online Interactive Network Tool KP HealthConnect Communicate, communicate, communicate Kick-offs Training (group and individual) Provider, support staff pairs Panel Management Time and Huddles 23
24 The Proactive Office Encounter Data HEDIS Select Measures Commercial HEDIS Select Measures Medicare 100.0% 100.0% 90.0% 90.0% 80.0% 80.0% 70.0% 70.0% 60.0% 60.0% 50.0% 40.0% 30.0% % 40.0% 30.0% % 20.0% 10.0% 10.0% 0.0% Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening CDC - HbA1c Screening CDC - LDL Screening 0.0% Breast Cancer Screening Colorectal Cancer Screening CDC - HbA1c Screening CDC - LDL Screening 24
25 Thank You Questions? 25
26 Example of POE SmartSet PreVisit (day of is very similar)
27 Example of POE SmartSet PreVisit (day of is very similar)
28 Example of POE SmartSet PreVisit (day of is very similar)
29 Example of POE SmartSet PreVisit (day of is very similar)
30 Example of POINT
31 Example of POINT
32 Example of POINT
33 Example of POINT
34 Example of KPHC/EMR Here we look for HMAs, orders, letters (test patient)
35 Example of KPHC/EMR Invoke the SmartSet (test patient)
36 Example of KPHC/EMR Complete the SmartSet (test patient)
37 Example of KPHC/EMR Utilize SmartPhrases for documentation (test patient)
38 Example of KPHC/EMR Invoke Dot Phrase (test patient)
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