Transforming Independent Physicians into High-Performing Organized Teams
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- Tracey Walton
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1 Transforming Independent Physicians into High-Performing Organized Teams Diane Laird, CEO, Greater Newport Physicians Debra Spindel, VP, Nautilus Healthcare Management Group Peter Kim MD, Medical Director, Coastal Family Medicine Organizational Overview Greater Newport Physicians (GNP) IPA 100,000 patients 1,000 independent physicians (180 PCPs) 90% PCPs are exclusive Nautilus Healthcare Management Group Management Services Organization 200+ independent physician clients Practice Management Billing Service Technology (EHR) Support 1
2 IPA Model: Physician Engagement Challenges & Strategies Independent Physicians (>30% solo) Varying levels of enrollment Office staff engagement EMR Strategy Large Financial Carrots Wide range of performance Encourage Practice Consolidation Practice Management offerings Physician Recruitment support Organizational Goals Improve Quality Ratings/HEDIS RAF Improve coding and documentation Reduce Costs Enrollment Growth and Patient Retention Strategic Themes: Enhance EHR capabilities Decrease performance variation Improve Physician Engagement 2
3 Transformation Imperative Transform who into what? Inconsistent t QM and RAF performance among independent practices - Also between physicians in the same group Inadequate levels of sustained physician engagement and desired behavior Too many competing priorities - Lack of team focus on aligned goals Independent Physicians exhibiting team characteristics Independent Physicians exhibiting normal individualistic tendencies 3
4 Independent Physician Characteristics IPA physicians are by definition Independent Resistant to change Protective of operational status quo Self-motivated Competitive Individualized workflows Fairly engaged Despite financial incentives, still much opportunity to improve IPA s performance Where to focus Attention: Create Physician Leadership committee Identify Target Engaged Practices to become test bed Develop strategy to share learnings with all PCPs 4
5 Underlying Principles of Organizational Change Agile Development Methodology a group of software development methods based on iterative and incremental development, where requirements and solutions evolve through collaboration between self-organizing, cross-functional teams. It promotes adaptive planning, evolutionary development and delivery, a time-boxed iterative approach, and encourages rapid and flexible response to change. Underlying Principles of Organizational Change Baby steps are the smallest, but they move the quickest. 5
6 Key Ingredient Key Ingredient Iterative system of improvement 6
7 13 The Essentials of Incremental Iterative Improvement Season, taste, judge, repeat Fire, ready, aim Process > Product Feedback 7
8 The Essentials of Incremental Iterative Improvement Adjust, and readjust quickly The Essentials of Incremental Iterative Improvement Speed is Life. 8
9 Qualities of High-performing Teams Meet regularly Agree to adjust Can-do, WTH Compete Role of GNP Physician Leadership Committee Beta-test new QM projects Brainstorm solutions to engagement obstacles Foster friendly & transparent competition Give feedback for IPA initiatives 9
10 Two Main Pathways 1. Test Case: Utilize engaged affiliated groups to test methods and track results 2. IPA-wide programs: Leverage results to focus resources and create effective IPA-wide initiatives 10
11 Case Study: Coastal Family Medicine 20 FT physicians employed by CFM: FP, IM, UC Et Extensive use of mid-level idl l providers Close affiliation with GNP and Nautilus (MSO) full practice management Fully electronic since 2001 no paper charts Ability to modify compensation formula Good stability and provider longevity QM and RAF scores inconsistent between PCP s Physician engagement OK, but not great Strategies Employed at CFM 1. Increase visibility to metrics and comparisons Un-blind EVERYTHING: QM ratings, RAF scores, bonus amount Friendly competition and simple f recognition: gift cards Humiliation and envy factors 11
12 Quarterly QM Reporting: Un-blinded Coastal Family Medicine GNP Quality Measure Results 2012 Measure GNP Avg. RB DB BC HF FF PK JK CN TP MS JW DY Asthma Medication Ratio Breast Cancer Screening LDL control:card Chlamydia Screening Colorectal Cancer Screening Generic Drug Use Optimal Diabetes Care Diabetic Eye Exam HbA1c<9% Adult Body Mass Index Blood Pressure: Diabetics Osteoporosis Management Rheumatoid Arthritis Mgmt % Higher than GNP Avg. 38% 77% 77% 50% 38% 91% 92% 91% 77% 27% 77% 58% Money Talks. Plus. 2. Financial incentives for providers and staff Redesign CFM Physician Compensation formula to emphasize QM performance with greater rewards Staff bonus potential based on QM results as well 3. Revamp operational workflows and share best practices Optimized utilization of mid-level resources MD/PA team development 4. Education and consistent feedback 12
13 IPA-wide Initiatives Leverage power of shared EHR platform Point of care QM and RAF alerts Patient portal used for targeted broadcast messaging and QM reminders Built-in support for IPA initiatives Centralized Patient Outreach Program Assistance to PCP s with administrative burden of QM monitoring and patient outreach Quality Dashboards and reporting Results 13
14 CFM Results % QM metrics favorable to GNP average improved from 63% to 77% Significant increase in RAF scores for CFM physicians Enhanced dialogue between physicians about QM and RAF compliance and idea sharing Proliferation of physician/mid-level partnerships to improve access to care as well as QM follow-up Greater involvement by practice manager and staff in solution identification sense of ownership Example 1: Diabetic LDL Pilot, 5 FPs, ~ 500 diabetic patients Target #1: LDL < 100, better than average Results: 2 SDs above the mean, in 4 months 28 14
15 Example 2: Diabetic ODC Same pilot group and patients Target: simultaneous LDL/A1c/BP/albumin control Results: 2 SDs above the mean, in 6 months 29 Success Specifics Actionable information IT and statistical staff, OR A healthcare analytics platform Iterative workflow revealing failures Innovator using the Pareto Principle HUD-like report 1-step action items 30 15
16 Results of Transformation Initiatives Quality Metric Improvement Physician acceptance Changes accomplished Future challenges Sustainability: pyramid building Questions? Physician Transformation
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