in Primary Care During COVID-19 May 21, 2020 10-11am PDT 1 - PowerPoint PPT Presentation

Managing Chronic Conditions in Primary Care During COVID-19 May 21, 2020 10-11am PDT 1

Agenda • Welcome and information • Polling questions • OHSU Hillsboro IM and Q&A • Springfield Family Physicians and Q&A • Polling questions and discussion • Resources 2

Presenters • Summer Boslaugh, Oregon Health Authority, Transformation Analyst • Martha Snow, OHSU Oregon Rural Practice-Based Research Network, Project Manager • Tonya Magwood, OHSU Hillsboro Internal Medicine, Practice Manager & Medical Home Coordinator • Kadie Kokkeler, Springfield Family Physicians, Assistant Administrator 3

Hillsboro Internal Medicine • Location: Hillsboro (urban) • Presenter: Tonya Magwood, Type: Health System Practice Manager & Medical • Staff: 4 providers, 1 acute Home Coordinator provider, 1 LCSW, 6 Certified Medical Assistants, 1 Panel Coordinator, 1 Heathplan Coordinator, 2 Medical Receptionists • Patients: 3,000 (average age 75 years old) • EHR: Epic • Insurance: mostly Medicare/Medicaid 4

Before COVID19: Management of Chronic Conditions • Patients with diabetes, hypertension, obesity, and/or high risk – Risk tiers determined via 2 step risk stratification • Step 1: EHR algorithmic stratification into four risk tiers • Step 2: Clinician intuition to modify • 1 Panel Coordinator for approximately1500 patients – Monitor care gaps – Routine preventative care and chronic condition outreach • CMAs – Care Plan outreach – ED and IP follow-up and education • Provider education and outreach 5

Early COVID19: Management of Chronic Conditions • COVID19 testing site • In-person visit workflow modifications – Restricted office hours (≈5 patients/day) – Patients chronically ill with respiratory symptoms – 30 minutes between patients • Expanded telehealth via MyChart – Frontline staff to providers work with patients to set up accounts • Rotation of daily MA assignment to identify pending accounts and outreach – Medicare Wellness visits – Partnered with care facilities to assist with technology • Patients’ care management – Identify care gaps – Checks on mental health and referrals to LCSW – Prescription refills 6

Coexisting with COVID19: Management of Chronic Conditions • Cohort prioritization for in-person visits – Clinicians reviewing empaneled patients’ risk scores and visit type needed (in-person, telephone, video) – Developing verbiage/script to help patients feel comfortable coming back • Maintain telehealth – TBD long-term volume – Both staff and patients enjoy benefits • Transportation not a barrier • More accommodating to work day schedules • Refining strategies for chronic conditions – Utilizing MyChart patient self-report and tracking feature more – Discussing recent lifestyle challenges from social distancing – Updating Care Plans – Increasing use and tracking of home blood pressure monitoring 7

Coexisting with COVID19: Ongoing Problem-Solving • Updating cohort prioritization for in-person visits • Potential long-term challenges to telehealth – Patients transparency with home measurements, e.g., weight, diet – Access to and correct use of home blood monitoring devices – Resistance to in-person visits • Fluctuations in COVID19 testing demands with re-entry into workplaces • Balancing access to care without being too restrictive • Exploring home visits • Impact to provider and staff 8

Questions? Enter into question box POLICY AND ANALYTICS Transformation Center 9

Springfield Family Physicians • Location: Springfield (urban) Presenter: Kadie Kokkeler, • Type: 3 Independent clinics Assistant Administrator • Staff: 17 Clinicians, 3 Pharmacists, 2 Care Managers, 5 Behavioral Health Specialists • Patients: 25,000 • EHR: eClinicalWorks (eCW) • Insurance: – Centennial Location: 90% Medicaid – Marcola & Timber Valley Locations: Commercial, Medicare, Medicaid 10

Before COVID19: Management of Chronic Conditions • In-person appts with clinicians • Co-visits with pharmacists ( including insulin titration for diabetics) • Care Managers support ~ 40 patient panel and care plans – Coordination with pharmacists and behavioral health staff – Follow-up phone calls • Designated pharmacist and MA for annual wellness visits • Nurses support anticoagulation clinic • No telehealth implemented – Started looking into telehealth features prior COVID-19 due to pharmacist request for comprehensive medication management 11

Early COVID19: Modified Workflows • Patients prioritized in-person visits – Overall visit volume: 60% • In-person visit workflow modifications – Screening at front door – Sanitizing all surfaces and rooms during the day – Urgent care provider designated as respiratory provider • Car/Tent visits – Performing Car/tent visits for high-risk, sick, or respiratory patients – Established 2nd phone line for car respiratory checks – When the patient arrives, they call a direct line to be checked in and the provider see’s the patient out at their car 12

COVID-19 Screening Protocol 13

Patient Visit in Vehicle Protocol 14

Early COVID19: Management of Chronic Conditions • Expanded telehealth through eCW Healow app • Telehealth (audio/video) visits with medical providers, behavioral health specialists, and pharmacists – ~ 20% of visits initially through telehealth • 90-95% visits through telehealth for other primary care practices in IPA – Start visit with video but if it disconnects, then do a phone call – eCW updated to provide automatic texting of weblinks to phone to easily access telehealth visit • Patients’ care management – Faced dilemma of proper monitoring vs exposure risk • Discouraged patients with chronic conditions to come in • Staff experience – Behavioral health staff sent out survey to monitor staff mental health 15

Staff Mental Health Survey Results 16

Staff Mental Health Survey Results Abbreviated: What kind of support would you like from our BH team? 17

Coexisting with COVID19: Management of Chronic Conditions • Providers asking about lifestyle habits, diet and exercise. Patients are encouraged to be pay attention to these in light of social distancing. • Telehealth decline in past few weeks • Overall in-person visit volume up from 60 to now 70% • Patients lack confidence in monitoring health conditions (e.g. Monitoring blood pressure) • Procedures that will continue – Front door Screening – Vehicle visits – Telehealth • Especially if covered by Medicare 18

Coexisting with COVID19: Ongoing Problem-Solving • Continuity of telehealth reimbursement – Patients will continue to expect it, but future reimbursements uncertain • Determining if a visit is appropriate for telehealth or not – Regular check/follow up can be via phone – Other visits may need to be in-person • Planning for Fall – Heavily focused on annual wellness visits • Can these be completed through telehealth to keep high risk patients safe? – Designate smaller clinic to serve patients with respiratory concerns (replace emergency car/tent structure) 19

Questions? Enter into question box 20

Resources These materials will be emailed after the event: • Springfield Family Physicians protocols and workflows • OHSU Connected Care Center - managing adult and pediatric patients with COVID-19 • OPAL-C - confidential peer support for primary care clinicians experiencing stress in response to COVID19 & psychiatric curbside consultations about adult and child patients • Upcoming Webinars for Primary Care Practices and Providers • Upcoming Training and Technical Assistance • Patient-Centered Primary Care Home Program specifications and resources 21

Post-event Survey Please let us know how we can help! https://ohsu.ca1.qualtrics.com/jfe/form/SV_e2wF272LN73SqBD 22