Todays Webinar will be starting soon Best Practices in Empanelment - PDF document

9/20/2013 François-Xavier Bagnoud Center Today’s Webinar will be starting soon Best Practices in Empanelment from For the audio portion of this meeting: the California HIV/AIDS PCMH Demonstration Project Dial 1-888-394-8197 Enter participant code 733225 HIV-MHRC François-Xavier Bagnoud Center François-Xavier Bagnoud Center Guidelines for Our Online Meeting Room Today’s Presenters: • PLEASE TURN OFF YOUR COMPUTER SPEAKERS and Mute your phone line & computer speakers Steve Bromer, MD • Questions Medical Director of Practice Facilitation – Enter questions into the chat room HIV Medical Homes Resource Center • Interactive activities Amy Sitapati, MD – Polls Interim Medical Director, Owen Clinic – Chat room questions Associate Clinical Professor of Medicine UC San Diego Health System • Evaluation Kathleen Clanon, MD Associate Chief Medical Officer Alameda County Medical Center 3 4 HIV-MHRC HIV-MHRC 1

9/20/2013 A Tale from Two Presenters Dr. Clanon Dr. Sitapati Learning goals Agenda Participants will: 1. Empanelment: What it Is  Relate empanelment to continuity of care in the PCMH model 2. Participant Self ‐ Assessment: PCMH ‐ A  Explain how empanelment can impact quality 3. Examples of Robust Empanelment outcomes (including retention) Implementation  Self ‐ assess level of empanelment in their clinics  Determine next steps toward empanelment in their 4. Taking Steps Toward Empanelment clinics 5. PCMH Recognition and Empanelment  Identify empanelment deliverables are specific to PCMH recognition/certification 6. Participant Q&A  Recognize specific challenges/solutions for empanelment from UCSD and HIV ACCESS (CHD) perspective 2

9/20/2013 Sustained Continuity of Care (SCOC): Empanelment: What It Is Why it Matters Empanelment is a method of enhancing continuity and completeness of care across a clinic’s patient population.  Same provider/team for every routine visit  Standardize the number and acuity of patients cared for by each team  Encourage proactive care and accountability for coordination of care and outcomes Cabana MD, Jee SH. Does continuity of care improve patient outcomes? J Fam Pract. 2004 Dec;53(12):974 ‐ 80. Another Benefit: Avoiding Quality Whack ‐ a ‐ Mole Empanelment and PCMH address multiple quality indicators at once…  Essential early step toward PCMH transformation  Forming care teams and empaneling patients sets the foundation for organized, proactive, patient ‐ centered care 3

9/20/2013 Empanelment and NCQA Joint Commission PCMH From the NCQA 2011 PCMH Standards:  Focus Area B: Designated Primary Care  Element 1D: Continuity Clinician  Factor 1: Expecting patients/families to select a personal clinician  Each patient has a designated primary  Factor 2: Documenting the patient’s/family’s choice of care clinician clinician  Factor 3: Monitoring the percentage of patient visits  The organization allows the patient to with a selected clinician or team select his or her primary care clinician  Standard 3: Plan and Manage Care  Empanelment will help ensure consistent implementation of care management Clinic – All Teams Clinic Dyad What Are the Challenges? • All patients assigned to a • Patients assigned to a team single provider  Academic Centers • Includes multiple • Includes one provider  Expanded hours providers and other • The patient will see the clinical staff same provider each time  Very part time HIV providers with restricted • On a given visit, the • E.g., academic centers hours at the clinic patient may see any • Better continuity, but  Determining panel sizes– how many HIV provider on the team access may be poor patients should one team care for? • E.g., prenatal care is done like this • Poor continuity 4

9/20/2013 Clinic Assessment: Where are you now with Continuity vs. Enhanced Access empanelment? Same ‐ Day Access Continuity of Care  Self ‐ assessment important early step in transforming to PCMH  Variety of tools available  Following questions adapted from Safety Net Medical Home Initiative PCMH assessment tool Goal: Same ‐ day appointments for routine and urgent visits (NCQA PCMH Factor 1.A.1)  www.safetynetmedicalhome.org Challenge: Prioritizing same ‐ day access may reduce continuity Highlights the importance of communication within and between teams Patients……. Self ‐ Assessment: PCMH ‐ A 1. …..are not identified with a specific practice panels 2. ….are identified with a panel but the practice is not operationalized around panels 3. ….are identified with panels but panels are only used for scheduling purposes 4. …are assigned and used for scheduling and to balance supply/demand http://www.safetynetmedicalhome.org/sites/default/files/PCMH ‐ A.pdf 5

9/20/2013 Reports on care processes or outcomes of Registry or Panel ‐ level data…. care…. 1. ….are not available to assess or manage care for 1. ….are not available to practice teams. practice populations 2. ….are routinely provided as feedback to 2. ….are available on an ad ‐ hoc basis but not used practice teams but not reported externally. routinely 3. ….are provided to teams and reported 3. ….are available to assess and manage care but only for a limited number of conditions externally but with team identities masked. 4. ….are available to assess and manage care across a 4. ….are provided to teams and reported wide range of conditions and risk states including externally with practice team identified. at point ‐ of ‐ care Taking Steps Toward Empanelment Self ‐ Assessment: What’s your score? Goal: Achieve balance between Level D Level C Level B Level A provider/team time and patient 1 2 3 4 needs Absent or First stage of Basic elements Most or all of minimal implementing of empanelment the critical implementation empanelment have been aspects of of empanelment may be in place, implemented, empanelment but fundamental although the are addressed by A mature real life example from changes have practice still has the item are well not yet been significant established in the Owen Clinic in San Diego made opportunities to the practice make progress with one or more aspect 6

9/20/2013 UC San Diego Health System: “I feel like I am working alone and swamped by all the needs of my patients!” ‐ Clinician Our HIV/AIDS medical home: The Owen Clinic Providing care for 3,100 HIV/AIDS lives Do you have a team for care delivery? PROBLEM: Providers historically have worked with interdisciplinary services but may not have clear roles and responsibilities targeting the care delivery needs “My panel is too big and I see all the hard patients!” ‐ Clinician LEVEL ONE EMPANELMENT: RESTRUCTURING PEOPLE Are patients fairly distributed? PROBLEM: Provider time is fixed (available minutes to work) – so is the work including number and type of patients fair in distribution? 7

9/20/2013 What Time is Available For the Provider? Balancing Panels Supply of Time  Balancing the Supply and Demand identifies the need  Calculate provider time in clinic for for some providers to remove Primary Care duties some patients from their panel and others to absorb more  Urgent Care, hospital rounding, education time, meetings, vacation  time, etc were all subtracted The Panel Manager’s role is to ensure the continuous and  Every provider has a different and fluid shifting of patients unique number of hours available ensuring provider and patient awareness, as well as balanced annually for clinic work panels Making it simple to see “who is full” using the “How do I identify which patients need help!” ‐ Clinician Stoplight Report Are patients at risk for outcomes readily identifiable? PROBLEM: Standard EMR do not easily allow a registry of patients to be tracked and followed for outcomes and intervention? 8