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WelcomeAdvancing Team-Based Care
WEBINAR 1: Building Your Primary Care Team to Transform Your Practice
February 18th, 2016
Community Health Center, Inc.
Foundational Pillars1. Clinical Excellence- Fully Integrated teams,
Fully integrated EMR, PCMH Level 3
2. Research & Development- The Weitzman Institute is the home of formal research, quality improvement, and R&D 3. Training the Next Generation: Post Graduate Training Programs for nurse practitioners, postdoctoral clinical psychologists, and students of the health professions
CHC Profile:•Founding Year - 1972•200+ delivery sites•130k patients
The Community Health Center, Inc. and its Weitzman Institute will provide education, information, and training
to interested health centers in: Transforming Teams• National Webinars on the team based care model• Invited participation in Learning Collaboratives to launch team
based care at your health center
Training the Next Generation• Two National Webinar series on developing Nurse Practitioner
and Clinical Psychology residency programs and successfully hosting health professions students within health centers
• Invited participation in Learning Collaboratives to implement these programs at your health center
Email your contact information to [email protected] and visit www.chc1.com/NCA.
Building Your Primary Care Team to Transform Your Practice
Today’s Objectives:1. Participants will cite two pieces of evidence supporting team-based care.2. Participants will be able to describe the roles and functions of three members of the primary care team.
Get the Most Out of Your Zoom Experience• Send in your questions using Q&A function in Zoom• Look out for our polling questions• Live tweet us at @CHCworkforceNCA and #primarycareteams and
#HRSAnca • Presentation and slides will be available after on our website• CME approved activity – please complete survey • Upcoming webinars: Register at www.chc1.com/nca
Building Your Primary Care Team To Transform Your Practice:
Learning from Effective Ambulatory Practices
MacColl Center for Healthcare InnovationGroup Health Research Institute
February 18, 2016
Ed Wagner, Director Emeritus Brian Austin, Deputy Director | Katie Coleman, Research
Associate
Why Primary Care Teams?
Improved clinical
outcomes
Better patient access
and experienc
e
Improved support
for complex patients
Reduced burnout
Become a recognize
dPCMH
Teams Improve Outcomes
Teams Can Expand Access
Type of care
Percent of physician’s time in traditional practice
Estimated percent of physician’s
work that can be reallocated to non
clinicians
Estimated percent of physician’s time
saved
Preventive 17 60 10Chronic 37 25 9Acute 46 10 5Total 100 — 24
Thomas S. Bodenheimer and Mark D. Smith: Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians, Health Affairs, 32, no.11
(2013):1881-1886
Teamwork Improves Patient And Staff Experience
Patients in U. Of Utah team model showed higher satisfaction with practice and with their provider.
Day et al., Ann Fam Med 2013
“Working in a tight team structure and perceptions of a greater team culture were associated with less
clinician exhaustion.” Willard-Grace et. al, J Am Board Fam Med 2014
PCT-LEAP Project Goals:
1. Select 30 high quality, innovative primary care practices that can serve as models for improving primary care teams.
2. Visit and study each practice for 3 1/2 days3. Summarize what we learn in a web-based Guide.4. Disseminate the Guide to practices involved in
practice transformation, and evaluate.
30 LEAP Sites
Team Structure:Major Findings From Site Visits
Medical assistants, receptionists, and lay-persons play key patient care roles .
Roles are expanded. All staff work at the top of their license and skillsets.
All core teams supported by RN care managers, behavioral health specialists, pharmacists, etc.
Providers and their panels supported by Core teams consisting of MAs, front desk, and others.
Primary Care Team
CentCoreTeam
Provider-MA
Teamlet
Provider-MA
Teamlet
Provider-MA
Teamlet
Extended Care Team
• Receptionist• Team RN• Health Coach• Panel Manager
• RN Care Managers• Lay Caregivers• Pharmacists• Behavioral Health
Specialists• Administrative Staff
How Do Teams Enable Practices To Become PCMHs Capable Of Achieving
The Quadruple Aim?
By using their teams to effectively perform key primary care functions.
Informed, Activated Patients
Comprehensive Services
• Engaged Leadership • Enhanced Access
Essential PracticeFunctions or Competencies
• Population Management• Planned Care• Medication Management• Care Management/Follow-
up• Referral/transition
Management
• Behavioral Integration• Self-management Support• Clinic-Community
Linkages• Communication
Management
• QI strategy/Meaningful Use• Empanelment/Continuity
• High-functioning Teams
Capacity for Quality Care
The Quadruple Aim
The Key Functions Or Competencies Of Excellent Primary Care
TheQuadruple
Aim
Track, identify, and reach out to
patients with care gaps
Population Management
Provide patient-centered,
evidence-based services
Planned Care
Self-management
Support
Medication management
Behavioral Health
Integration
Provide follow-up and care outside the
office
Care Management
Referral management
Clinic-Community Connections
Communication Management
Enhanced Access
Meet patient needs in a timely
manner
How do effective practices create effective teams?
• Hire bright, energetic folks with good interpersonal skills.
• Define key roles and tasks and distribute them among the team members (everybody at top of their license).
• Train staff to perform tasks.• Use protocols and standing orders to
enable staff to operate independently.• Establish job ladders.• Give teams time to meet.
Care Team BasicsWho is on the care team?
• Those folks needed to respond to all common problems for which patients seek care.
How are they organized? • Often, around a clinician and medical assistant/nurse dyad.
Who is responsible? • All have authority &responsibility for elements of care. Requires trust & transparency.
What does each member do? • The most they can in terms of patient-facing work. Training and role clarity matters.
How big are care teams? • Smallish, 5-7 team members, communication breaks down with increasing size.
How do you know when you’re done? • Ongoing efforts, training new staff.
Where to start?
•Daily Huddles•Weekly/biweekly QI meetings•Start with Core team 1st, then expanded care team
Meet together
•What’s the work?•Address staff concerns•Understand scope of practice•Evaluate how things are going
•Patient input•Plan for spread
Redesign Care Team Roles •Trust
•Training•Titles•Data needs•Think hard about part-time providers
•Standing orders•Co-location
Facilitate teamwork
www.ImprovingPrimaryCare.org
https://vimeo.com/152518627
Introducing CHC’s Clinical Chiefs
Veena Channamsetty, MD, Chief Medical OfficerMary Blankson, DNP, APRN, FNP-C, Chief Nursing OfficerTimothy Kearney, Ph.D., Chief Behavioral Health OfficerHeather Crockett Miller, DDS, MPH, Chief Dental Officer
Open Space for Discussion
RemindersSign up for our next webinar in this series:
Enhancing the Role of the Medical AssistantThurs., Mar 3, 2016 2:00-3:00 PMEST
Complete our survey!
Sign up at www.chc1.com/NCA
SpeakersFrom Community Health Center, Inc.:Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director Kerry Bamrick, MBA, Senior Program Manager Veena Channamsetty, MD, Chief Medical OfficerMary Blankson, DNP, APRN, FNP-C, Chief Nursing OfficerTimothy Kearney, Ph.D., Chief Behavioral Health OfficerHeather Crockett Miller, DDS, MPH, Chief Dental Officer
From MacColl Center for Health Care Innovation, Group Health Research Institute:Ed Wagner, MD, MPH, Director Emeritus Brian Austin, Deputy DirectorKatie Coleman, MSPH, Research Associate
