IHA and the PCMH

PCMH
An entire team to call
YOUR OWN
Ann Arbor Family Practice
Dr. Steven Thiry M.D.
Wynda Carter R.N.
Sue Saxton R.N, Practice Manager
Presentation Overview
The path to PCMH
• In the beginning…………….
• The Electronic Medical Record
• PGIP
• PCMH roll- out
What is IHA?
•
•
•
•
•
•
•
•
150 Physicians
37 APN/PA
30 Sites
250,000 Active Patients
22,000 New Patients in 2008
488,000 Patient Visits in 2008
2,652 Deliveries
700 Employees
What is IHA?
 5 divisions including Internal Medicine, Family Medicine,
Pediatrics, OB/GYN, and Surgery
 After Hours
 Ancillary Services – CT, General Ultrasound, General
Radiology
 Specialty Services – Maternal-Fetal Medicine, Pediatric
and Adult Neurology, Dermatologic Surgery, General
Surgery
 Hospitalist Services at SJMH, Saline, and Chelsea
for adult patients
IHA’s Network of Care
Leadership Structure and Committees
IHA
endeavors through its
evolved and participatory
structure to bring all its
resources to meet the
needs of our patients and the
community.
Inspired by our Mission
Integrated Health Associates (IHA) exists to meet community needs
through the provision of personalized,
high quality health and medical services
to our patients in a manner which results in high levels of patient satisfaction
with clinical quality, services, accessibility and value.
Driven by our Values
Commitment
Advocacy
Respect
Efficiency
Service
PATIENTS AND COMMUNITY
FAMILY MEDICINE OFFICES
Ann Arbor Family Practice
Brighton Family Care Specialists
IHA Family Practice
Milan Family Medicine
Okey Family Practice
Pinckney Family Care
INTERNAL MEDICINE OFFICES
Chelsea Internal Medicine
AIIM-Cherry Hill
AIIM-Commonwealth
Huron Valley Neurology
IHA Plymouth Internal Medicine
IHA Hospitalists
AIIM-Pauline
OB/GYN OFFICES
Ann Arbor OB/GYN Associates –
Ypsilanti/Milan/Plymouth
Associates in Gynecology &
Obstetrics –
Brighton/Ypsilanti/Chelsea
Canton Obstetrics and Gynecology
IHA Maternal-Fetal Medicine
IHA Menon, Miller & Midwives
IHA W estArbor OB/Gyn
Walker Gyn. of IHA
PEDIATRIC OFFICES
Chelsea Pediatrics
Child Health Associates-Ann Arbor
Child Health Associates-Plymouth
Huron Valley Neurology
IHA Livingston Pediatrics
Pediatric Healthcare AssociatesCanton
Pediatric Healthcare AssociatesYpsilanti
Primary Pediatrics
SURGICAL OFFICES
Canton Obstetrics & Gynecology?
Chelsea Surgical Associates
IHA Dermatologic Surgery
Associates
FAMILY MEDICINE OPERATING
TEAM
Bob Breakey, MD - Chair
Michael Bruderly, MD
Karen Edwards
Cindy Elliott
Zoë Foster, MD
Janet Hubert, MD
Mike Jasbeck, MD
Marty Murray
Monty Okey, MD
Melissa Sokol-Keith, MD
Mark Zawisa, MD
INTERNAL MEDICINE
OPERATING TEAM
Karl Brenner, MD
Peter Dews, MD
Mary Durfee, MD
Cindy Elliott
Michael Friedlander, MD
Joyce Leon, MD
Mark Lindley, MD - Chair
Evan Padgitt, CNP
Art Tai, MD
Dave Winston, MD
Steve Yarows, MD
OB/GYN OPERATING TEAM
Cheryl Bachman, CNM
Wes Beemer, MD – Chair
David Bryant, MD
Cindy Elliott
Jody Jones, MD
Kris Miller, MD
Bryan Popp, MD
Joanne Vicari, MD
Karen W alker, MD
PEDIATRIC OPERATING TEAM
Nancy Anastasi, MD
Ginny Bareham, CNP
Susan Bass
Karen Brenner, MD
Cindy Elliott
John Gardner, MD
Beth Hall, MD
Kim Meisenhelder, MD
Marty Murray
Lisa Profera, MD
Nancy Spangler, MD - Chair
Elizabeth Stone, MD
Howard W einblatt, MD
Mary W esthoff, MD
SURGICAL OPERATION TEAM
(part of OB/Gyn Ops Team)
Renee Bayer
Wes Beemer, MD – Chair
Cindy Elliott
Jody Jones, MD
Jennifer Kulick, MD
Mel Larson
Bruce Maki
Karen W alker, MD
CLINICAL QUALITY
IMPROVEMENT COMMITTEE
Wes Beemer, MD
Robert Breakey, MD
Amy Cooke, MD
Mary Durfee, MD –Chair
Cindy Elliott
Nancy Griffith
Olav Jaren, MD, PhD
Lynn Klima
Jennifer Kulick, MD
Lynn Lewis, CNP
Mark Lindley, MD
Lee McDonagh, RD, CDE
Pary Reza, MD
Nancy Spangler, MD
Sandy Talbott, CNP
Steve Thiry, MD
COMPLIANCE ADVISORY
COMMITTEE
Cindy Elliott
Jackie Gandol
Chris Holda
Brad Judge, MD
Linda MacEllven
Marty Murray
Lena Payne
Joanne Vicari Block, MD
Carol Ways, MD – Chair
David Winston, MD
MARKETING COMMITTEE
Sue Archer, MD
Nancy Anastasi, MD
Cheryl Bachman, CNM
Mike Bruderly, MD
Cindy Elliott
Bill Fileti
Julie Gargan Kozma, CNP
Bridget Long, MD
Kristin McFadden, DO
Amy Middleton
Lisa Profera, MD – Chair
FINANCE COMMITTEE
Bob Adams, MD
Raj Deenadayalu, MD
Bill Fileti
Mike Friedlander, MD
Jim Marley, MD – Chair
Marty Murray
Melissa Sokol-Keith, MD
Lowell Sprague
Neal Weinberg, MD
Francie Youssef, MD
MEDICAL INFORMATICS
COMMITTEE
Matthew Bressie, MD
Chris Holda
Janet Hubert, MD
Chris Kottke, MD
Joyce Leon, MD
Marty Murray
Mike O’Donnell
Evan Padgitt, CNP
Sandy Talbott, CNP
Neal Weinberg, MD
Mark Zawisa, MD - Chair
COMMITTEES AND SUBCOMMITTEES
CLINICAL RESEARCH
COMMITTEE
Will Chamness, MD
Jeff Dimaya
Cindy Elliott
Olav Jaren, MD, PhD
Mark Lindley, MD
Gayle Moyer, MD – Chair
Sharon O’Leary, MD
Melissa Sokol-Keith, MD
Lowell Sprague
Steve Yarows, MD
COMPENSATION COMMITTEE
Wes Beemer, MD
Bob Breakey, MD
Karl Brenner, MD
Bill Fileti
Dawn Johnson
Mike Kucera, MD – Chair
Ted Merkel, MD
Lowell Sprague
Art Tai, MD
APN/PA COMPENSATION SUBCOMMITTEE
Wes Beemer, MD
Craig Brockman, CNP
Cindy Elliott
Bill Fileti
Dawn Johnson
Mike Kucera, MD
Jodi Lambert, CNP
Linda MacEllven
Pat Reckling, CNP
Nancy Sebby, CNP
Diane Weid, CNP – Chair
HEALTH PROMOTION
Mira Agrawal, MD
Lynn Klima, CNP
Ginny Johnson, MD
Jay Lodwick, PA-C
Amy Middleton
Pary Reza, MD
Nancy Sebby, CNP
Steve Thiry, MD – Chair
Marti Walsh, MD
Melissa Zarow, DO
Vicki Zilke, CNP
HUMAN RESOURCES
COMMITTEE
Renee Armstead, MD
Yuvelle Eaton-McFarland, MD
Cindy Elliott
Bill Fileti
John Gardner, MD
Joyce Leon, MD
Linda MacEllven
Gayle Moyer, MD
Alberto Nacif, MD
Karen Walker, MD – Chair
IHA GOVERNING BOARD
(IGB)
Wes Beemer, MD
Bob Breakey, MD – Chair
Mary Durfee, MD
Bill Fileti
Julie Gargan Kozma, CNP
Mike Kucera, MD
Mark Lindley, MD
Jim Marley, MD
Gayle Moyer, MD
Melissa Sokol-Keith, MD
Nancy Spangler, MD
Steve Thiry, MD
Neal Weinberg, MD
PUBLIC POLICY COMMITTEE
Cindy Elliott
Delores Garcia, MD
Maria Heck, DO
Chris Holda
Jody Jones, MD – Chair
Madelyn McMurtrie, CNP
Pary Reza, MD
Karen Selle
RETIREMENT PLANNING
COMMITTEE
Jim Alford, MD
Virginia Bareham, CNP
Osamah El-Aroud, MD
Bill Fileti
John Gardner, MD
Jay Lodwick, PA-C
Linda MacEllven
Ted Merkel, MD
Kelly O’Connor, MD
Monty Okey, MD
Jim Sansone, MD – Chair
Lisa Sprague, MD
Lowell Sprague
Liz Stone, MD
David Winston, MD
MULTI-SPECIALTY EXPANSION
Robert Breakey, MD
Mary Durfee, MD
Cindy Elliott
Bill Fileti
Mike Friedlander, MD - Chair
Maria Heck, DO
Jennifer Kulick, MD
Rajiv Deenadayalu, MD
Peter Meyers, DO
Lowell Sprague
Brian W oodruff, MD
NOMINATING COMMITTEE
Rossana DeGrood, MD - Chair
Mary Durfee, MD
Bill Fileti
Madelyn McMurtrie, CNP
Monty Okey, MD
Steven Popper, MD
PATIENT SERVICE COMMITTEE
Roger Chen, MD
Pam Davies, MD – Chair
Joanne Dommer-Kind, CNP
Mary Durfee, MD
Kathy Kise, CNP
Linda MacEllven
Kimberly Meisenhelder, MD
Darcey Owings, CNP
Pat Reckling, CNP
Brian W oodruff, MD
LEADERSHIP DEVELOPMENT
COMMITTEE
Wes Beemer, MD
Bob Breakey, MD – Chair
Mary Durfee, MD
Bill Fileti
Michael Kucera, MD
Mark Lindley, MD
Nancy Spangler, MD
RISK MANAGEMENT
COMMITTEE
Wes Beemer, MD - Chair
Cindy Elliott
Bill Fileti
Ginny Johnson, MD
Julie Gargan Kozma, CNP
Allison Kreske, MD
Mark Lindley, MD
Ken Owings, MD
Carol Ways, MD
WEB SITE COMMITTEE
Cindy Elliott
Pat Gordon, MD
Chris Holda
Vaishali Katial, MD
Lynn Klima, CNP
Amy Middleton
Lisa Morris, MD
Theresa Poppe, MD
Brian Woodruff, MD - Chair
Steven Yarows, MD
Carla Zahuranec, MD
Mark Zawisa, MD
IHA MANAGEMENT TEAM
Jackie Gandol
Director of Business
Services
Chris Holda
Director of Technology &
Information Services
Lynn Klima
Director of Clinical
Improvement
Marty Murray
Vice President Administrative Services
Amy Middleton
Director of Marketing
Linda MacEllven
Director of Human
Resources & Customer Service
Cindy Elliott
Chief Operating Officer (COO)
Lowell Sprague
CFO
Bill Fileti
President & CEO
Where do we start?
• Select Offices to Pilot
– Cherry Hill Internal Medicine
– Okey Family Practice
– Plymouth Internal Medicine
– CHA-Plymouth
–Ann Arbor Family Practice
What are IHA’s tools for building our
Patient-Centered Medical Homes?
•Extended Access
•Test Tracking
• Patient Registry
• ePrescribing
•Care Management
•Patient Provider
Partnership
•Performance
Reporting
Patient Satisfaction at IHA
“Getting through to the Office”
Survey Period
Spring 2005
Spring 2006
Spring 2007
Fall 2007
Spring 2008
Fall 2008
Spring 2009
IHA Overall
(Excellent)
33%
38%
38%
41%
44%
45%
47%
AMGA Norm
(Excellent)
39%
42%
45%
45%
44%
44%
44%
Advancing Access
IHA ER Utilization Trends
225
205
185
165
145
125
HAP ER Rate/1000
Priority ER Rate/1000
Jan 08
Feb 08
Mar 08
Apr 08
May 08
June 08
July 08
Aug 08
Sept 08
Oct 08
Nov 08
Dec 08
Jan 09
180
216
185
149
167
159
142
141
163
171
166
152
169
217.51
224.48
223.84
208.28
203.11
197.3
182.39
190.17
220.9
191.65
171.12
163.05
182.09
Barriers to getting started……
• Resources, resources, resources
– Project Manager
– Training – IHA University
– The SE Michigan and National Economy
• Decreased Visits in 2008
• System interfaces with multiple institutions
• EMR vendor limitations
Thinking in a New Way… LEAN
•
•
•
•
•
Registry Function
Test Tracking
Development of Internal Coaches
Roles and Responsibilities
Care Coordination: Learning Collaborative with
HVPA and U of M
Identifying Teams
Planned Care: The Chronic Care Model
Chronic
Condition Visit
Recall
Recall
f/u appt
scheduled
Task
Planned care
follow-up:
phone/face to face
Pre-call
Run
registry
Recommendations for Planned Care:
Complicated Diabetes
•
•
•
•
•
•
•
•
Newly diagnosed
BP >130/80 on two consecutive visits
A1C > 8.0
Co-morbidity associated with diagnosis: CAD, CHF,
CVA, PVOD
Depression
LDL >100
Change in medications
Recent hospitalization
PEACHFARM
Diabetes Flow Sheet
Health Changes Action Plan
Planned Care Follow-Up
The Future State
•
•
•
•
•
Program Manager
Learning Collaborative
Build infrastructure
Develop and track desired metrics
Collaboration between Medical Management
and I.T.
• Align compensation structure
• Align management incentives
It’s kind of fun to do the impossible!
Walt Disney
AAFP and the PCMH
• Our primary goal is to provide the best possible
care to every patient.
• It is a transformation.
• Some changes will be noticeable as we build our
medical home.
• It will require a commitment to change.
Getting Started
• Choose/identify the “Office Leads”
Process committee should include representatives from:
•
•
•
•
Clerical (Phones, check in/out, file rm.)
Clinical (MA’s, Nurses)
Provider
Practice Manager
-
WHY?
This group will facilitate evaluation and change in office policy and
procedures. They will function as the “go to” people for the staff.
Committee Evaluation Meetings
• Start the LEAN process
• Evaluate/Map the present office process for a patient.
• Take each step from first contact by phone through
checking out at the end of the visit. (Your process)
WHY?
You will get a clearer picture of the patient experience and how the
staff response affects each step.
Cont….
• Evaluate/Map the future office process. Define Step
by Step what the “ideal” process should be.
• Choose one or two goals each week to change.
• Each committee member reports back at weekly
meetings, how the changes affected that area and
suggest change if needed.
• Committee continues to add changes until FUTURE
office process goals are met.
Cont.
• Keep in mind some goals are more easily met
than others. Flexibility and patience are key
to a successful change.
Increase Efficiencies and
Decrease Errors
Make the Right Thing the Easy Thing
Same Way
Every Time
No Double Work
Processes Identified for Change
• Clerical/front office:
• Phones: operator takes live
calls.
• Answering menu activated
for pt only if all operators
are on another call.
• Answering menu changed.
Choices made clearer.
Decreased number of
choices.
All pt. insurance confirmed
prior to visit (decrease wait
time at check in).
• Check-in/check out
consolidated in one area.
• Planned care patients
identified at check in by
EMR alert and flagged for
MA and provider.
Cont…
• MA rooming the
patient: standardized
rooming protocol.
• Provider visit:
– Interruption policy
– Standardized equipment
supplies for each exam
room
– Preferred specialist list
for referrals in each
exam room
* Improved overall cycle
time.
Processes Identified for Change
cont.
• Planned Care Visits
– Diabetic patients only
Develop protocol
– Expand role of the office RN
Billable planned care follow-up phone call and nurse only
office visit ( T-code billing)
• Template in EMR for provider and nursing.
Planned Care Follow-Up
Patient Education
• Informational bulletin board designed and
displayed in the lobby.
• Handouts- informational brochureIHA patient centered medical home.
• Protocol-discusses with all patients PCMH
done by clinical/provider staff.
• Documention in EMR.
Implementing the Plan
• PCMH competency
• Staff Education:
– Updates and process
changes discussed at
monthly meetings, on
alternating weeks.
– Clerical only
– Clinical only
– Providers only
– All staff meeting
– Each staff member
reviews an online power
point presentation.
“IHA and the PCMH”
– Assessment test to
validate competency
Implementing the Plan cont…
• PCMH office LEAD process committee
Weekly meetings
• Ongoing evaluation, maintenance and
implementation of office processes
Predictors of Success
• We’re aligned with our mission/vision
– IHA exists to meet community needs by providing
personalized, high-quality health and medical services to
every patient. We strive to achieve unparalleled patient
satisfaction with our clinical quality, service, accessibility
and value.
• There’s been an articulated need for change
• We have the commitment of Leadership
• We have an effective transition team
• Failure brings consequences
ASK US HOW IT’S GOING
NEXT YEAR…