PCMHAn entire team to call
YOUR OWNAnn 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
• 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
What is IHA?
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 WestArbor 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 Associates-Canton
Pediatric Healthcare Associates-Ypsilanti
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 Walker, 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 Weinblatt, MD
Mary Westhoff, 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 Walker, MD
COMMITTEES AND SUBCOMMITTEES
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
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 SUB-COMMITTEE
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
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
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
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
LEADERSHIP DEVELOPMENT
COMMITTEE
Wes Beemer, MD Bob Breakey, MD – Chair
Mary Durfee, MD Bill Fileti
Michael Kucera, MD Mark Lindley, MD
Nancy Spangler, MD
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
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
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
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 Woodruff, 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 Woodruff, 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
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 Chris Holda Lynn Klima Amy Middleton Director of Business Director of Technology & Director of Clinical Director of Marketing Services Information Services Improvement Marty Murray Linda MacEllven Vice President - Director of Human Administrative Services Resources & Customer Service Cindy Elliott Lowell Sprague Chief Operating Officer (COO) 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 ourPatient-Centered Medical Homes?
•Extended Access
•Test Tracking
• Patient Registry
• ePrescribing
•Care Management
•Patient Provider Partnership
•Performance Reporting
“Getting through to the Office”
Patient Satisfaction at IHA
Survey Period IHA Overall AMGA Norm
(Excellent) (Excellent)
Spring 2005 33% 39%
Spring 2006 38% 42%
Spring 2007 38% 45%
Fall 2007 41% 45%
Spring 2008 44% 44%
Fall 2008 45% 44%
Spring 2009 47% 44%
Advancing Access
IHA ER Utilization Trends
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
HAP ER Rate/1000 180 216 185 149 167 159 142 141 163 171 166 152 169
Priority ER Rate/1000 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
125
145
165
185
205
225
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
• Registry Function
• Test Tracking
• Development of Internal Coaches
• Roles and Responsibilities
• Care Coordination: Learning Collaborative with HVPA and U of M
Thinking in a New Way… LEAN
Identifying Teams
Planned Care: The Chronic Care Model
Chronic Condition Visit
Recall
f/u appt scheduled
Planned care follow-up:
phone/face to face
Run registry
Pre-call
Task
Recall
• 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
Recommendations for Planned Care: Complicated Diabetes
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.
Make the Right Thing the Easy Thing
Same Way
Every Time
No Double Work
Increase Efficiencies and
Decrease Errors
Processes Identified for Change
• 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.
• Clerical/front office:
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 RNBillable 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 brochure-
IHA patient centered medical home.
• Protocol-discusses with all patients PCMH done by clinical/provider staff.
• Documention in EMR.
Implementing the Plan
• Staff Education:
– Updates and process changes discussed at monthly meetings, on alternating weeks.
– Clerical only
– Clinical only
– Providers only
– All staff meeting
• PCMH competency
– 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…