Creating Team Based
Proactive Office Encounters
___________________
Connie Barath, RN – Neighborhood Family Practice John Jason, BA – Neighborhood Family Practice
Marianella Napolitano, RN, MBA – Neighborhood Family Practice Ann Reichsman, MD – Neighborhood Family Practice
Faith Walsh, MA, CPT – Neighborhood Family Practice Michelle Mencke, Operations Consultant - Kaiser Permanente
1
Better Health Greater Cleveland relies on the presenter to obtain all rights to use and display copyright-protected information. Anyone claiming a right or interest in or to any posted
Disclosure
Presenters reported no financial interest relevant to this presentation
Our Make Up
3 Community Health
Centers – all providing Primary Care Health services
Membership as of YE
2011 = 13, 399
15 Medical Office
locations – all with Primary Care Teams (additional admin. offices)
Current membership =
91,000
Objectives
1.
Participants will learn the primary concepts of
Proactive Office Encounters (POE) and the
importance of team work in accomplishing these
concepts.
2.
Participants will learn how team formation has
enhanced communication, increased efficiency
and provided better patient care.
3.
Participants will learn how technology is used to
support care teams in ensuring patient care is
addressed via a POE, as well as the importance
of staff engagement in the process.
What is a Proactive Office Encounter?
All the processes, tools and workflows supporting
both patient preventive and chronic care as well as the healthcare team in the Primary Care Team
setting
Patient ready, room ready, provider ready
Prior to, during and after a member initiated patient encounter
Includes face-to-face office visits and telephone visits
Why Team Building?
To get ready for the 21
stCentury Care utilizing:
Patient Centered Teams Pre-Visit preparation
Implementation of
Care Team Re-Design
Team Training provided
to all members
From a provider
centered team to a team based approach
Increased efficiency
and more clear communication
Pre-Visit:
Patient Advocate (PA) Reviews Patient Chart, Identifies Chronic Disease PatientsPre-Visit: PA Identifies
Care Gaps
Pre-Visit: PA Enters
Pre-Visit: PA Documents
Identified Care Gaps
Day of Visit: PA Documents
Identified Care Gaps
Day of Visit: Medical Assistant Chart
Scrubbing
Review patient list Release pre-orders Circle CPEs to identify
which health history form is needed & whether
PAPs are due
Alert the provider to the
Day of the Visit: Nurse
Contribution During Huddles
Participate in the huddle
Provide OARRS reports
Anticipate nurse visit needs such as
DM teaching, foot examinations
Brief discussion of pertinent patient
concerns
MA Prints List Review information with Provider: Writes down orders needed Provider Uses EMR Opens each chart: Reviews information
Role Play
Day of Visit: Huddle Process
Inefficient vs. Efficient
INEFFICIENT HUDDLE PROCESS
The Proactive Office Encounter
Outcomes Data
56% 56%
66%
71%
49%
54%
63% 66%
63% 65%
85% 86%
12% 31% 51% 58% 33% 42%
54% 55%
0% 20% 40% 60% 80% 100%
Mar-12 Apr-12 May-12 Jun-12
Diabetes Care Standards
LDL Checked yearly *** LDL < 100 or on Statin ** M-alb or ACE/ARB Rx ** Foot Exam/Pod referral (yr)*** Eye Exam Done annually **
What is different at Kaiser
Permanente Ohio?
17
PreEncounter or PreVisit Encounter via POINT
Identify missing labs, screening procedures ~ care gaps Communicate care gaps to our member(s)
What is different at Kaiser
Permanente Ohio?
PreEncounter or PreVisit Encounter via EMR
Check for concurrent communication(s)
Health Alerts Letters
Check for open orders
Labs X-rays
Initiate a telephone encounter
Utilize SmartSets and phrases as designed
What is different at Kaiser
Permanente Ohio?
Office / Telephone Encounter or Day
of Encounter via POINT and EMR Room ready
Patient’s electronic chart is open Does the provider have everything
he/she needs for the visit
Patient ready
Identify and flag alerts for providers
(addressing when possible)
Visit/vital sign collection (rooming
standards)
PreEncounter follow-up
Proactive Office Encounter SmartSet Dressed per exam
Provider ready
Reviewed electronic medical record
What is different at Kaiser
Permanente Ohio?
Post Encounter
After visit summary/After care instructions Follow-up (future) appointments
Health education materials
What is different at Kaiser
Permanente Ohio?
Proactive Office Encounter & Team Composition
Providers RN Leads LPNs
CMAs
The Proactive Office
Encounter Teamwork
It takes a team
and
communication!!
The Proactive Office Encounter
Teamwork
In our teams
Must “fit” in to the team’s workflow and “habits”
“Start of day” procedures Familiar processes
Maximize our systems
Permanente Online Interactive Network Tool KP HealthConnect
Communicate, communicate, communicate
Kick-offs
Training (group and individual)
Provider, support staff pairs – Panel Management Time and
Huddles
The Proactive Office Encounter
Data
24 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening CDC -HbA1c ScreeningCDC - LDL Screening HEDIS Select Measures
2010 - 2011 Commercial 2010 2011 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Breast Cancer Screening Colorectal Cancer Screening
CDC - HbA1c Screening
CDC - LDL Screening HEDIS Select Measures
2010 - 2011 Medicare
2010 2011
