Implementing PCMH in a Safety Net Clinic

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Implementing PCMH in a  Safety Net Clinic The Terry Reilly Experience The Fifth National Medical Home Summit Philadelphia, PA March 13‐15, 2013

Terry Reilly Overview • 41 year history in Southwest Idaho • 7 Primary Care Clinics – 3 “Urban” – 4 Rural

• 5 Dental Offices • Behavioral Health Services co-located in all 7 Clinics • 8.09 MD’s 14.44 NP/PA • 1.92 support staff per clinician

Patient Demographics 2012 • • • • • • •

27,636 users 105,741 encounters (3.8 encounters per patient) 56% male, 44% female 5,605 children/adolescents 64% uninsured 62% at or below 100% poverty 53% White not Hispanic 39% Hispanic

Terry Reilly and PCMH • • • • •

Began 4 years ago Corporate Leadership Empanelment Care Coordination QI/HIT

Engaged Leadership • Visible and sustained leadership • Ensuring that the PCMH transformation effort has the time and resources needed to be successful • Ensuring that providers and other care team members have protected time to conduct activities beyond direct patient care

Empanelment •

Addressing key questions



Determining patient definitions



Working with front office staff



Writing procedures on how to maintain empanelment



Creating and using panel reports to drive balancing of supply and demand



Developing metrics to help us monitor the patient’s ability to access their PCP



Developing methods to determine when a provider’s panel needs to be closed to new patients

Care Coordination • • •

Establishing and providing organizational support Linking patients to a provider and care team Assuring that patients are able to see their provider or care team whenever possible • Creating and implementing a closed loop referral coordination process • Developing policies and protocols for Behavioral Health/Medical care integration • Developing scheduling options that are patient and familycentered and accessible • Developing and Implementing a patient portal

Quality Improvement/Health Information Technology •

Streamlining our rooming protocols



Creating registries



Choosing and using a formal model for quality improvement



Establishing, and monthly monitoring, metrics to evaluate improvement efforts and outcomes



Creating templates and tools in our EMR

What a PCMH Clinic Looks Like The Boise Clinic Experience • • • • • •

11 exam rooms 4 Behavioral Health/Nurse consult rooms 2 bullpens for all staff 2 procedure rooms 1 Conference Room and 1 Group Room Both Express and Empanelled care

Overview of new Clinic location Staffing Level and Support Ratios •

3.2 clinician FTE - 2.0 FTE Primary Care and 1.2 Express Care. – The 2.0 FTE in Primary Care provides empanelled coverage of approximately 2400 patients. The 1.4 clinician team in Express Care can likely serve up to 2000 additional patients in a nonempanelled model of care.



1:1.5 matching of Clinicians with MAs plus an RN



Behavioral Health integration – 1 social worker 1 Case Manager, 1 prescribing Clinician

New Clinic Floor Plan

New Clinic Beginnings

• Beginning of the remodel

New Clinic •

Clinical Outcomes 2010-2012 +4

+ 14

+5

Patient Satisfaction 2010-2012 100% 90% 80% 70% 60% 2010 50%

2011 2012

40% 30% 20% 10% 0% Patient Access

Parternship

Time

Explanations

Running on time

Provider Satisfaction 2009-2012

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Implementing PCMH in a Safety Net Clinic

Implementing PCMH in a  Safety Net Clinic The Terry Reilly Experience The Fifth National Medical Home Summit Philadelphia, PA March 13‐15, 2013 Terr...

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