Challenge

Some providers and staff were unfamiliar with the medical home concept. Unlike many areas of the country, little or no local payer participation existed to support the significant costs the client would incur to develop a successful Patient Centered Medical Home. In addition, low physician reimbursement rates in California make efficient use of resources a key factor.

Solution and Results

We met with administrative and physician leadership to learn about their medical home goals, reviewed the payer mix and assessed clinical operations including EHR integration into workflows, chronic illness care and the use of physician resources. We were then able to identify high value strategies to build the necessary medical home infrastructure to match client readiness and goals.

We identified and assisted with reducing inefficiencies in workflows and EHR utilization by physicians and staff including duplicate data entry. We facilitated innovations in clinical operations including group medical appointments as well as delegating non-physician tasks to free up so-called hidden capacity.

Customized physician and staff learning sessions were conducted to develop hands-on knowledge and skills to implement a medical home. Statewide and national trends regarding medical home participation and funding were reviewed to plan the timing of next steps. Ongoing dialogue with physicians helped build understanding and alignment for change. While local payer incentives remain low, medical home infrastructure development has begun with significant improvements in EHR resources and processes as well as the streamlining of clinical operations.

Challenge

A complex project which required a broad range of skills from advising project leaders to on-site facilitation of clinical operations improvement, and training of practice coaches – all within a tight budget. The majority of provider operations were focused on longstanding payment incentives to boost office visit volumes, however, rising per member, per month payments to participating practices was generating a shift in incentives away from volume-based care in favor of accountability for quality outcomes such as improving diabetes care.

Solution & Results

We conducted site visits and worked on improving clinical workflows, access, EHR utilization, group medical appointments, and optimizing practice revenues. To reduce unnecessary hospital re-admissions and ED visits, we helped guide development of nurse care manager roles and training of physicians and staff on proven medical neighborhood strategies for post-hospital visit planning and patient support. Our customized redesign boot camp provided coaches with the hands-on skills needed to address the specific improvement issues facing physician practices.

A local learning community of participating physicians and staff was facilitated to share best practices and clinical outcomes data. Access to 24/7 learning about local and national best practices was put in place with BRIEF VIDEOS OF SITE VISITS. We also recruited assistance from local physician thought leaders to forward the project's goals. 

97% of attendees said they would recommend to colleagues the training program we conducted on the cultural and operational transformation required for successful medical homes. 98% of attendees were prompted to make changes in their practices.

Challenge

The project required development and implementation of training for a groundbreaking national project to redesign numerous medical office processes. An important consideration when planning was that some of the facilitators had no prior experience in healthcare.

Solution & Results

We designed and delivered a 2-day training for practice redesign facilitators using highly interactive learning scenarios in order to build problem-solving skills. Visual tools helped simplify complex office practice workflows for facilitators new to healthcare. Subject matter included how-tos for improving chronic illness care, workflows, patient access, and group visits with simple financial modeling. Attendees gained a new ease in effectively guiding improvement at participating practices. We were also invited to conduct how-to workshops for the 36 participating medical groups on managing culture and operational change as well as optimizing the use of EHRs. The project has become a model for Patient Centered Medical Homes nationally.

Challenge

Inefficiencies and high no-show rates were negatively impacting revenues as well as creating long waits for visits for a high-need and under-served patient population. Limited community health center budgets were a major factor.

Solution & Results

We helped BMS to improve patient access by 25% and revenues increased by 20%. We redesigned inefficient workflows, enabling patients to get access care on the day that they called, and identified metrics with which to measure success. We facilitated discussions to constructively deal with the resistance of some physicians and staff to change. A customized skills training was conducted for physicians and staff on how to use redesign concepts to improve access. We also advised BMS's CEO and COO on how to leverage national best practices to sustain the desired changes as well as common costly pitfalls to avoid.

Following the successes of the initial health center, the project was rolled out at an additional three sites.

Challenge

Lack of existing structure and process to ensure high level of patient satisfaction, and a lack of physician and staff awareness of how to manage the patient service experience. Existing processes were provider and staff centric rather than patient focused, with little patient self-management skill building.

Solution and results

We facilitated the development of a physician led improvement team that met regularly, identified patient satisfaction goals and metrics as well as a process to rapidly test desired changes. A curriculum was developed and training conducted for physicians and staff to design and manage the patient service experience as well as service recovery. Inefficiencies and duplication of tasks which often frustrated patients were identified and eliminated. Physician specific patient satisfaction surveys were designed and implemented and the results posted in common areas. Patient self-management skills were facilitated via self-care tools on the practice website. We also facilitated the sometimes-difficult dialogues with staff resistant to the changes required to delight patients.

Patient and family comfort issues were addressed such as providing warm blankets routinely to patients undergoing procedures rather than only when requested, and a refreshment area for family members was added. Scheduling redundancies, background rock music at one site and the pervasive smell of antiseptics were also addressed. An organizational customer service vision was developed with physician leaders. As a result, patient satisfaction scores increased over 10%.