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G UIDANCE ON INTERVENING WITH PANEL MANAGEMENT : HIV CLINICS AT THE FOREFRONT OF PCMH MODELS Itta Aswad, MPH November 28 th, 2012- Ryan White All Grantees.

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Presentation on theme: "G UIDANCE ON INTERVENING WITH PANEL MANAGEMENT : HIV CLINICS AT THE FOREFRONT OF PCMH MODELS Itta Aswad, MPH November 28 th, 2012- Ryan White All Grantees."— Presentation transcript:

1 G UIDANCE ON INTERVENING WITH PANEL MANAGEMENT : HIV CLINICS AT THE FOREFRONT OF PCMH MODELS Itta Aswad, MPH November 28 th, Ryan White All Grantees Meeting

2 D ISCLOSURES This continuing education activity is managed and accredited by Professional Education Service Group. The information presented in this activity represents the opinion of the author(s) or faculty. Neither PESG, nor any accrediting organization endorses any commercial products displayed or mentioned in conjunction with this activity. Commercial Support was not received for this activity.

3 D ISCLOSURES Itta Aswad, MPH Has no financial interest or relationships to disclose Kathleen Clanon, MD Has no financial interest or relationships to disclose

4 L EARNING OBJECTIVES At the conclusion of this activity, the participant will be able to: 1. Define Panel Management and describe a typical PM program. 2. Describe the association between the Patient Centered Medical Home Model and Panel Management. 3. Identify barriers and facilitators to implementing this design in their agencies

5 O BTAINING CME/CE C REDIT If you would like to receive continuing education credit for this activity, please visit:

6 W HO ARE WE HIV ACCESS is a consortium of Primary Care clinics working to provide comprehensive quality care to PLWHA The Family Care Network is a consortium of agencies that works to provide comprehensive, services across disciplines for children, youth, women and families living with HIV

7 A GENDA Overview of PCMH What is Panel Management? How PM works How PM can be implemented in your clinic

8 T HE REALITY OF THE 15- MINUTE VISIT IN PRIMARY CARE Only 37% of patients in one study were adequately informed about medications they were taking 50% of patients leave office visit not understanding what the doctor said Study of 1000 physician visits, the patient did not participate in decisions 91% of the time. Roter and Hall. Ann Rev Public Health 1989;10:163. Braddock et al. JAMA 1999;282;2313.

9 R ACIAL D ISPARITIES IN S URVIVAL Life Expectancy Lost (y) Women Men Overall White BlackHispanic Late initiation or early HAART discontinuation results in life- expectancy loss Data indicate minorities present later and have higher rates of premature discontinuation Losina E et al. 14th CROI; 2007; Los Angeles, CA. Abstract 142. Slide courtesy of Dr. William King

10 W HAT IS A PCMH? A primary care practice that has gone through an independent evaluation process, such as through the NCQA, to validate that it is able to: Deliver comprehensive, patient- centered care Of the whole person, Supported by health information systems And with accountability for results. Slide courtesy of Dr. Kathleen Clanon

11 K EY FEATURES OF A PCMH INCLUDE : Enhanced Access and Open Scheduling Adopting and Implementing Evidence Based Guidelines Systematic, HIT based tracking of tests, results, screens, preventative therapy Referral tracking, and follow-up Alternate forms of patient-physician interaction ( , phone) PCMHs are accountable for reporting on evidence-based measures of quality and patient satisfaction. Slide courtesy of Dr. Kathleen Clanon

12 12 Patient Centered Medical Home Implementation Continuum Pre- contemplation (Inconvenient hours, no outreach to missing patients, difficult to reach clinic on phone) Visualized as PCMH (Philosophic commitment to PCMH and talk about concepts, no action yet) Organized as PCMH (Patient navigators, panel management, staff huddles, using registry) Standardized as PCMH (Staff training and job descriptions include new duties, reimbursement is tied to pt satisfaction) Recognized as PCMH (By NCQA, etc.) Realized as PCMH (Org culture and operations have fully integrated PCMH) Doctor and Staff Centered model PCMH Fully Integrated Slide courtesy of Dr. Kathleen Clanon

13 W HY DO WE NEED THIS CHANGE ? PLWH/A are living longer List of beneficial preventative disease activities is growing Resources are becoming more limited Payer models are changing (pay for performance) Utilizing meaningful use incentives

14 W HAT IS P ANEL M ANAGEMENT Use a registry to track who needs what Have written selection criteria to decide which patients to focus on for what Link criteria to standing orders for labs, immunizations, counseling referrals, etc Empower MA/peer teams to take over managing routine care outside of the MD/NP visit Slide courtesy of: Barbara Ramsey, MD

15 W HAT CAN P ANEL M ANAGEMENT DO FOR US ? Uncouple the Dr. visit from some of the - Adherence counseling- Smoking cessation - Prevention counseling- Vaccinations - Mental Health and Substance Abuse treatment Produce actionable interventions - phone messaging - med reconciliation

16 P ILOT PROJECT - A LAMEDA C OUNTY M EDICAL C ENTER, O AKLAND CA Team Approach: 1 Clinician 1 Medical Assistant 1 Registered Nurse ~125 clients Goal: Increase retention in care Increase vL suppression Increase health maintenance activities

17 T ASK S HIFTING MA- Vitals and referrals as ordered RN- Case Management and discharge orders MD- focus on HIV care and Primary care needs as remembered MA- Vitals, promotes for HM tasks, referrals, in- reach to the out of care without order RN- Case Management and discharge orders MD- Focus on HIV and Primary care needs using support tools Pre Panel ManagementPost Panel Management

18 W HAT DOES P ANEL M ANAGEMENT SOUND LIKE ? Hi Andre, Im calling from Dr. Js office. I see you are overdue for your labs. I have a lab slip for you, can you come in a see me tomorrow? Great, and we can get your flu shot done then too, and well set you up to see Dr. J. Hello Ms. R, this is Itta calling from Dr. Cs office. How are you today? We were looking over your chart and noticed that you are coming up due for your pap smear and also your ADAP needs renewal. Is it ok if I make appts for you next week to get those done?

19 I NTERVENTIONS AND TOOLS Health messages In-reach Registry reports Huddles Decision Support sheets

20 A DVANTAGES Proper provider assignments Focused HIV and Primary Care tasks Increase quality numbers Organized care coordination Movement toward NCQA qualification

21 A LAMEDA C OUNTY M EDICAL C ENTER : P ANEL M ANAGEMENT A T WORK

22 U SE OF A R EGISTRY R EPORT - How many clients in your panel? - What information is available on each patient? - Which patients are overdue for CD4, Viral Load, TB, Paps? - Which patients are at goal? Which are not? - Which patients could be prioritized for self- management support groups?

23 E XERCISE : U SING THE R EGISTRY Exercise: 15 minutes. In groups of 3-4, degsinate each person a role (MA, RN, Panel Manager, Clinician). Which clients should the Panel Manager work with first? How did you prioritize the clients? Why? What interventions would you recommend for follow-up? What is the role of other team members?

24 PM AT WORK … THE RESULTS TELL ALL

25 C HALLENGES AND S OLUTIONS Time Prioritizing needs Shifting medical practices Scheduling protected time Use Registry report and Decision Support tools Communication SolutionsChallenges

26 D O YOU HAVE THE RESOURCES TO PULL THIS OFF ? 4 Central PM concepts 1. Use a registry 2. A team of providers willing to align resources 3. Prioritizing criteria 4. Take care out of the PCP visit when possible

27 DISCUSSION

28 N EXT S TEPS ….. Identify staff Determine PM activities Carve out protected time with PCP Celebrate successes Learning opportunities

29 R ESOURCES Itta Aswad, MPH- Kathleen Clanon, MD- William King, MD, JD- Barbara Ramsey, MD-


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