1. OVERVIEW OF PCMH JOHN BENDER, MD, MIRAMONT FAMILY MEDICINE PATIENT H. RICHARD BRACK & HIS WIFE DEBBIE BRACK 10:00 AM OVERVIEW OF PCMH- AN XTREME MAKEOVER From the Patient and Physician Perspective Presented by John L Bender, M.D., FAAFP January 9th, 2014 Colorado PCPCC, Denver

2. Our story begins…. 2002 in Fort Collins Colorado…. 2002 H.G. Carlson, M.D. One of the oldest practices in Fort Collins Open 8-5 most days Paper Charts One Employee One Computer (386) 1000 patients

4. In a basement, paneling on the walls

5. Walls of Paper Charts

6. Move that Bus!!!

8. Our story today… 2014 in Colorado…. 7 locations in 6 separate communities (Urban, Suburban, Rural, and Frontier) Open M-F 8-8, Saturdays 9-1 22 providers (11 physicians) 75 employees Electronic Charts, Patient Portal, NCQA III PCMH recognition Over 100 company computers operating in a terminal service environment and a centralized data center 35,000 patients Davies Ambulatory Award recognition from HiMSS in 2010

9. 4 th fastest growing company in Northern Colorado

10. Miramont’s Growth Curve yearreceipts volume 2001$169,000.00 2002313,565.00 2003428,876.00 2004494,264.00 2005559,110.00 2006845,298.00 20071,449,348.00 20081,940,499.00 20092,616,000.00 20103,505,440.00 2011 4,356,230.00 2012 4,804,885.00

11. 2010 HIMSS Ambulatory Award

12. 2011 Colorado PCMH of the Year

13. 34 primary care physicians leave practice during the same time

14. 8 are bankruptcies…

15. Hospital Movement IN the past 4 years: The number of EM physicians double, and ED utilization increases by 50%. IN the past 2 years: 250 physicians become employees of the local hospital owned medical group (600 total physicians in the county)

16. Our Product in 2002… Test results are slow Labor costs high with much non-revenue generating activity / waste No open appointments No clinical data management Barely any financial data management High variability in patient experiences from day to day Documentation illegible Unable to compete with retail clinics, urgent care, emergency departments, etc.

17. Wanting to get out of last century …

18. “The Restaurant with Bad Food”

19. Made friends with the banker, accountant, attorney and local business leaders We decided it would take money to make money and the process starts with investing We pledged that we would make Miramont safer, more efficient, and up to date Ensure our own profitability at all times in order that we could be there for our patients for many years to come Eliminate as much as possible non-revenue generating activity Find ways to provide needed services in our house, in the free market health care system that we are given Find a better EHR (transition out of a free product we acquired in 2005) Attain NCQA recognition for a Patient Centered Medical Home

20. $1.4 million in new building in 2005

21. Every Year We Bring New Products and Services 2002 Female Provider, DEXA scanner 2003 Level 2 Laboratory, IV therapy 2004 Visiting Surgeon, 8-5 hours M-F 2005 New Building, X-ray, bilingual services 2006 Physical Therapy, Psychotherapy, After Hours 2007 INS, Coumadin clinic, Nerve Conduction studies, Saturday hours, Nurse Educator 2008 Female Physician, Colposcopy, Pain Management Specialist, Group visits, The Dispensary, Psychologist

22. Every Year We Bring New Products and Services 2009 Patient Centered Medical Home, New Website, patient portal, online registration, online scheduling requests, online bill payment, Miramont Value Plan (MVP), Allergy Testing and AIT, Second location and Third Locations, Laser Aesthetic Medicine 2010 Botox, digital Mammography, Audiology, Pediatrician, CEO level administrator, email blast marketing to patient base, automated collections calls 2011DME sales, drive through pharmacy, fluoride dental treatments for children 2012 4 th location in Parker Colorado, self check in kiosks, Phreesia tablets, Medtronics Insulin pumps, iPro 2013 5 th location Loveland, 6 th location Fairplay, 7 th location Glendale

24. THE PROCESS OF GAINING NCQA RECOGNITION or ACHIEVING MEANINGFUL USE IS A WORKFLOW REDESIGN PROCESS IN ITSELF

25. Quality Focused – Practice Tranformation Basic Tenants in the PCMH/Specialist Practice Transformation: –Physician Leaders who are willing to lead a team. –Every person on the team must be empowered to contribute to process improvement and workflow redesign

26. Process as a Root Cause 7 Causes of Waste or MUDA

27. How to Make a Physician Owned Lab (POL) Work in Your Office: Evaluating the Costs and Benefits John L Bender, M.D., FAAFP & Amanda J. Cline, RMA

28. Old Model Physician orders test MA fills out requisition Patient given directions to local lab Patient drives to lab, has test drawn Outside lab runs test Test is reported back to physician next business day MA pulls chart to go with test Physician reviews test, signs it off, and tries to remember what he/she was looking for…

29. Old Model, continued… MA calls and leaves message on answering machine telling patient that results are in but unfortunately due to HIPAA cannot leave results on machine and patient will now have to call back Patient’s spouse hears message, assumes the worst, and calls back three times with an urgent message asking for a return call from physician MA finally makes contact with patient, new medication is ordered, another follow-up visit is scheduled with repeat blood work ordered Receptionist refiles chart. TOTAL TIME: 20 + minutes

30. New Model Physician orders test MA draws patient Test is run in house Result is reported in room to physician and patient Decision is made for new med, result is signed off Patient schedules follow up at check-out Chart is filed TOTAL TIME: 10 minutes

32. We finally know how many diabetics we have

33. A1C documentation improved over time

34. Managing population metrics for chronic disease is realistic with an EHR

35. Leveraging New IT

37. Build the Medical Neighborhood

38. A Call for Courage “Sometimes the opposite of Cautious is not Careless… Sometimes the opposite of Cautious is Courage” - John L Bender, M.D., FAAFP

40. Overview of PCMH – an Xtreme Makeover From the Patient and Physician Perspective Presented by John L Bender, M.D., FAAFP January 9th, 2014 Colorado PCPCC, Denver