Martin Army Community Hospital Family Medical Home Terry Newton, M.D., F.A.A.F.P. Assistant Professor of Family Medicine Medical Home Champion

2 Military Health System The Quadruple Aim Readiness Improving quality and health outcomes for a defined population. Advocating and incentivizing healthy behaviors. Patient and family centered care that is seamless and integrated. Providing patients the care they need, exactly when and where they need it. Managing the cost of providing care for the population. Eliminate waste and reduce unwarranted variation; reward outcomes, not outputs. Enabling a medically ready force, a ready medical force, and resiliency of all MHS personnel.

Martin Army Community Hospital Fort Benning Georgia

Access to Care and Information Practice- Based Care Teams Health Information Technology Care Coordination Practice- Based Services Quality and Safety Practice Management A continuous relationship with a personal physician & team coordinating care for both wellness and illness Mindful clinician-patient communication: trust, respect, shared decision-making Patient engagement Provider/patient partnership Culturally sensitive care Continuous relationship Whole person care 23,500 Enrolled patients

PCMH A continuous relationship with a personal physician & team coordinating care for both wellness and illness ◦ Improves experience of care ◦ Improves quality ◦ Improves safety  More intimate knowledge of patient ◦ Reduces costs through reduction in resource utilization Access to Care and Information Practice- Based Care Teams Health Information Technology Care Coordination Practice- Based Services Quality and Safety Practice Management

Hypothesis In order for residents to value the continuous relationship between a patient and their provider and team, the resident must experience high levels of continuity with their patients over the course of their residency training

How Are We Organized? 1 Clinic OIC 1 Clinic Manager 1 Clinic Nurse Manager 1 Head Nurse 1 Population Health Nurse Consultant 1 Population Health Admin Assistant 1 MAPS Sustainment Trainer 1 Scheduler 1 Nurse Educator (all PCC) Super Team 1 1 NCOIC 1 Behaviorist 1 PharmD 1 Care Coordinator 1 Team Float (RN) 1 Float Provider 1 Disease Management/Wellness Nurse Pract. 1 Coder Green Team (provider team leader) 4 provider FTEs 1 Triage RN 3 LPNs 7 CNA/Medics Population Health Tech 2 Clerks Yellow Team (provider team leader) 4 provider FTEs 1 Triage RN 2 LPN’s 8 CNA/Medics Population Health Tech 2 Clerks Super Team 2 1 NCOIC 1 Behaviorist 1 PharmD 1 Care Coordinator 1 Team Float (RN) 1 Float Provider 1 Disease management/Wellness Nurse Pract. 1 Coder Red Team (provider team leader) 6 provider FTEs 1 Triage RN 2 LPN’s 12 CNA/Medics Population Health Tech 2 Clerks Blue Team (provider team leader) 6 provider FTEs 1 Triage RN 3 LPN’s 11CNA/Medics Population Health Tech 2 Clerks Anticoagulation Clinic 1 Pop. Health Admin. Assistant (Share) 2 Pharm. D Providers 1 Pop Heath Tech Special Team Visiting specialists 4 CNAs 1 RN – Procedures 1 LPN – OB intake 1 LPN – Immune 1 GXT/EKG/PFT Tech 1 Radiology tech (new hospital) 1 Clerk

Residents on Teams Green Team (provider team leader) 3 non-residency FTEs 1 FTE (residency pod) Residency Pod = (faculty, PGY III, PGY II, PGY I) Blue Team (provider team leader) 4 non-residency FTEs 2 FTE (residency pods) Residency Pod = (faculty, PGY III, PGY II, PGY I)

PCMH Access/Continuity Initiatives 1. Strict business rules to ensure minimal cross-team booking to maximize team continuity 2. Advanced access appointing to improve patient’s access to team and PCM 3. Faculty on advanced access teams having daily appointments to improve PCM continuity for faculty

MACH Family Medical Home Advanced Access Timeline Jan 2010Mar 2010May 2010July 2010 Continuous supply and demand management

Schedule Adjusting Typical faculty clinic schedule – 2-3 half days per week of clinic Typical resident clinic schedule – PGY I = 1 half day per week – PGY II = 3 half days per week – PGY III = 5 half days per week

Modified Scheduling Faculty on Yellow and Green went to advanced access scheduling with daily appointments in January (remainder of green team implemented advanced access template in March)

How Are We Doing?

Team Continuity Advanced access

Faculty Continuity

Resident Continuity

Other Trends of Advanced Access

No-Show Rates By Team Advanced access

March 2010: Green 73 Blue 104 Red 92 Yellow 41 Monthly Urgent Care by FM Team As of 28 Mar 10 Advanced access

Emergency Room Visits By Team Advanced access

Patient and Family Advocate Office Patient Centered Medical Home Complaint Feedback Percentage

Summary Patient centered care requires a continuous relationship with provider and team To teach residents the value of continuity they must experience it in the PCMH Improved business practices can achieve high team continuity rates High team continuity improves PCM continuity To achieve the best possible PCM continuity rates we must have high team continuity with advanced access and daily appointment availability

Next Steps Begin daily OPAC-3 clinics for all faculty as their teams enter advanced access appointing Begin daily OPAC-3 for all interns beginning academic year starting July 2010 and continue for the duration of training. Entire residency transitioned into daily availability to their patients over next three years.

QUESTIONS ?