1. Ambulatory Practice of the Future
David Judge, MD – APF Medical Director
Nicola Majchrzak, MPH, MSW – APF Project Manager
Collaborators: MGPO, CIMIT, MGH Lab of Computer Science
Stoeckle Center for Primary Care Innovation, SimsLab
Boston, February 2010

2. Agenda Background and charge Our Vision Shifting Paradigms for Care
The APF Care Model
Discussion

3. Background and Charge
Multidisciplinary team assembled in 2004, charged with designing a new care model to radically improve the care experience for patients and providers and anticipate the challenges of the future.

4. The Ambulatory Practice of the Future
“We will design the ambulatory care practice that delivers ideal care in the ideal environment to optimize outcomes for all.“

5. Shifting Paradigms for Care
Focus on sickness Focus on health & wellness Directive communication Culture of collaboration One size fits all Mass customization Individual experiences Team-based experiences Event-based care Continuous care Patient goes to treatment Treatment goes to patient Obscurity Transparency Static model Evolving care model
Consider changing order

6. The APF Care Model Health & Life Balance Plan Compact
Orientation & guide
- Customized care plan
Advisory role in ongoing APF development
Patient

7. The APF Care Model
Members - MD, RN, NP, MA, Care coordinator, Greeter, Medical Secretary
Acute / chronic care
Proactive pop. mgmt.
Shared responsibility of ongoing practice redesign
‘Productivity’ redefined (Compensation supports longer visits and non- traditional care activity)
Care Team
Patient

8. The APF Care Model Patient-centered design Critical components:
Check-in Kiosk
Living room/library
Central team area
APF Exam Room
Large meeting space (group visits)
Urgent care Procedures
Communication tech
Prototyping Lab
Physical Practice
Care Team
Patient

9. The APF Care Model Virtual Practice APF Portal (LCS)
Chart review, visit prep, ongoing care plan work
Synchronous and asynchronous e-visits
Remote physiologic monitoring (CCH, CIMIT)
New services (online scheduling)
Population management
Peer–to–peer care
Virtual Practice
Physical Practice
Care Team
Patient

10. Evaluation Patient experience Provider and staff experience
Clinical outcomes
Utilization of services & cost

11. Discussion