1. Building Our Medical Neighborhood
Provider to Provider Communication
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2. Agenda Defining your Medical Neighborhood
How to be a high functioning medical neighbor
Why should we implement Care Compacts?
Importance of PCP & Specialty Collaboration
Expectations, Vision & Goals
Next Steps
Welcome, everyone! We are looking forward to talking with you today and sharing some meaningful collaboration opportunities.
Let’s talk about:
Defining your Medical Neighborhood
How to be a high functioning medical neighbor
Why should we implement Care Compact?
Importance of PCP & Specialty Collaboration
Expectations, Vision & Goals
Next Steps
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3. Defining the Medical Neighborhood
Patient
Primary Care
Specialists
Mental Health Providers
Community Resources
Social Workers
Pharmacists
Home Care
Patient centered care is more than adapting new processes or office structure. It is important that providers begin to establish relationships with patients, their families, and their medical neighborhood in order to improve care delivery. Care coordination within the medical neighborhood can enhance patient care, decrease duplication of testing, increase continuity of care, improve quality outcomes and build a multidisciplinary care team.
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4. High-Functioning Medical Neighbor
What does it means to be a high-functioning medical neighbor?
Care coordination
Focus on patient
Implement care compacts
Seamless co-management
Clearly defined roles/responsibilities
Timely and appropriate referrals
Effective data sharing and prompt two-way communication
Let’s talk about what it means to be a high functioning medical neighbor- Talk through slide
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5. What are Care Compacts?
Care Compacts improve care coordination and communication between referring/consulting providers to enhance quality of care and patient experience.
Care Compacts are an agreement between primary care providers and specialists that defines each providers roles and responsibilities as well as data exchange processes.
Care compacts are a framework for better communication and safe transition of care between primary care and specialty care providers.
Practice-to-practice care exchanges often produce frustration in the absence of care compacts:
Primary care physicians refer patients and hear nothing back from the specialist practice, sometimes only learning the visit actually occurred when the patient returns for a primary care visit
Patients arrive at specialist physician offices without needed pre-work, test results, etc., which leads to a wasted encounter and the need for visit rescheduling and delays in care OR numerous unneeded and avoidable tests are inappropriately ordered pre-consult, leading to healthcare spending waste and inefficiency
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6. Care Compacts
Why should practices build their medical neighborhood with care compacts?
Patient experience
Quality outcomes
Preventative care compliance
Care Coordination
Meaningful, appropriate referrals
Patient safety
Communication
Support PCP treatment plan
Lower costs
Decrease duplication of testing
What is meaningful for your practice and neighborhood?
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7. Medical Neighborhood Functional Comparison
Lack of communication between referring and consulting providers
Patients unsure why they are being referred or what to expect
Office staff might be frustrated without all the patient information
Before Care Compacts
Coordinated referral process
Streamlined communication & patient information
Providers effectively coordinate patient care
Patient understands the reason for the visit
After Care Compacts
Let’s talk through the before and after scenarios. Leverage this information when negotiating with potential medical neighborhoods. Help them see the before and after.
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8. Collaborative Vision & Goals
Vision: (Practice to define)
Goals: (Practice to define)
Plan for implementing Care Compacts (formal/informal)
Practice to complete :Opportunity for Specialty Practice to share their vision & goals they hope to achieve with PCP partner collaboration
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9. Expectations of the Primary Care Partner
Patient-Centered Specialty Care (PCSC) incorporates the principles of the American College of Physicians’ PCMH-N concept in order to facilitate care coordination.
Expectations of the PCP Partner (and the Specialist)
Effective two-way communication between primary and secondary providers
Appropriate and timely referrals and consultations with prompt feedback of findings/recommendations
Effective co-management of patients when necessary
A commitment to practice in a patient-centered fashion across all physicians delivering care to a patient
Benefits to PCP Partner
Improved communication with specialist
Timely feedback loop on office visits
Prepared and informed patient
There are also be expectations of primary care partners. Specialists’ ability to improve the quality of the encounter with a patient referred to their practice is dependent in many ways on the quality of referral that they receive from the primary care physician.
We hope that practices will improve the quality of communication, not only with referring primary care providers, but with patients as well.
We are looking for primary care partners that were open to this kind of effort and willing to make some adjustments on their end if necessary.
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10. Questions & Next Steps
Specialty Contact Information
Practice to complete
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11. Appendix
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12. Invite Letter Template
Dear Colleague, This letter is an invitation to you and your practice to partner with us in an exciting pilot program to improve our mutual patients’ care through enhanced care coordination. We are engaged in a Patient Centered Specialty Care (PCSC) pilot study with Anthem to implement care compacts with our primary care partners. Based on our collaborative, professional relationship and shared commitment to provide high quality patient care, we would like to work with you to establish enhanced referral and communication processes. Our practice will be working to improve upon our internal and external referral and communication processes over the next several months. This involves outlining mutual responsibilities and expectations for a ‘partnership of care.’ You, along with our patients, will benefit in many ways: improved referral processes, timely and complete demographic and clinical information, prepared patients and assurance of appropriate follow-up. While we commit to improving our internal processes, we ask that you be willing to assess and, where appropriate, be receptive to refining your referral process. In particular, we will be evaluating opportunities around the clarity of the referral reason, the information that is provided upon referral and patient communication. Thank you in advance for your consideration. We would be privileged to build a medical neighborhood with your practice. If you are interested in participating, please contact me at xxxxx. [optional language for an Enhanced Personal Health Care Program practice: Your participation in Anthem’s Enhanced Personal Health Care Program provides you with additional resources and support. Your patient-centered care consultant through this program can help you.] Warm regards, Xxxxx, MD
Feel free to adapt this letter to the practice’s goals and vision for collaboration
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13. Legal
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
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