advancing team-based care: enhancing the role of the medical assistant

WelcomeAdvancing Team-Based Care

March 3, 2016

WEBINAR 2: Enhancing the Role of the Medical Assistant

Community Health Center, Inc.

Foundational Pillars1. Clinical Excellence- Fully Integrated teams,

Fully integrated EMR, PCMH Level 3

2. Research & Development- The Weitzman Institute is the home of formal research, quality improvement, and R&D 3. Training the Next Generation: Post Graduate Training Programs for nurse practitioners, postdoctoral clinical psychologists, and students of the health professions

CHC Profile:•Founding Year - 1972•200+ delivery sites•130k patients

The Community Health Center, Inc. and its Weitzman Institute will provide education, information, and training

to interested health centers in: Transforming Teams• National Webinars on the team based care model• Invited participation in Learning Collaboratives to launch team

based care at your health center

Training the Next Generation• Two National Webinar series on developing Nurse Practitioner

and Clinical Psychology residency programs and successfully hosting health professions students within health centers

• Invited participation in Learning Collaboratives to implement these programs at your health center

Email your contact information to nca@chc1.com and visit www.chc1.com/NCA.

Enhancing the Role of the Medical Assistant

Today’s Objectives:1. Participants will be able to identify at least two new areas for medical assistant roles in the primary care team. 2. Participants will be able to identify at least one way that state-by-state variation and regulation can affect medical assistant practice.

Get the Most Out of Your Zoom Experience• Send in your questions using Q&A function in Zoom• Look out for our polling questions• Live tweet us at @CHCworkforceNCA and #StartingResidencies and

#HRSAnca • Presentation and slides will be available after on our website• CME approved activity – please complete survey • Upcoming webinars: Register at www.chc1.com/nca

Expanding the Roles of Medical Assistants

Learning from Effective Ambulatory Practices

MacColl Center for Health Care InnovationGroup Health Research Institute

March 3, 2016

Ed Wagner, Director Emeritus

Brian Austin, Associate Director

Who are MAs?• “Medical assistants are not licensed but work under the

license of a physician. They cannot make medical assessments, offer medical advice, or triage patients. They

may, however, provide information to patients and follow a wide variety of physician-approved protocols provided that training and supervision are in place.”

• Formal training – usually 3-6 mos.• Median salary -- ~$30,000/yr

Willard-Grace et al. JAMA Int Med 2014;174:1025-6.

Team Structure:Major Findings From Site Visits

Medical assistants play key patient care roles beyond rooming patients.

Roles are expanded. All staff work at the top of their license and skillsets.

Providers and their panels supported by Core teams built around PCP—MA dyads.

How to Achieve the Quadruple Aim?

Informed, Activated Patients

Comprehensive Services

• Engaged Leadership • Enhanced Access

Essential PracticeFunctions or Competencies

• Population Management• Planned Care• Medication Management• Care Management/Follow-

up• Referral/transition

Management

• Behavioral Integration• Self-management Support• Clinic-Community

Linkages• Communication

Management

• QI strategy/Meaningful Use• Empanelment/Continuity

• High-functioning Teams

Capacity for Quality Care

• Improved Health • Improved Patient Experience• Reduced Total Costs

• Improved Staff Experience

MA Involvement in Key Functions or Competencies

Track, identify, and reach out to

patients with care gaps

Population Management

Provide patient-centered,

evidence-based services

Planned Care

Self-management

Support

Medication management

Behavioral Health

Integration

Provide follow-up and care outside the

office

Care Management

Referral management

Clinic-Community Connections The

QuadrupleAimsCommunication

Management

Enhanced Access

Meet patient needs in a timely

manner

Deploying MAs• LEAP practices generally build teams around fixed MA-

PCP partnerships (teamlets).• Multiple MA to provider models:

– High Plains (CO) - 3 patient facilitators per care team who rotate front and back office tasks, coordinate referrals immunizations, bring everything into the patient room

– Family Care Network (WA) – 2 clinical assistants who alternate between rooming the patient & “scribing” during the patient visit.

What does MA role expansion look like?Team Guide Assessment item-- MAs in our practice:D Mostly take vital signs and room patients.

C Perform a few clinical tasks beyond rooming patients, such as reviewing medication lists or administering a PHQ-2.

B Perform a few clinical tasks and collaborate with the provider in managing the panel (reviewing exception reports, making outreach calls, managing in-basket).

A Collaborate with the provider in managing the panel, and play a major role providing preventive care and services to chronically ill patients, such as self-management coaching or follow-up phone calls.

Newer Roles for MAsPre-visit planning

13

Reconciling medications

Scribing for providers

Participating in quality improvement work

Health coaching and motivational interviewing

Delivering or arranging preventive services

Providing telephone or in-person follow-up

How do effective practices deliver planned care?

Identify the key clinical tasks associated with evidence-based care and decide who does them.

MA reviews patient data prior to the encounter to identify needed services.

Encounters are organized so that relevant team members deliver all needed care.

How do effective practices implement self-management support?• linkages with self-management programs in the

community.Forge

• team members to provide basic self-management support. Can be MA, trained layperson, or nurse.Organize & train

• self-management support into every interaction.Build

• self-management goals and their attainment in the patient’s record.Document

How do effective practices manage medications?

• Medication reconciliation is viewed as a critical intervention for both patient and practice—often begun by MA at intake.

• Pharmacists and RNs play important roles in complex med. rec., titrating medications, and addressing non-adherence and other drug problems.

How do effective practices deliver planned follow-up and Care Management (outside of visits)

• Follow-up between office visits is a core function of the practice team.

• Care teams regularly monitor patients and promote self-monitoring.

• Follow-up can range in intensity from periodic status checks by telephone or e-mail (MA) to active care management (RN).

• Higher risk patients (poor disease control, frailty, etc.) receive regular follow-up (monitoring) AND active care management.

The steps to consistently high team performance

Build trust and communication

Identify and assign tasks

Train staff Develop standard work

IT supports work flow

Enable staff to work

independently

Build a Career Ladder

Floor coordinator

Health coach

Medical assistant

Union Health Center MA Career Ladder

http://improvingprimarycare.org/team/medical-assistant-ma#tab-2

Resource Spotlight #1

Resource Spotlight #2

Resource Spotlight #3

High Plains Community Health Center

• Located on the Plains of SE Colorado

• 120 miles from the closest mall• 40,000 Medical, Dental and

Behavioral Patient Visits per Year in a catchment area w/ 12,000 people

• Level III PCMH • Comprehensive Services including

Medical, Dental, Labs, X-ray, Behavioral Health & Health Coaching

Jay Brooke, MSW, Former Chief Executive OfficerCeCe Bohl, Medical Assistant and Quality Improvement Coordinator

Open Space for Discussion

RemindersSign up for our next webinar in this series:

The Emerging Role of Nurses in Primary CareThurs., Mar 31st, 2016 2:00-3:00 PMEST

Complete our survey!

Sign up at www.chc1.com/NCA

SpeakersFrom Community Health Center, Inc.:Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director Deborah Ward, RN, Senior Quality Improvement ManagerMary Blankson, DNP, APRN, FNP-C, Chief Nursing OfficerNatasha Quinn, Senior Medical AssistantDipak Patel, DO, Meriden Onsite Medical Director & Family Medicine Physician

From MacColl Center for Health Care Innovation, Group Health Research Institute:Ed Wagner, MD, MPH, Director Emeritus Brian Austin, Deputy DirectorKatie Coleman, MSPH, Research Associate

From High Plains Community Health CenterJay Brooke, MSW, Former Chief Executive OfficerCeCe Bohl, Medical Assistant and Quality Improvement Coordinator