quality improvement strategies for enhancing care coordination with specialists lisa m. letourneau,...
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QUALITY IMPROVEMENT STRATEGIES FOR ENHANCING CARE COORDINATION
WITH SPECIALISTS
Lisa M. Letourneau, MD, MPH
November 4, 2011
Objectives
Discuss interactions among integrated care team, patients and specialists
Share best practicesProblem-solve on ways to
improve shared treatment planning, care coordination
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The Medical Home: A Model for Change!
Providers transform practice, create value with
viable & sustainable payment for desired
services
= Practice Transformation
Employers & payers pay for desired services
because providers demonstrate value AND
reduce spending
= Payment Reform
AND
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“It Takes a Village”
Medical Home model is also about relationships
The effectiveness of the PCMH model to promote integrated, coordinated care throughout the healthcare system depends on the availability of a “hospitable and high-performing medical neighborhood.”
Elliott Fisher MD, MPH, NEJM, 2009
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The Wider “Neighborhood”
Payers
Pharmacies
Home Care
HealthMane
PartershipsSpecialists
NursingHomes
Home Health
Hospitals/Hospitalists/
CareManagers
Employers
Primary Care Providers
PatientCenteredMedical Home
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Reality of Care Coordination
The typical primary care physician has 229 other physicians working in 117 practices with which care must be coordinated. Pham et. al Ann Int Med. 2009
In the Medicare population, the average beneficiary sees 7 different physicians and fills upwards of 20 prescriptions per year Partnership for Solutions, Johns Hopkins Univ. 2002
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The Neighbors
• Consistently voice concerns about referral information they receive
• Often believe they are currently meeting primary care expectations
• Have wide variety of practice capacities & infrastructure
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Referral and Consultation CommunicationBetween Primary Care and Specialist
Physicians
PerceptionPerception
PCPs: 69.3 % reported they "always" or "most of the time" send notification of patient's history and reason for consultation to specialists
Specialists: 80.6 % said they "always" or "most of the time” send consultation results to the referring PCP
RealityReality
Specialists: 34.8 % said they receive info from PCPs "always" or "most of the time
PCPs: 62.2 % reported getting info from specialists "always" or "most of the time”
Arch Intern Med. 2011;171(1):56-65
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“Neighborly” Characteristics
TrustMutual respect SafeLeveraged services Safe environmentAgreementsCommunication
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Primary Care - Behavioral Health Referrals
“Unique” challenges:Widely dispersed networkVariable availability
Psychiatrists, psychologists – limited LCSWs, MSWs, LCPC,… - many!
Limited information on effectivenessConfidentiality concerns
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Small Group Exercise - #1 (15 mins)
How effective are referrals for your patients? How do you know?
What is happening in your community that might impact referral/coordination processes?
How does practice ensure that behavioral health is addressed/coordinated when referring to non-behavioral health providers?
How do you identify, address, and communicate patient goals for specialty consultation?
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Purpose and PrinciplesDefinitionsTypes of Care TransitionsService Agreements
Transition of Care Access Collaborative Care Management Patient Communication
Transition of Care Records (PCP and Specialist)
Primary Care - Specialty Care Collaborative Guidelines
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Primary Care - Specialty Care Compact
Types of Care Transition Pre-consultation exchangeFormal consultationCo-management (Referral)
With Shared management With Principle Care of the disease With Principle Care of the patient
Complete transfer of care (Specialty Medical Home Network)
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Primary Care – Specialist Service Agreement
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PCP Toolkit Example
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Specialist Toolkit ExamplesSpecialty Provider Checklist PCMH “Identifier”20
Small Group Exercise - #2 (15 mins)
Considering PCP-Specialist Toolkit,what can be done in your practice (redesign/QI strategies) to improve specialty referral process?
What can be done to improve coordination of care following specialty referrals?
Are there specific steps that could be taken to improve behavioral health referrals?
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Making Forward Progress
“I’ve got it, too, Omar…a strange feeling like we’ve just been going in circles.”
The Far Side
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www.mainequalitycounts.org 23
Contact Info / Questions
Lisa Letourneau MD, MPH• [email protected]• 207.415.4043 Maine PCMH Pilot• www.mainequalitycounts.org
(See “Programs” PCMH)
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