Team Presentation Developing a Cross-Disciplinary Medical Home Team

1. Team Presentation Developing a Cross-Disciplinary Medical Home Team Pediatric Associates – Miami Beach Learning Session 2 April 27-28, 2012

2. Disclosure I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

3. Pediatric Associates – Miami Beach 4308 Alton Rd. #710, Miami Beach, FL Our Practice sees approximately 10,148 children annually 40% Medicaid, 51% Private Insurance, 5% Self pay, 4% other

4. Aim Statement Developing a Cross-Disciplinary Medical Home Team is critical to meeting our goals. We began our team meetings on September 14, 2011 and committed to meet formally with the entire team at scheduled times. Beginning in November 2011, the team began to do daily “informal” huddles and has continued this as part of their daily routine. Our original primary AIM was to provide a medical summary/ comprehensive care plan to 90% of our patients. In August 2011 we were at 0% and by March 2012 we were able to achieve above our goal at 100 % because of improved communication in meetings and the office team’s daily huddles.

5. Changes we made to get results We initially tried to have a scheduled weekly meeting with the entire office team but found it very difficult to get the entire team together or to keep the scheduled time. PLAN / DO / STUDY ACT - Round #1 We revised our plan to consider an every two week meeting Meetings were scheduled, but this was, again, too difficult to accomplish. PLAN / DO / STUDY ACT - Round #2 Our next test was to have a scheduled monthly office team and core team meeting, but staff were to identify a flexible time each day to have a huddle. The scheduled meetings were accomplished on a monthly basis. This meeting focused on our performance and higher level discussions Having flexibility with the daily huddle timing actually facilitated success. These meetings were patient level discussions and planning for patient flow. Our compliance, with giving Medical Summaries/Comprehensive Care Plans was facilitated by the dual meeting structures and our scores were improving.

6. Results to Date

7. Reflection We learned we needed: To allow the meetings to occur informally if we wanted them to have any regular frequency. To assign a huddle champion who was responsible for making sure the huddles occurred. To still identify at least monthly meetings where we could discuss more formally our performance, goals, and the PDSA cycles. We identified that we still need to: Use the huddle to address specific content, like engaging patients and eliciting their secondary concerns at each visit.

8. Reflection One of our initial assumptions which turned out to be invalid was that we had so many systems in place that PCMH would be an easy transition. One assumption we had when we started that held true was that a PCMH Champion (i.e. MA Case Manager) is invaluable to the success of this project.

9. Be persistent and ready to make changes. Team leaders must be committed to making time to meet with staff & celebrating even the small positive changes. Make sure everyone is heard and develop a consensus. Each meeting should end with a recap in order to engage the team: Finish with “Areas where we need your help”. We know this is good advice because when we started to regularly practice this, we made significant improvements. Advice

10. We are wondering if next we should… Evaluate our huddle content to see if we can improve how and what we are communicating. Develop some redundancy in our PCMH Champion role to account for when key individuals are absent from the office.