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Quality Improvement Strategies for enhancing Care coordination with Specialists

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 practices

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Quality Improvement Strategies for enhancing Care coordination with Specialists

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  1. Quality Improvement Strategies for enhancing Care coordination with Specialists Lisa M. Letourneau, MD, MPH November 4, 2011

  2. Objectives • Discuss interactions among integrated care team, patients and specialists • Share best practices • Problem-solve on ways to improve shared treatment planning, care coordination

  3. The Medical Home: A Model for Change! Employers & payers pay for desired services because providers demonstrate value AND reduce spending = Payment Reform Providers transform practice, create value with viable & sustainable payment for desired services = Practice Transformation AND

  4. “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

  5. The Wider “Neighborhood”

  6. 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

  7. 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

  8. Reality Referral and Consultation CommunicationBetween Primary Care and Specialist Physicians Perception 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 • 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

  9. Trust Mutual respect Safe Leveraged services Safe environment Agreements Communication “Neighborly” Characteristics

  10. Primary Care - Behavioral Health Referrals “Unique” challenges: • Widely dispersed network • Variable availability • Psychiatrists, psychologists – limited • LCSWs, MSWs, LCPC,… - many! • Limited information on effectiveness • Confidentiality concerns

  11. 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?

  12. Primary Care - Specialty Care Collaborative Guidelines • Purpose and Principles • Definitions • Types of Care Transitions • Service Agreements • Transition of Care • Access • Collaborative Care Management • Patient Communication • Transition of Care Records (PCP and Specialist)

  13. Primary Care - Specialty Care Compact Types of Care Transition • Pre-consultation exchange • Formal consultation • Co-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)

  14. Primary Care – Specialist Service Agreement

  15. PCP Toolkit Example

  16. Specialist Toolkit Examples • PCMH “Identifier” • Specialty Provider Checklist

  17. 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?

  18. Making Forward Progress • “I’ve got it, too, Omar…a strange feeling like we’ve just been going in circles.” • The Far Side

  19. www.mainequalitycounts.org

  20. Contact Info / Questions • Lisa Letourneau MD, MPH • LLetourneau@mainequalitycounts.org • 207.415.4043 • Maine PCMH Pilot • www.mainequalitycounts.org (See “Programs”  PCMH)

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