QUALITY IMPROVEMENT STRATEGIES FOR ENHANCING CARE COORDINATION WITH SPECIALISTS Lisa M. Letourneau, MD, MPH November 4, 2011.

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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