2011 AMGA Annual Conference

Care Process Improvement

This track is dedicated to sharing innovations developed by healthcare organizations for improving health outcomes, lowering the cost of care, and increasing patient and provider satisfaction. Healthcare leaders and directors involved with quality management should attend these sessions, hear about the solutions, and build upon these innovations by continuing the quality improvement cycle at their organizations.

Friday, 2:00 p.m. - 3:15 p.m. Transforming Primary Care: Designing the Plane While Flying
Beth Averbeck, M.D., Associate Medical Director, Primary Care; and Joan Flaaten, R.N., Regional Clinic Director, Primary Care, HealthPartners Medical Group

HealthPartners Medical Group (HPMG) is re- engineering its ambulatory care delivery. Providing population-based health care focused on patient choice, convenience, and care coordination has yielded improved results in both health and experience outcomes for patients and satisfaction for physicians and clinical staff, while lowering the total cost of care. The presenters will discuss innovations in care delivery that are occurring in a fee-for-service payment system, including the use of a convenience package of services for patients, the ability to manage complex appointments, and coordination of care between hospital and specialties. They will demonstrate care models that are more patient-centered while providing more efficiency for physicians and provide an introduction to a new clinic model that offers integrated care with a physician and a chiropractor with an emphasis on healthy lifestyle.
Upon completion of this activity, participants should be able to describe how practice transformation contributes to the achievement of Medical Home recognition; identify how a capacity assessment can be used to diagnose the need for additional or different work; identify innovations that can positively impact a fee for service payment system; develop a structure to provide process "upgrades" as part of ongoing primary care redesign; and utilize improvement tools such as a Visit Cycle Template to improve performance and outcomes.

Friday, 2:00 p.m. - 3:15 p.m. Physician Office-Based Health Coach Training
Kelly Taylor, R.N., M.S.N., CCM, Director of Quality, Mercy Clinics, Inc.

Mercy Clinics will share an abridged edition of Physician Office-Based Health Coach (POHC) training which has evolved over the past five years into a certification program. Nationally, more than 100 forward-thinking, certified POHCs put patients and quality measures first. Of the 100 coaches trained, 75 represent clinics and systems from across the nation. In large part, the coaches and their teams helped Mercy Clinics, Inc. become recognized nationally for Best Practices in Diabetes Care by the NCQA and ADA, and to receive the 2008 AMGA Acclaim Award. The presenters will also discuss PDSA models, self-management support, and managing a disease registry as keys to success.
Upon completion of this activity, participants should be able to summarize key elements in Physician Office- based Health Coach training; and develop their own SMART goal for themselves personally or for QI in their clinic.

Friday, 3:45 p.m. - 5:00 p.m. Flowing with Boeing: How the Virginia Mason Production System (VMPS) Provided a Foundation for Success in an Advanced Medical Home Program
Carolyn Cone, Strategic Initiatives Director, Department of Primary Care; and Ingrid Gerbino, M.D., FACP, Deputy Chief of Primary Care, Virginia Mason Medical Center

This presentation will illuminate how application of the Virginia Mason Production System, and specifically "just-in-time"/flow provided a foundation of quality and safety in adult primary care clinics. With this foundation in place, VMMC was able to deliver successfully on an advanced medical home model for employees/dependents of a large local employer (Boeing) and achieve a 53 percent reduction in predicted healthcare spending for the employer. The presenters will demonstrate the application of "flow" in many forms in VMMC's primary care clinics, and the resulting gains in quality and safety; will outline the details of the innovative advanced medical home/ambulatory intensive care program and outcomes achieved; and will propose alternative finance models to sustain innovative and successful provision of primary care.
Upon completion of this activity, participants should be able to describe the VMPS Seven Flows of Medicine© as they pertain to quality and safety in adult primary care clinics; discuss an integrated group practice's strategy to partner with a large employer to create an advanced medical home programs for employees at risk for high healthcare spends; and identify the economic considerations for a sustainable primary care medical home delivery system.

Friday, 3:45 p.m. - 5:00 p.m. The AMG Integrated Care Network; Foundation for an Accountable Care Organization
Tarek Karaman, M.D., M.B.A, FHM, Hospitalist Program Director; and Judith Heyworth, M.D., C.M.D., Geriatrics Program Director, Advocate Medical Group
Through a highly coordinated structure, dedicated staff, and leadership, the Advocate Medical Group (AMG) hospitalist program was able to achieve stellar results in providing high-quality care and substantially decreased cost of hospitalization. This structure and coordination of care is a significant attribute to the creation of an Accountable Care Organization. The structure of the AMG hospitalist program will be shared, including the design of the physician compensation model, and the alignment built into this compensation model. This presentation will also elucidate the coordination of care expectations and processes implemented within the program, how case management support needs are met, and how parallel Skilled Nursing Facility program developed as part of AMG's continuum of care.
Upon completion of this activity, participants will be able to describe specific tools and processes which will lead to success in decreasing hospitalization costs while improving quality of care; and describe how specific, coordinated communication expectations among teams of hospitalists, skilled nursing facility clinicians, and primary care physicians add value and drive their organization towards success.

Friday, 3:45 p.m. - 5:00 p.m. Bending Lean to Facilitate Accountable Care and the Pursuit of Demonstrated Quality
Jeffry G. James, Chief Executive Officer; and Jonathan Hines, M.D., Chief Medical Officer, Wilmington Health

Traditional Lean does not drive change at the speed necessary to keep up with the current demands of the healthcare industry. This presentation is designed to demonstrate how Lean thinking can be modified to accelerate a flight to quality and ultimately drive culture and profitability in ACOs and multispecialty group practices. Examples will be given demonstrating that using evidence-based medicine to improve quality of care can also drive revenue in the group practice model and how quality improvements can be used to fund process improvement.
Upon completion of this presentation, participants should be able to describe how Wilmington Health is modifying the approach to Lean implementation to better comport with the changing healthcare paradigm; explain the difference between a standard Value Stream and a Quality Stream; and use Lean to rapidly demonstrate quality, reduce cost, and improve patient satisfaction.

Friday, 3:45 p.m. - 5:00 p.m. Emergency Response Care in the Ambulatory Setting: The First Ten Minutes
Chantal Girod, M.D., Family Practice Physician, and Jennifer Kuroda, Quality Improvement Coordinator, SwedishAmerican Health System

Patient safety and quality of care are always a priority. This presentation focuses on emergency response care during the first ten minutes in ambulatory care settings. Emergency Response Care in the Ambulatory Setting: The First Ten Minutes was developed at SwedishAmerican Health System to help staff in the ambulatory care setting increase patient safety and quality of care and to address the number of emergent situations that had been identified in the clinics through anecdotal reports and data analysis. Clinic staff, who are not emergency care experts, had to learn to manage emergencies before ambulance arrival to ensure patient safety and quality of care. The presenters will describe how the organization implemented the training and measured its success.
Upon completion of this activity participants should be able to determine what steps they can take to improve patient safety and quality of care in emergent situations that occur in ambulatory care settings.

Saturday, 11:00 a.m. - 12:15 p.m. Medical Groups and CG-CAHPS: A Shotgun Wedding? Testing E-Mailed vs. Mailed CG CAHPS
Steven Bergeson, M.D., Medical Director Quality; and Cheryl Hermann, R.N., Vice President of Operations, Allina Medical Clinic

Patient-centered care requires feedback from patients to clinicians. Allina Medical Clinic (AMC) was part of a statewide pilot of the Clinician and Group CAHPS (CG-CAHPS) survey, a standardized tool developed by AHRQ to measure patient perceptions of care provided by a physician in an office setting. It is a validated survey, but costs of feedback at the clinician level are prohibitive. AMC began exploring the use of an electronic version of the survey and sought answers to essential methodological questions. This presentation will explore how different patient populations respond to electronic surveys, whether clinics get less reliable feedback if they move away from mailed surveys, how clinics should crosswalk historical data with that collected electronically, and other issues regarding converting to an electronic survey.
Upon completion of this activity, participants should be able to discuss the current trend in Minnesota to require the assessment of patient satisfaction statewide, using CG CAHPS and the implications for costs and quality Improvement; describe the results of a test of electronic vs. mailed CG CAHPS survey in the Allina Medical Clinic, and use these results to prepare their organization for the future of electronic patient satisfaction surveying; and delineate the differences between versions of CG CAHPS (visit-based survey vs. once a year) and implications for performance improvement.

Saturday, 11:00 a.m. - 12:15 p.m. Lean Facility Design as an Agent of Organizational Change for the Future of Ambulatory Care
Randall D. Huss, M.D., Division President; and Gerald Dowdy, M.H.A., Vice President, Operations, St. John's Clinic-Rolla Division; Whitney Churchill, Design Manager and Dan Garofalo, Vice President of Business Development, The Neenan Company

Using the acclaimed and highly innovative St. John's Clinic-Rolla facility as the kickoff for discussion, the presenters will describe how the Lean facility design served to drive Lean process improvement and a new model of patient-centered care. Presenters will provide one-and-a-half-year follow-up data, including voice of the customer surveys, patient satisfaction, call center metrics, provider feedback, and lessons learned. An emerging national trend in healthcare organizations utilizing Lean facility design, as well as results that can be obtained, will be discussed.
Upon completion of this activity, participants should be able to discuss application of Lean principles to ambulatory facility design in order to achieve operational and construction cost efficiencies made possible by the capabilities of a robust electronic health record and Lean workflow redesign; describe how the Lean facility design process can serve as a catalyst to Lean process improvement and developing a new model of patient-centered care for the future of ambulatory care; and implement Lean principles of facility design to drive lean workflow redesign and patient-centered care for upcoming building projects in their organizations.

Saturday, 2:00 p.m. - 3:15 p.m. The Patients and Families as Partners Program: A Tool Kit for Advancing Patient- and Family-Centered Care
Joe Bianco, M.D., Chief, SMDC Regional and Neighborhood Clinics; Amy Vanderscheuren, Coordinator of Patient- and Family-Centered Care; Mary Jackson, Lead Patient and Family Partner, Essentia Health - East Region

Increasingly, institutions are practicing patient- and family-centered care. As part of its strategic implementation of the patient- and family-centered care philosophy, Essentia Health, formerly SMDC, has created a program that successfully engages patients and family members as partners across the healthcare system. The presentation will include an overview of the patient- and family-centered care principles and an explanation of the development and practical application of a program that engages patients and family members as advisors, mentors, and educators as a means to changing behaviors and advancing the patient- and family-centered care culture.
Upon completion of this activity, participants should be able to define patient- and family-centered care and recognize its four core concepts; identify the benefits and understand the value of engaging patients and family members as partners; develop tools to recruit and vet patient and family member partners; develop staff and volunteer training materials; implement assessment and evaluation tools; and describe how the Patients and Families as Partners program is a vehicle to, ultimately, change core behaviors and advance a culture of patient- and family-centered care.

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