the harvard vanguard medical associates lead story
TRANSCRIPT
The Harvard Vanguard Medical Associates LEAD Story
Continuously Building Upon Innovation….
Pt. Centered Med. Home Shared Med. Appts. Leadership Academy
Lean Process Clinical Innovation
EngagementCell Med
LEAD
Patient Centered
Care
Model Clinical
Unit
Since HCHP opened the doors in 1969, we have a strong history and culture of innovation…with an emphasis on thedelivery of highquality care
Hypothesis for Health Care Transformation
Payment & Coverage Reform (Finances/Economics)
Redesign Clinical Care Delivery (Care Model Paradigm)
Transformational Change in Health Care
Engagement of Multiple Stakeholders
+
+
=
Clinical Outcomes Goals
Measurably improve outcomes of our patients with:
(1) Obesity
(2) Cardiovascular Risk
– Hypertension / Diabetes / Dyslipidemia /Tobacco Use
(3) Depression
The Case for Redesigning Ambulatory Care
Schroeder S. N Engl J Med 2007;357:1221-1228
The Case for Redesigning Ambulatory Care
Pre-visitPost-VisitVisit
Between Visits
Between Visits
Patients’ behaviors are most critical determinant of health.
Patients’ behaviors are most costly determinant of health care.
Engage patients in healthful behaviors
The ‘3rd Paradigm’ of Care & Between Visit Care
Hospital Clinic Home/Work/Play (1st Paradigm) (2nd Paradigm) (3rd Paradigm)
Late Stage & Acute Care
High Complexity
High Cost
Less patient participation
Early & Mid Stage of Care
Less Complexity
Less Cost
Moderate patient participation
LEAD
Changes in Pre-Visit, Visit & Post-Visit
• Pre-Visit
– Labs
– Demographic & PCP Verification
– Medication Reconciliation & Health Maintenance Update
• Streamlined & Service-oriented Check-in Process
– Included improvements to the “late patient” process, printed receipts, insurance
card scanning, welcome packets for new patients, kiosks…
• Visit
– Medical Assistant Medication Reconciliation & Allergy Verification
– Use of “walkie talkies” for clinician-MA handoffs
• Post-Visit
– After Visit Summary (also available on MyHealth)
– Care Coordinator Role
– Cross-booking into specialty appointments & radiology
Health Risk Assessment Tool
• Administer behavioral risk assessment at all physicals
– Physical Activity 58% sedentary
– Depression 33% dysthymic or depressed
– Nutrition 74% risky nutritional behavior
• Provide EPIC supports to document plan of care
• Deliver personalized, written instructions after patient visit
• Match patient to appropriate treatment option
• Monitor progress between visits
Clinical Outcomes Interventions
• Prescriptions for Healthy Living
• Health Coach
• Virtual Nutritionist
Use of the After Visit Summary: 2008AVS use: CHE, MFD & HVMA
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SEP OCT JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC
Months
% o
f FTF
Enc
ount
ers
CHE IM-A CHE IM CHE MFD IM MFD HVMA
MyHealth Enrollment
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
SEP OCT NOV DEC JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC
Month
Perc
ent E
nrol
lmen
t
CHE IM-A CHE IM CHE MFD IM MFD HVMA
13
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Weight LDL SBP DBP A1c
Team A
Team C
LEAD Clinical Outcomes
0.420.170.091 0.0420.5P Value =
14
LEAD principles, approaches to change,
operational processes and clinical tools
have become integrated and infused into
Harvard Vanguard Medical Associates . . .
Transformation & Sustainability
15
LEAD and HVMA 2009 Strategic Goal Development
· Engagement Process
· Rapid Prototyping Process Improvement
Approach
· Improvement and Innovation
LEAD Initiatives HVMA 2009 TacticsApproach
New Care TeamCheck-in / Check-outClinical OutcomesAgreements of Belonging
Patient Centered Medical Home
Check-in / Check-outQuick FixLean process Improvement
Shared Medical Appointments Pilot
Agreements of BelongingEngagementLeadership Academy/ Training
Site-based Councils
Shared Medical Appointments Program
Team and Lean Process Improvement
Check-in / Check-outVisit Efficiency
Epic Optimization and Workflow Efficiencies
Lean Process ImprovementCheck-In / Check-OutAgreements of Belonging
Rescue and Re-allocate
Charles HandyThe Age of Unreason
The future we predict today is not inevitable. We can influence it, if we know
what we want it to be…
We can and should be in charge of our own destinies in a time of change.
Reflections . . .