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Welcome
Mark MasselliPresident and CEOCommunity Health Center, Inc.Connecticut
Board Chair, NIMAA
Team-Based Care Model The Curriculum Host Clinics Role of Preceptors A Students Perspective Strategic Steps
What We Will Cover
Ed Wagner, MD, MPH MacColl CenterWashington
Tom Bodenheimer, MD, MPH UCSF School of MedicineCalifornia
Why does NIMAA Matter?
Tom Bodenheimer, MDCenter for Excellence in Primary CareUniversity of California, San Francisco
Well-trained MAs are essential for
primary care teams
Competence
• I want my physician to have the knowledge needed to help me
Empathy
• I want my physician to care about me
Familiarity
• I want to know my physician; I want my physician to know me
Continuity
• I want to see my personal physician when I need help
It doesn’t have to be a physician. It could be a NP, PA, RN, behaviorist, pharmacist, physical therapist, or medical assistant.
What do patients want from physicians?Detsky AS, JAMA 2011;306:2500; Safran DG, Ann Intern Med 2003;138:248
Stable team structure: teamlets
Patientpanel
1 team, 3 teamlets
Clinician + MAteamlet
Patientpanel
Clinician + MAteamlet
Patientpanel
Clinician + MAteamlet
RN, behavioral health professional, social worker, pharmacist, complex care manager
Definition: stable team/teamlets
1• The same people always work together
2
• Patients empaneled to a teamlet are always cared for by that teamlet
3
• The teamlet is responsible for the health of its patient panel and only sees patients on its panel
Why should teams be stable?
1• Patients: “I want to know the people caring for me”
and “I want the people caring for me to know me”
2
• Clinicians working with the same MA every day tend to have lower levels of burnout than clinicians working with different people on different days [Willard- Grace et al, J Am Board Fam Med 2014;27:229].
3
• Research shows that patients prefer small practices. A stable team/teamlet divides a large, impersonal practice into small, comfortable units that feel like small practices [Rubin et al, JAMA 1993;270:835].
Patientpanel
Clinician + MAteamlet
Patientpanel
Clinician + MAteamlet
Patientpanel
Clinician + MAteamlet
Panel management and health coaching
MAs taking responsibilityfor panels of patients
Sharing the care with MAs:Panel Management
• Preventive care: immunizations, cancer screening (cervical, breast, colorectal)
• Chronic care: e.g. diabetes: all lab tests are done in a timely fashion
Medical assistants identify patients overdue for routine services and arrange for those services to be performed
Physician-written standing orders are needed to empower the medical assistants
Quality of preventive services improves [Chen and Bodenheimer, Arch Intern Med 2011;171:1558]
An estimated 50% of all preventive care activities could be performed by medical assistants [Altschuler et al, Ann Fam Med 2012;10:396-400]
Sharing the care with MAs:Health Coaching
Health coaching: assisting patients develop the knowledge, skills and confidence to become informed, active participants in their care [Ghorob, Family Practice Management, May/June 2013]
In RCT, patients with MA health coaches had significant drop in A1c and LDL-cholesterol compared with controls [Willard-Grace et al, Ann Fam Med 2015;13:130]
Estimated 25-30% of chronic care activities could be performed by MA health coaches [Altschuler et al, Annals of Family Medicine 2012;10:396]
For health coaching curriculum and 4 videos, see the Center for Excellence in Primary Care website, cepc.ucsf.edu, Tools for Transformation, Health Coaching
Primary Care Team
Team Structure:Major Findings from Site Visits
MA Involvement inKey Functions or Competencies
http://www.improvingprimarycare.org
Improving Primary Care
Mary Blankson, DNP, APRN, FNPChief Nursing OfficerCommunity Health Center, Inc.
Mark Splaine, MD, MSEducation DirectorWeitzman Institute
The Curriculum
Traditional ContentMedical career workforce skillsHealth, disease processes, and preventionPractice in a community health centerCore skills & Externship
NIMAA-specific ContentThe health system and communityTeam-based care (health coaching, panel mgmt)Quality improvementDeveloping as a professionalNIMAA skills
What is the content?
National CurriculumEveryone does same online workExperience at sites is also coordinated
Site-based LearningLearning specific skillsParticipating in clinic setting from Day 1Close work with preceptors and mentors
How does the curriculum work?
NIMAA ParticipantIncremental learning with hands-on clinical
application Socialization to the MA role on the care teamExplore possibilities for academic progression
What is the impact?
Host Clinic SiteOpportunity for existing staff to solidify
commitment to train the next generationEnhances current QI activityEnhances current staff development
programming
What is the impact?
NationallyCreates a knowledge network between centersPromotes a new standard for MA educationEnhances the interprofessional collaborative
practice team
What is the impact?
Tillman Farley, MDChief Medical Officer Salud Family Health Center
Teri Brogdon, M.Ed.Education and Training Design DirectorSalud Family Health Center
The Role of the Host Site
Train students to your center Hire students that you knowReduce training costsIncrease efficiencyImprove care to your patientsImprove the health of your community
What are the benefits for a host site?
Commitment to the PCMH team-based healthcare delivery model
Recruit and select students Identify staff to be trained as preceptors Support the training model Communicate with NIMAA Help graduating students find a job
In the communities you serve!
Key Expectations of Host Site
Skills based learning
– students are helpful from day 1 Students are assigned a weekly skill to practice Students are not assigned to an individual MA Every skill is taught, then repeated until
mastery No lost opportunities for practice
NIMAA Additive Skills Training Model
Productive
Effective
Limited
Graduation
Orientation
NIMAA Additive Skills Model
Provide curriculum and content Provide on-line training Playbook to guide the host clinic Preceptor trainings and support Technical assistance
NIMAA Role in Supporting The Host Clinic
Recruitment of students Identifying a NIMAA liaison/Site directorReleasing preceptor time for trainingInvolvement in skills training each weekProviding evaluations and feedback to NIMAAHelping students find a job after graduation
What are the costs for a host site?
NIMAA host clinics transform health care, one MA at a time!
Natasha Quinn Senior Medical AssistantCommunity Health Center, Inc.
The Role of Preceptors
Role of the Preceptor
Training NIMAA Participants
Benefits of being a Preceptor
The Role of the Preceptor
Jenn DepreyNIMAA’s Pioneer ClassCommunity Health Center, Inc.
A Participant’s Perspective
Differences between NIMAA and standard MA education models
NIMAA provides a better way of learning
Working in Team-Based Care
A Participant’s Perspective
David AylwardNIMAA Project Lead
What’s Next?
Characteristics of a NIMAA Host Clinic: Strong support and involvement of top leadership Share NIMAA’s dual goals: better care through trained workforce; better student
careers Implementing model of care where MAs are becoming key members of the PCMH
team
NIMAA Provides to Host Clinics: Experienced faculty and Instructional staff: regular live, taped lectures and discussions Complete online curriculum and program with textbooks, supporting IT systems Preceptor training program, with guidance for teaching and measuring specific
traditional and PCMH skills; available to all staff during Phase II Support for host clinic leader and preceptors Manage all enrollment, grading, certification and grievance issues.
Phase II “Get”
Responsibilities of a NIMAA Host Clinic: Interview, help select, host MA candidates for the 7 month training
session Appoint a NIMAA program leader Select qualified preceptor for each medical assistant candidate Host candidates 4 hours daily as they assist a care team and learn
from preceptors Organize weekly coordination and feedback meeting for candidates Support NIMAA in obtaining state teaching licensure Provide feedback Pay tuition
Phase II “Give”
Survey for all of you What are your pain points? Interests in workforce development?
NIMAA Host clinic for full Phase II program (9/17) Host clinic for full Phase III program (4/18) Contributor to program content Upskill existing staff: apprentice programs
Other workforce development/transformation training
Next Steps Pathways
February: Fill out survey February: Conversations Early March: Virtual workshop April and May: Selection of Phase II partners June and July: Recruit and qualify students Summer: Host clinic selects, NIMAA trains site lead
and preceptors July and August: Select students September: Training begins
NIMAA Full Program Phase II
Any Questions?
Contact us:[email protected]
Thank you for attending!