Download - Practice Transformation
Practice Transformation
Thriving in a Time of Change
Stephen Weeg
A fundamental redesign of the organization’s:
Mission, vision, and strategic goals Organizational responsibilities and roles Policies and procedures Care processes Use of data Relationships with patients and community
Transformation
Six clinics (1 urban, 5 rural) in southeast Idaho
located within a 50 mile radius 5 of the 6 have a single medical provider each
day; Pocatello has 3-4 providers per day. 9,000 patients with 31,000 visits annually 45% Uninsured Annual budget: $3.5 million Migrant and community health center; 2 sites
serve over 60% Hispanic patients
Health West Background
Strategic Position
Patient Care
Staff Satisfaction & Empowerment
Financial Advantage
Why PCMH
Meeting HRSA Program Requirements UDS Clinical and Financial Indicators Seeing patients Fiscal stability Meaningful Use, Affordable Care Act & politics Changing healthcare environment Tyranny of NOW
Challenges
Before PCMH
Safety Net Medical Home Initiative: July 2009 Team-based care & huddles: 2009 EMR: December 2009 Empanelment, Data, Position redefinition: 2011 New mission: 2011 NCQA Site Recognition: March – July 2012 Embed and strengthen roles: 2012 Meaningful Use Incentive: 2012
Health West Journey
After PCMH
56 yo diabetic female suffering from obesity
and depression. She had a poor self image and lacked motivation to make changes. Her primary care provider reviewed with her all aspects of her current situation including her current lab work, medications, goals, feelings towards her current health, and more…”
Patient Impact
Over the next two months, and with a little
encouragement, she was able to do the following: Meet with our health educator and mental health
counselor Adjust to a better medication regimen Begin a regular exercise program and improve her
diet, helping her shed 6 pounds, have more energy throughout the day, have longer, more restful sleep, and improve her mood
Move forward in her life with help of the counselor
Patient Impact
“The very best part of the Patient Centered
Medical Home is that the patient gets, better, more effective care than ever before, and the provider, because everyone is working as a team, can deliver this care with even less effort than before. More for less—you can’t beat that!” Mark Horrocks, MD, Medical Director
Provider Impact
“With Team-based care, we can better anticipate our
patients’ needs when it comes to medication refills, scheduling lab work, and setting up for an office visit, etc. Plus, our patients’ needs are better served. I also feel that I can work more comfortably with my provider.” RH, LPN
“Team-based care helps our patients by giving them a support group and the exceptional care they need. They are always followed up with and have a medical team they can count on to help with their needs. “ MP, Receptionist
Staff Impact
Elements of Success
Vision
Focus
Team Focus
Technical Assistance & Support
Humor
Organizational Engagement & Leadership
Passion
Persistence
Data
This is the kind of care that wewould
want for ourselves and for the persons we know and love. It is the
right way to care for the whole person.
Why Become a Patient Centered Medical Home?