Spread of The Planned Care Initiative at NPN

1
Spread of The Planned Care Initiative at NPN

• Cathy Irby, Mgr QI Initiatives
• Jean Gambrielle, Mgr Credentialing,
• Kelly LaRue, RN
• Shari Peterson, RN
• Jim Strawn, IT
• Liana Pence, BA
• Community Health Improvement Coordinator

2
Northwest Physicians Network

• Independent Physicians Association with 400
  members. South King and Pierce Counties
• Pay claims for Managed care products
• PacifiCare Secure Horizons and Commercial
• Molina Healthy Options
• Savings from these lines of business created the
  Quality Improvement Dept at NPN in 2001
• Initiatives Value Add for Providers
• Chronic Care Improvement registries in 20
  offices

3
NPN QI Staff Grew

• Rick MacCornack Jan. 2001
• Cathy Irby Sept. 2001 .8 FTE
• Jean Gambrielle Oct. 2003 .2 FTE
• Jim Strawn, IT Oct. 2003 PRN
• Kelly LaRue, RN Dec. 2003 .2 up to .4 FTE
• Shari Peterson, RN Sept. 2005 .2 FTE
• Liana Pence Oct. 2004 PRN

4
Spread - 1,969

• Wilson 173 1/02
• Kennel 299 2/02
• Vance 135 3/02
• Morgan 121 5/02
• Scherbarth 264 5/02
• Samms 68 9/02
• Craddock 72 9/02
• Harris 21 9/02
• Alleman 131 7/03
• Roscetti 113 7/03
• Ziemann 85 7/03

• Millik 60 3/04
• Roes 145 7/04
• Smith 32 1/05
• Lamba 54 8/05
• Dacus 12 9/05
• Fircrest 163 9/05
• Braun 9 9/05
• Lukens 12 about to install
• Leverett new 11/05
• Jin 2003-8/04
• Allchin 95 retired 11/05

5
Persuasions for Adopting this change

• More control
• Increase job satisfaction
• Empowerment
• Reduce faxes
• Looking forward to the future in different areas.
  Offering new procedures and tools.
• Most important, better care for patients

6
Independent PCP Personality

• Autonomous The final say in matters, they
  think. (Staff often control decisions.)
• Very protective of what they feel is working.
  If it isnt broken, why fix it.
• Very protective of staffs time.
• Very thoughtful in their decisions. They do not
  have committees to go to.

7
Independent PCP Personality

• Highly value control money, time and
  decisions.
• Resentful of recent changes. They went to school
  a long time and they deserve better from
  insurance, hospitals etc.

8
Independent PCP Personality

• Advice, outside ideas or programs
• Even for the right reason (patient care)
• With tools they are unsure of (computers and a
  different kind of work) and
• Not reimbursed for, from anywhere besides the
  government (i.e. mandates)
• NOT TAKEN WELL.

9
Value Added

• More appointments generated
• More control given back to providers and staff
• Improve flow of information reduce faxes
• Improved job satisfaction with less turnover
• Overall health of patients is improved
• Less time involved in gathering information

10
Spread First Steps in Offices

• Build registry with NPN staff
• Establish route within the office of the flow
  sheet
• Best place in chart
• Filling out of flow sheet
• Queries driven by summary reports
• Appointments/Planned Visits

11
Office Changes

• Schedule must project at least 6 months ahead to
  accommodate f/u visits
• Not scheduled just as f/u but chronic condition
  specific.
• Meds by Appointment
• Reduce faxes
• Reduce triage phone calls for med refills
• Save 2 hours/day tracking charts down and phone
  tag
• Providers are not the only ones who can have
  patient appointments

12
Information Technology (IT)

• Computers are just a tool like anything else.
• Spirometry, EKG, Scheduling
• Individual charts do not give aggregate
  population based data.
• Its a tool to find who is being missed.
• NPN IT staff are not practices employee
• Standardization vs. customization of forms

13
Lessons

• Focus on simplicity and practicality
• Patient Education component
• Staff turnover
• Staff and or provider running a race without a
  finish line, no time
• Staff meetings and communications

14
Lessons

• Support staff vs Mentor to staff
• Outside IT staff is another layer to deal and
  navigate around Physician or OM to direct IT
  for importance of work.
• Take time to make time If you plan a trip its
  more enjoyable.
• Abstracting chart vs. inputting from filled out
  flow sheet

15
Patient Education, Preparation and Expectation of
Outcome of Appt.

• Starts with person making appointments
• Specific follow up appointments
• 15-30 minute concentrated appt.
• Moving away from feeling rushed provider and
  patient.
• More benefit for both provider and patient from a
  focused appointment.

16
Spread

• Group Visits 2003 (3)
• TCC students for intermittent data entry
• Quest interfaces
• Labs NW interface
• Join existing or initiate staff meetings
• Diabetes classes at NPN targeting different
  office registries (4)

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Goal

• 50 PCP registries by 2008
• Begin adding second conditions
• Specialists registries
• Asthma registries
• Offices independent with data entry and using
  reports and queries