Advanced Access Patient Centered Redesign

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Advanced Access Patient Centered Redesign

• Clinica Family Health Services - Colorado

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Clinica Family Health VISION

• Every low income and other underserved person in
  our service area will have access to high
  quality, primary health care.

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Need in Service Area

• 487,000 People (1 in 10 Coloradans)
• 115,000 Low income
• 76,000 Uninsured

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Clinica Campesina

• 145,000 Medical visits
• 37,000 Medical patients
• 4,000 dental visits
• 1,700 dental patients
• 3,000 pregnancies 2,000 deliveries
• Comprehensive Primary Health Care
• 20 FTE FPs, 22 FTE NP/PA, 4 OB/Gyn,
• 0.6 Pediatrician46.6 Clinician FTE

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Clinica Patient Population

• 50 uninsured
• 40 Medicaid
• 5 CHP
• 56 lt Poverty
• 98 lt200 of Poverty
• 91 women and kids

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Deal with the DevilThe Access Imperative

• Either provide acute care to nearly every
  underserved person or comprehensive preventive
  care to half as many.
• Define panel size so that access can be assured
  for enrolled patients
• With a capacity/demand match, there is no reason
  to impose waits for visits.
• With Advanced Access no-show rate dropped from
  34 to 8, now at 10
• Improved outcomes.

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Determining Panel Size

• Panel patients seen in 18 months
• 1,200 is approximate number of patients one
  clinician can see in 18 months given our schedule
  (19 slots per day) and visits per user per year
  (3.8 4.0)
• Individual provider panel sized adjusted by
  gender and age of patients and our utilization
  experience

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2 Access-Quarterly Panel Report
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What is Advanced Access?

• Each provider will see all their own patients who
  want to be seen today..today!
• We have the capacity to do the work today for our
  ESTABLISHED PATIENTS
• Demand decreases when access improves
• New patients can be gradually added in this
  opening capacity
• Continuity is maximized

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Principles of Designing Advanced Access

• Do todays work today and plan for the future.
• Accomplish as much as possible during each
  patient visit.
• Collaborate with your team to do phone follow up
  rather than brining the patient in.
• Avoid recheck appointments unless necessary.
  Consider scheduling a recheck appointment as a
  nurse visit.
• Plan around call, leave and vacations
• -Discuss planned vacations and call in advance
  with your team.
• -Check out patients with unresolved issues to
  team members.

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Principles of Designing Advanced Access

• -Schedule chronic disease patients around seasons
  of increased demand and leave.
• -Plan how you will schedule patients the week you
  return from vacation or call. Involve the nurse
  and your team.
• -Work with your team to manage your patients
  while you are on call or during your
  administrative days.
• -Plan group visits with your team when there will
  be increased demand or decreased supply (provider
  support).
• -Use the huddle to plan ahead and educate your
  team about your needs and the patients needs.
• -Plan around busy times of the year, ie August,
  Flu season and Spring Break.

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How to get to advanced access

• Demand Analysis
• Number of calls
• Triage Volume
• Panel Size Analysis
• Unnecessary backlog
• Is schedule being used as a reminder system?
• Set scheduling guidelines
• Minimize appointment types/times
• Minimize appointment rules
• Strategize how to do all visits (new patients,
  well exams) in 20 minutes
• Work down backlog during slower periods
• Pick April
• Cancel meetings
• Add appointment slots supported by nurses
• Pizza

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Demand

• True Demand Formula
• External
  Appointment calls
  regardless of day appted.
• Walk-ins for appts.
• Deflections
• Internal
• Returns booked today

Total Demand
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Moving the system

• 30 carved out for schedulers and MAs to book
  into future
• 70 held for same day
• Finally.remove the carve out!

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Managing Demand Group Visits
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Improved Patient and Staff Satisfaction
Much more beneficial
Much less beneficial
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Diabetes Group Outcomes
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Time to Third from EHR
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Access to Care
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Improved Office Efficiency Outcomes
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Improved Office Efficiency Outcomes
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