The Third National Medical Home Summit 2011 Team-Based Care: the Mojo of the Medical Home David Ehrenberger, MD, Chief Medical Officer, Colorado
Ruben s Story Diabetes for 10 years, Max weight 301# December 5, 2009. December 2010: Weight loss now at 69#...HgbA1c down from 10.0 to 7.0. What worked?
Medical Home 1. Performance Improvement Team Medical Home Elements 2. Patient Self Management 3. Diabetes Registry 4. Order Tracking 5. Group Visits
Powerful change Patient Experience + Outcomes + Decreased Cost But where to start? Access Health IT Accountability HIT + Data Payment Methodology Reform Patient Centered Medical Neighborhood
Transformational Change
Why is Teamwork the MOJO? Types of Teamwork: Teamwork = Organizational and functional constructs essential to effect transformational change. 1. Working Teams--performance improvement teams. 2. Team Systems--coordinated, processoriented transparent goals and contributions to goals, measurable performance, evolving, patient-centered, data-powered.
Teamwork Vivisection: the sports team Illustrates both working teams and team systems Drives home the notion of continuous quality improvement as hallmarks of highly functioning teams Data: front and center What is a winner? Captain as Leader
Teamwork Fundamentals Team Principles/Concepts Coach Captain Teammates Playbook Common goals Communication huddles Accountability at teammate level Contribution transparency Statistics--performance measures Score matters Competition based on Q of teamwork Who wins? Application in Sports Team leader, strategy, common goals Quarterback, tactics, real-time leader Goal/strategic-specific roles, skills Defines goal-directed strategy, tactics Focused on mission, explicit, shared Real-time strategic planning (goals ) Measured impact on common goals Meaningful/understood impact (goals) Players, game, season, tactics Coaching/teamwork/strategy working? Communication, execution, skill Team, accountability players, value fans (business) sustainability
Teamwork Fundamentals Team Principles/Concepts Coach Captain Teammates Playbook Common goals Communication huddles Accountability at teammate level Contribution transparency Statistics--performance measures Score matters Competition based on Q of teamwork Who wins? Application in Sports Team leader, strategy, common goals Quarterback, tactics, real-time leader Goal/strategic-specific roles, skills Defines goal-directed strategy, tactics Focused on mission, explicit, shared Real-time strategic planning (goals ) Measured impact on common goals Meaningful/understood impact (goals) Players, game, season, tactics Coaching/teamwork/strategy working? Communication, execution, skill Team, accountability players, value fans (business) sustainability
Teamwork Fundamentals Team Principles/Concepts Coach Captain Teammates Playbook Common goals Communication huddles Accountability at teammate level Contribution transparency Statistics--performance measures Score matters Competition based on Q of teamwork Who wins? Application in Sports Team leader, strategy, common goals Quarterback, tactics, real-time leader Goal/strategic-specific roles, skills Defines goal-directed strategy, tactics Focused on mission, explicit, shared Real-time strategic planning (goals ) Measured impact on common goals Meaningful/understood impact (goals) Players, game, season, tactics Coaching/teamwork/strategy working? Communication, execution, skill Team, accountability players, value fans (business) sustainability
Teamwork Fundamentals Team Principles/Concepts Coach Captain Teammates Playbook Common goals Communication huddles Accountability at teammate level Contribution transparency Statistics--performance measures Score matters Competition based on Q of teamwork Who wins? Application in Sports Team leader, strategy, common goals Quarterback, tactics, real-time leader Goal/strategic-specific roles, skills Defines goal-directed strategy, tactics Focused on mission, explicit, shared Real-time strategic planning (goals ) Measured impact on common goals Meaningful/understood impact (goals) Players, game, season, tactics Coaching/teamwork/strategy working? Communication, execution, skill Team, accountability players, value fans (business) sustainability
Teamwork Fundamentals Team Principles/Concepts Coach Captain Teammates roles, skills Playbook strategy, tactics Common goals explicit, public Communication--huddles Accountability at teammate level Contribution: transparency/satisfaction Statistics player, game, season Score matters Competition based on Q of teamwork Who wins? Team, players, fans Application in Practice--CURRENT Nope You bet the buck stops here Employees, coworkers, min skill-set Increase visits/hr, dbl book, no lunch Max-pack volume; JD-focused goals Real-time directives; perform. reviews JD focused, yearly reviews, remedial Restricted, limited growth potential OV/mo, no-shows, JD performance Profit/Loss, AR aging, production Compete on pt volume, services The accountability business; value primary/rescue sustainability care
Patient-Centered Teamwork Team Principles/Concepts Coach Captain Teammates RNs, MAs, Front Office Playbook coordination of care Common goals population-based Communication huddles Accountability at teammate level Contribution transparency Statistics clinical care Score matters Competition based on Q of teamwork Who wins? Patient-Centered Teamwork Team leadership accountability Physician as teammate & leader Specific roles, skills: planned care Defines planned care strategy, tactics Explicit, shared, measured objectives Real-time pt-care planning (goals ) Measured impact on common goals Meaningful/understood impact (goals) Outcomes, efficiency; moving the dot Practice/Provider-level outcomes P4P, PCMH, NCQA, PQRI Practice, providers, staff, patients
Take home themes Teams maximize efficiency, communication, use the same playbook, strive for the same and explicit goals Hold each other accountable Teams have a coach Model for Improvement or bust Make the time Teams are built: representative (process- touchers ), facilitated dialogue, horizontal hierarchy) The only constant is CHANGE
Playbook: steps to building teams in your Medical Home Job #1: Build your Performance Improvement Team ( working team ) Make the time Standing meeting be consistent Get Data then use, display, update it Establish goals; take aim, make measures Minutes accountability Facilitated leadership Recruit a sponsor, get authority Ensure representation and, patient as teammate Get a coach, learn to coach
Impact of Teamwork Broomfield Family Practice Performance Improvement Team Meaningful Work Skills of CQI A new culture Patient presence Top of license
The Data Wall A1c avg Motive Force for Team Work: provider data 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 A1c avg Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Christie Connelly Del Neg Ehrenber Elder Essig Hazen Hill Kinsey Koza Robert Salas M 9MD1 2PA1 19 PA2 64 MD2 13 PA3 33 MD3 59 PA4 82 MD4 2PA5 MD5 13 66 MD6 34 DO7 Sarinop MD8 45
Impact of Teamwork Goal #2: Build Team Systems Pre-Visit Planning/Huddle Registry Management Lab tracking Medication Reconciliation Transitions of Care coordination Planned Care Model in action Care Compacts Anything worth doing well is worth measuring. Any process that involves people deserves teamwork.
Impact of Teamwork Care Compacts:
Heart Disease BFP IVD Results IVD Measure 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 2010 BP <140/90 ASA/Plavix Tob Cessation CAD Perfect Care LDL<100
Jan-11 BFP Pneumovax Prevention Task Force Broomfield Family Practice - Pneumococcal Vaccination n = 801 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pneumovax Acheivable Goal NCQA Certified for Heart and Stroke Care Mar-09 Baseline
Diabetes: A1c Barrier? Diabetes Poor Control 40% 30% Introduction of the Group Visit TARGET <=20% 20% 10% A1c>9 or not done 0% Mar- 10 Apr- 10 May- 10 Jun- 10 Jul- 10 Aug- 10 Sep- 10 Oct- 10 Nov- 10 Dec- 10 NCQA Certified for Diabetes Care
Impact of Teamwork Group Visits: Diabetes Team-based efficacy (led by MAs--vs MD as teacher) Content Thread (vs content box) Group Self-Management (vs orders) Facilitation (vs didactic)
A1c improved by 15% (compared to 3% for all BFP diabetics)
More info: davidehrenberger@centura.org Q s? ipn.org
Finis