Converging Health Website

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 14 Sponsored by              WWW.THEMDCEO.COM This is a continuation of the consideration of how an Advanced Medical Practice can Sharpen the Saw for each member of the team. The Power of Gratitude During a staff meeting ask each member of the team to share one thing they are grateful for in their work and in their personal lives. It will encourage people to self-disclose and thereby each team member becomes known more fully to their colleagues. The Honored Patient Ask the team members to identify patients/families they feel especially honored to care for. Identify patients who are working hard to care for others, and patients who have overcome great obstacles. Ask the patient if they would be willing to have their picture taken and placed on the walls or on the Center’s website. Patients will feel honored to be so recognized. (Make sure you get their permission in writing) I first met Eugene when I took care of him on our inpatient family medicine service during my intern year. He was a man who did not have a family physician and relied on the generosity of volunteers at St. Anthony’s, our local free health clinic, to receive his health care. He was a long-time smoker, had hyperlipidemia, hypertension, and undiagnosed diabetes. I took care of him during one the darkest times in his life. Since he went decades without receiving routine primary care, his medical problems eventually cost him his left foot, which had to be amputated. He was devastated. Eugene is a proud man who provided not only for himself, but also his wife through his job working as manual laborer. We worked through the physical and the emotional toll his disease caused. He promised me that he would do anything to improve his life. When he stopped smoking, Eugene gave me his pipe and tobacco–I still have them sitting on my desk to this day to remind me why I chose to pursue family medicine. Every time I see Eugene in the office, he enthusiastically shares his gratitude and always knows how to make me smile. Despite his amputation, he is grateful to be alive and continues to have a refreshingly positive outlook on life. For these reasons, I feel honored to be his physician and his friend. TedTalks provide a well of inspiration for all. Once a month share via internal listserv a poignant TedTalk with the team. During the next staff meeting, ask one or two in the team to share what the TedTalk meant to them. Here are a few TedTalks to get you started. The Placebo Effect            https://www.youtube.com/watch?v=KvT1a3kE_DA The Four Things that Matter Most            https://www.youtube.com/watch?v=vcMmx-6RIUY What Matters in Medicine     https://www.youtube.com/watch?v=UAVOVw1KnMA&t=148s And don’t forget the value of humor. Start with doctor jokes, clean ones. Who cares if they are silly. Let everyone have a good chuckle. Maybe start each team huddle or a staff meeting with someone telling a joke. It can be printed on a piece of paper or memorized. Have some fun! Man calls the office: “My wife is pregnant, and her contractions are only two minutes apart!” Doctor: “Is this her first child?” Man: “No! This is her husband!” A man walks into a doctor’s office. He has a cucumber up his nose, a carrot in his left ear, and a banana in his right ear. “What’s the matter with me?” he asks the doctor. The doctor replies, “You’re not eating properly.” Doctor: “Nurse, how is that little girl doing who swallowed 10 quarters last night?” Nurse: “No change yet.” I went to the doctor, and he said I had acute appendicitis, and I said compared to who? Some offices will place motivational posters on the walls of the conference room or the lunchroom. For the most part these are a waste of time because they are not connected to the lived experience of the team members. Create your own posters that have words or pictures that mean something to the group. Take a lesson from the TV show Ted Lasso. For a powerful experience, once or twice a year, invite 8 – 10 selected patients to the staff meeting. Focus the discussion on each person’s experience of giving or receiving care in your Center. You will be amazed by what the patients have to say. Make sure to pick patients who are articulate and well-balanced. This is not a gripe session. Io be effective a skillful facilitator is required. For a model review this video:  https://www.youtube.com/watch?v=akECUGH2SPg&t=30s  The value of curiosity – it’s an antidote for burnout Hans Duvefelt, MD Author of A Country Doctor Writes: CONDITIONS: Diseases and Other Life Circumstances Use your team’s quality improvement efforts to spark some curiosity among the clinicians and the staff. Ask the team to brainstorm and identify questions they have about how well they are doing with your operations. Identify topics that can be answered by one-person collecting data for a maximum of one day. Think small. During a staff meeting, ask the team to identify patients or medical conditions they find puzzling. The group selects one topic, and someone is assigned the effort to search for answers/solutions. During the next meeting the answer(s) are shared, and a group discussion can follow. Reading: Each quarter ask the team to pick a book/short story/article that all will read. Keep the book/story brief. There are plenty to choose from.  An article in a magazine or journal might work. Many of the medical journals now have a stories/narrative medicine section. Fit Over 50: Make Simple Choices Today for a Healthier, Happier You by Phillip Bishop and Walt Larimore M.D. The Best Care Possible by Ira Byock, MD The Four Things that Matter Most by Ira Byock, MD Intuitive Wellbeing: Winning the Game of Health by Scott Conard, MD Hey Doc”“Memoirs of a Rural Family Physician by Jamos Damos, MD Trust Me I’m a Doctor” by Mark DePaolis, MD Bryson City Tale by Walt Larimore, MD

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 12 Sponsored by              WWW.THEMDCEO.COM  We really need to understand how to align the incentives for both of the clinicians and their team, so they value access and trust. How do we do that? There are some tools that we have that can help us. The 11-item Person Centered Primary Care Measure is an excellent survey tool that CMS has now approved that could be used to assess the patient’s engagement and trust with their practice. (https://tinyurl.com/4cj7e7ww). We highly recommend this tool as it allows the patient/consumer to inform you if effective primary care is being offered. We also want to reward clinicians for managing complexity so looking at patients’ risk scores and what their panel looks like as far as overall risk is a great way for us to think about compensating clinicians based on the complexity of their panel. Likewise, we think it’s important that the team is properly incentivized and that you allow in your contracts with your clinical team’s rewards for each team member or across the team equally so that team members are rewarded for providing good access and providing good care and maintaining good connections with their patients. Also having a conversation that’s focused on leading indicators that empowers the staff to be able to get things done is valuable. It is really important to have them be empowered and rewarded for what they can control and their response and aligning those incentives with what the system wants to achieve is the key to have the system actually achieving It is also important to link the compensation model with the goals for center transformation and clinical excellence. Just be sure that the focus is on things that the clinicians and the clinical team can directly influence. This would mean that data has to be available about the leading indicators. Scott Conard, MD              Michael Tuggy, MD                  Susan Lindstrom                 Laurence Bauer, MSW, MEd [email protected]   [email protected]   [email protected]   [email protected] #innovation #healthinnovation #advancedprimarycare #apc #directrimarycare #dpc #healthinnovation #healthbenefitinnovation #healthrisk  #trustiscurrencyprimarycare #healthliteracy #primarycare revolution #newhealthcaresystem #betterheatlhcaresystem #wholepersonriskscore #intuitivewellbeing #highvaluevisits #personalhealthassistant #MyPHA #intuitiveanalytics #healthcareanalytics #advancedprimarycare #APC #Directprimarycare #valuebasedcare #medicareadvantage #populationhealth #wholepersoncare #healthcare innovation

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 11 Sponsored by       WWW.THEMDCEO.COM  One of the things we’ve seen with our work is that the “Tyranny of the Urgent” often ruins the schedule because of the response to patients of all various risk levels calling in for appointments. If you don’t have a process for managing those high-risk patients, they start to overwhelm your schedule and they don’t get the care they need when they need it. The low-risk patients oftentimes don’t need to have a face-to-face visit. Perhaps a telehealth visit or a phone interaction with a clinician would suffice as they only need to have a connection with the practice to get some advice on how to evaluate a particular complaint, they may have that doesn’t require a face-to-face visit. What we’re encouraging centers to do is to move to an advanced access scheduling model where almost 30 or 40 percent of the appointments are same day or appointments that occur within 24 hours of the call. That allows patients to be placed in those appointments who really need to be seen that day. We would use the Whole Risk Score as a primary guide for that process flow with a triage nurse evaluating patients who are high risk or really looking to be seen right away and getting them in on the schedule because there are open appointments available. This decompresses your schedule over time and you’ll see that you’ll have fewer bookings out of patients because you’ll eliminate those patients who typically might no-show if their appointments are scheduled three to four months now. Instead, you get those patients who need to be seen on the same day and then their follow-up needs become less if you’re addressing their acute problems more rapidly. That’s the whole idea about having this advanced access scheduling with more same-day, less long-term booked appointments. You want to get the people the care they need the day that they call in. This is the way that we found to move into a service model that works instead of one that continually frustrates the staff. Scott Conard, MD              Michael Tuggy, MD                  Susan Lindstrom                 Laurence Bauer, MSW, MEd [email protected]   [email protected]   [email protected]   [email protected] #healthinnovation #healthbenefitinnovation #healthrisk  #trustiscurrencyprimarycare #healthliteracy #primarycare revolution #newhealthcaresystem #betterheatlhcaresystem #wholepersonriskscore #intuitivewellbeing #highvaluevisits #personalhealthassistant #MyPHA #intuitiveanalytics #healthcareanalytics #advancedprimarycare #APC #Directprimarycare #valuebasedcare #medicareadvantage #populationhealth #wholepersoncare #healthcare innovation

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 8 Sponsored by              WWW.THEMDCEO.COM The high value visit concept is one that we’ve seen work really well in a direct primary care model where the longer appointments allow the physician and the patient to have more time to build an understanding of each other and how the physician wants to care for that patient. We started implementing this process in the DPC clinic model that we (Mike) had in Seattle when he first opened a clinic there back in 2009. We’re doing the same work with our current pilot at Jamaica Hospital in Queens, NY. We lengthen some visits to 40 minutes so we can engage the high-risk people and fill those slots with high-risk patients. This creates more time to actually understand what the needs are from the patient’s perspective looking at their total risk and what their risk factors are. They use that time to build trust. The longer time frame has shown to have a huge impact on total cost of care and compliance with the care plans that the patient and the clinician wants to develop for the patient. The High Value Visit is a really important step in transforming into the Advanced Primary Care model. Give the clinicians more time with the patients that really need to establish the trust relationship and develop a plan for care for them with the right team support around them (like Care Navigators) who can help the patient follow through on that plan and actually accomplish the goals. That leads to the next thing too because with the information that identifies in real time the areas of challenge that we have through the Whole Risk Score™ and the care plan development that was created during the high value visit. This helps each staff member to play a more focused and significant role in caring for those individuals and it flows in a way that has team members able to live out their life’s mission as a health care clinician. Scott Conard, MD              Michael Tuggy, MD                  Susan Lindstrom                 Laurence Bauer, MSW, MEd [email protected]   [email protected]   [email protected]   [email protected]

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 6 Sponsored by              WWW.THEMDCEO.COM  We believe that the clinicians’ philosophy of care and their scope of practice are foundational elements that create the opportunity for success in a prospective payment-based system. A whole person approach to healthcare is the approach that will produce the highest levels of health and well-being among the patients served. In a prospective payment model, the whole person approach will also produce the greatest financial rewards. The core idea of whole person health care, what’s most important in taking care of our patients, is to understand what matters most to them in their lives and making that the centerpiece of how we try to help with their lives and their health care. This differs from the FFS orientation which focuses on identifying and treating disease. For the clinician, we begin with our belief that each person has an “inner healer” that can be activated and supported as a patient responds to the forces that set him/her back. What kinds of skills and assistance does a patient need to help them move toward health and well-being? Using the power invested in the healer provides us a lever that can help the patient move forward. It is the patient’s beliefs and actions that matter most. We are their guides and a resource they can use. The “Jedi Warrior” believes in and can tap into the “force” for health and well-being and works to support the patient on their path towards health. This approach to care juxtaposes to the clinician as “car mechanic” who fixes body parts. We draw heavily on the work of several primary care thought leaders. Listed alphabetically Steve Bierman, MD is the author of “Healing Beyond Pills and Potions.” Dr. Bierman understands the tremendous impact of ideas on health and healing—ideas held by patients, and ideas delivered by caregivers. His approach has resulted in lasting cures of so-called chronic diseases, regression and disappearance of advanced tumors, bloodless and painless surgeries, and resolution of a wide array of “gray zone” syndromes that defy diagnosis. Scott Conard, MD is the author of “The Seven Healers” and other books The Seven Healers are seven specific ingredients that every human being needs in order to survive and thrive in this life. These essentials are not limited by a person s nationality, skin color, or religion. They are universally required by all. The Seven Healers, in order of their necessity for survival, are Air, Water, Sleep, Food, Play, Relationships, and Purpose. Without these time-tested elements, you cannot flourish and live a meaningful life. Once you identify the problem, you can trace it back to the root cause and find the answer.            https://www.goodreads.com/en/book/show/16070555-the-seven-healers Wayne Jonas, MD is the author of “How Healing Works” Dr. Jonas is a champion of whole person and integrated care. He believes that healing is as important as curing. For Dr. Jonas, whole-person care addresses the four dimensions of a human being–physical, behavioral, social and emotional, mental and spiritual, and it is delivered in a person-centered way. He created the HOPE Note a tool to elicit the information needed from a patient to better understand their issues beyond the regular medical visit. The HOPE note builds off the SOAP (subjective, objective, assessment, and plan) note that every medical student learns and is applied every day in practice. The HOPE note is a patient-guided process designed to identify the patient’s values and goals in their life and for healing. The role of the physician is to provide the evidence and support to help them meet those goals.                           https://drwaynejonas.com/ James Mold, MD is the author of “Goal Oriented Medical Care” The premise of Goal-Oriented Medical Care is that, prior to consideration of strategies, the health care team must understand the patient’s personal health goals and priorities. The addition of the goal-clarification step changes the focus from problem-solving to goal attainment, forcing a reconsideration of the meaning of health and the purpose of health care. It elevates the role of patients in decision-making, broadens the range of strategies, encourages individualization and prioritization, and creates a conceptual framework for true person-centered care. And while the idea is deceptively simple, it provides a blueprint for the transformation of health care systems trying to adapt to changing health concerns, scientific and technological advances, health and health care inequities, and rising costs. Scott Morris. MD, MDiv. is the author of “Health Care You Can Live With: Discover Wholeness in Body and Spirit” Dr. Morris is the creator and leader of Church Health in Memphis, TN. He knows that hope, health, and healing happen when we consider the whole person. His model of care connects the dots across faith, medicine, movement, work, emotions, nutrition, and friends and family. Whether caring for patients or reaching out to the community, he holds high the dignity and worth of each person. The Church Health Model for Healthy Living recognizes that our lives are complicated. We are better together when we help one another access the quality health care necessary to live with dignity, vitality and joy. He believes that all health care delivery begins with love of patients. He has developed a Model for Healthy Living that is a tool for individuals to use to take charge of their own health, and it reflects that true wellness is not just about our bodies but about the interconnectedness of body, mind, and spirit in all the ways that we live. https://tinyurl.com/2cf62zxx   and  https://tinyurl.com/4c8u94pb Scope of Practice refers to the range of services that can be offered through the primary care practice. Can patients receive services such as simple dermatologic procedural services, sports medicine services, treatment of common musculoskeletal problems, (Osteopathic manipulation therapy, physical therapy, massage, Acupuncture, etc.) brief office counseling for mental/behavioral health issues, etc. The goal is “one-stop shopping” as much as possible. The final issue here involves helping the clinicians to reconnect with and renew their understanding of and commitment to their core values. It’s more than continuing