Key Principles
• Planning
• Education and
Communication
• Measurement
• Do Today’s Work Today
• Continuity of Care
• Understand Demand
and Capacity
• Work Down Bad Backlog
• Standardize and Reduce
Appointment Types
• Establish Contingency
Plans
• Engage Providers
• Daily Huddles
• Process Redesign

• Tactics
– Identify sponsors
– Identify stakeholders
– Create a planning team
– Involve physicians and staff
– Develop an Aim Statement (overall goals)
– Identify priorities based on current performance
– Define scope, tasks, and timelines
– Identify resources needed
Planning

Education & Communication
• Tactics
– Share best practice standards and data
– Develop a communication strategy
– Obtain buy-in from physicians and staff
– Share resource availability

Measurement
• Tactics
– Determine data needs and select appropriate tools
– Identify and validate data sources
– Identify data analysis resources
– Share measurement results with stakeholders, providers,
and staff

Do Today’s Work Today
• Tactics
– Define what this means by specialty
– Create disease criteria
• Pre-assessment guidelines
• Care bundles
• templates

Continuity of Care
• Tactics
– Set up care teams (Microsystems)
– Identify use of mid-level and non-provider staff
– Communicate with referring physicians
– Identify patient’s responsibility to communicate
– Physicians communicate with patient (after-visit
summaries)
– Patient education (pre and post visit)
– Define expectations for patients

Demand and Capacity
• Tactics
– Measure demand and capacity by provider
– Identify capacity constraints
– Determine how to meet the demand and adjust capacity
– Match demand with capacity

Reduce Bad Backlog
• Tactics
– Define good and bad backlog
– Measure by provider
– Share data with providers
– Identify steps to reduce bad backlog
– Phased implementation with physician stories of success

Reduce Appointment Types
• Tactics
– Evaluate existing visit types
– Standardize appointment types and duration by specialty
– Set up appointment type rules
– Determine number of closed appointment slots (good
backlog)
– Build scheduling template
– Adjust scheduling process and staff

• Tactics
– Measure demand and identify peak demand times
– Establish rules to adjust capacity
Contingency Plans

Engage Providers
• Tactics
– Identify physician champions
– Involve physicians to educate physicians
– Share patient experiences
– Share referring physician experiences

Daily Huddles
• Tactics
– Identify care team members
– Select time and process for care team to meet
– Share purpose, plan, and objective

Process Redesign
• Tactics
– Engage providers through physician leadership
– Create a blameless culture that fosters teamwork and
cooperation
– Analyze processes – map current and future states
– Understand what process capabilities exist
– Train on new process design

“A Different System is Needed…
… one that is reliable, proactive, efficient
and engages patients in ways that ensure
the best outcomes” Institute for Healthcare Improvement, 2006

Care Team Objectives
• Micro team approach to care
• Staff roles and responsibilities realigned
• MA’s work in an expanded role
• Patient centered, personalized, efficient visit
• Cycle time reduced
• Provider focus on patient
• Patients develop relationship with care team
• Increase in visits and WRVU’s
• Patient, staff and provider satisfaction improved
• Increase in market share and referrals

Care Team Configuration
• Providers and MA’s work in teams
• A small number of providers are supported by
a pool of medicals assistants - typical ratio is
2-2.5 MA’s per physician
• Two to three physicians work interchangeably
with 5-7 MA’s
• Impact of increasing MA staffing offset
by decreases in other support staff

Expanded Role of MA
• MA’s work in rotation – greeting, rooming and
supporting the visit regardless of provider
• MA’s responsible for the “full cycle” of visit
• MA acts as facilitator
• MA documents the visit in the EMR – acts as
scribe during the exam
• Patients develop a personal relationship
• Allows physicians to focus on services they
uniquely provide – (cost of MA vs. Physician)

MA’s work in Rotation
• Greeting, rooming and supporting the visit for
the next arriving patient (regardless of the
provider they are seeing)
• Responsible for other support processes –
messages, running lab tests, paperwork,
stocking rooms etc.
• Rotation maximizes MA resources, reduces
disruption and delays in patient flow

Standardization
• Standardized documentation templates
• Condition-specific questionnaires
• Order sets based on protocol
• Exam rooms organized and stocked in a
standard manner – same place in each room
• Printers are standard equipment in each room

Real-time Communication
• Communication enhanced between team
members
• Use of technology – vocera, hand-held radios,
white boards, electronic screens etc.
• Improves provider efficiency
• Improves flow
• Supports smooth transition from one patient to
another
• Messaging through EMR – MA works the pool

Planning for Daily Work
• Share information
about changes in
schedule or staffing
• Identify opportunities
to work in walk-ins or
unscheduled patients
with urgent needs
• Huddles – brief, stand-up care team meetings
at the start of the day and after lunch
• Identify patients that need additional work-up
prior to seeing the provider

Patient Accompanied at all Times
• MA’s act as the facilitator of
the patient’s visit
• Same MA with the patient
the entire visit
• MA present during
assessment, diagnosis and
treatment
• MA knows patient
background and care plan
• MA answers appropriate
questions and refer others
to the provider

Waiting Times
• Patient does not wait – services brought to
patient – do not move the patient
• MA facilitation reduces patient waiting times
• MA anticipates and responds to service needs of
patient
• Labs drawn in exam room by MA’s
• Referral appointment made in exam room
• Instructions and after-visit summaries given and
reviewed with patient in exam room

Call Management
• Centralized call center
• Minimal telephone disruption – QUIET CLINIC
• Call center does scheduling and registration –
streamlines check-in
• Call center routes messages through EMR
• Standards for response times set and monitored
• Triage and escalation protocols used to address
urgent and emergent situations

Support Resources
• Electronic Medical Record
– Access to complete medical record
– Offers point of care reminders
– Allergy and interaction alerts
– Ability to export data
• Nursing resource pool

Planned Care
“Currently Americans receive only about 55%
of the recommended medical care they need,
regardless of their race, gender, income, or
where they live.”

“Studies show it
would require 31.6
hours a day for a
provider to manage
the care needed for
an average panel of
2,500 patients.”
Not Enough Time in the Day

Planned Care…The Solution
Provide all the recommended care and
services at the right time
Supports patients in maintaining or
improving their health status
Creates positive outcomes in quality,
satisfaction and financial performance
Competitive advantages

Apply evidence-based
guidelines to the individual
needs of individual patients
Facilitate population
management, coordination/
conformity of care, chronic
disease management, and
self-management
Relationships with Patients

Expected Outcomes of
Planned Care
The patient receives all recommended care
according to guidelines
Achieve care plan goals
Increase in quality measures performance
Personalized, patient-centered care
Increase in patient satisfaction
Increased revenue
Increased referrals and
market share

Elements of Planned Care
Population
management
Coordination of care
Pre-visit planning
Care management
Self-management
support

Population Management
Assessment of patients to identify groups
Determine specific services and
notification to patients of services needed
Services include preventive care/health
maintenance; follow-up visits; patient
safety alerts; medication recalls
Outreach and reminders to patients

Coordination of Care
Management of the transition of care
between facilities and external care sources
Providing clinical information at the time of
admission
Contacting patients after discharge
Coordinating follow-up care & appointments

Pre-visit Planning
Pro-active management of scheduled
appointments
Ensure effective use of time & activities
associated with the patient’s visit
Medication management
Arrangement of lab & preventive care orders

Care Management
Use of expanded team to
develop individualized care plan
Individualized care plan to meet
patient’s specific needs,
treatments, and goals
Collaborative practice
agreements
Referral coordination

Self Management Support
Use of resources and
tools to help patients
and families manage
their conditions outside
the office visit
Use of technology
resources such as
MyChart
Group education
classes and workshops

Expanded Team Members
Case managers
Pharmacists
Social workers
Self management
facilitators
Other support members
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