Communication among providers about a patient can be difficult without a central repository for patient data. Lack of information can lead to errors or omissions in treatment, resulting in readmissions to the hospital or long-term care facility. This presentation describes the types of patient information available through health information exchanges and show how increased access to patients’ clinical information fosters smoother transitions of care, especially in a post acute care setting.

1. Jessica Langley, MS, Exec. Director of Education and Provider Markets, National Healthcareer Association
Lindsay Gainer, RN, MSN, Director of Clinical Services and Innovation, North Shore Physician Group
Audrey Lum, RN, MPA, Chief Clinical Officer, Union Health Center
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of PAHCOM.
Continuous Workforce Development: The Next Rung on the
Medical Assistant Career Ladder

2. Tell us what kind of imprint they have made within your practice.

3. Why are we here?
• Care for chronic diseases accounts for 75% of our
nation’s spending.
• 1% of health dollars are spent on public efforts to
improve overall health
• Nearly half of Americans suffer from chronic
conditions.
• Seven out of every 10 deaths in the US are
attributed to a chronic condition and almost half of
the patients fail to receive the appropriate treatment.

4. Continuous Workforce
Development with a
focus on Medical
Assistants
• Professional Evolution
• Trends and Drivers
• Challenges and Obstacles
• Training and Skills Gaps
• Elevating the Profession
• Why Career Laddering
• Examples
– North Shore Physicians Group
– Union Health Center
Agenda:

5. • $2.8 trillion in health
expenditures
• Millions more patients entering
the health care system
• Shortage of 130,000 physicians
and 260,000 registered nurses
by 2025
• 50% of the 18 million
individuals employed in the
U.S. healthcare workforce are
front line health care workers
5
Healthcare Trends and Drivers
277h Annual PAHCOM Conference
• Care Coordination (ACOs and
PCMHs) and Population
Management
• Healthcare Regulation/MU
• Electronic Health Records
• Emphasis on Clinical
Outcomes
• Performing to “Top of License”
• Engage and Invest in Front
Line Workers
• Career Advancement
Opportunities

6. Professional Evolution

7. Challenges and Obstacles
• Lack of Standardization
– Scope of practice, curriculum, training, education, etc.
• Professional Acceptance (trust and support)
• Lack of MA Skills and Professionalism
• Executive, Provider, and Staff buy-in
• Training Demands (time, resources)
7277h Annual PAHCOM Conference

8. Training and Skills Gap
Gaps that are critical to patient
outcomes.
• Communication in all aspects – with
patients, providers, supervisors;
written and oral
• Critical thinking, problem solving,
knowing when to ask for help
• Documentation and note taking
• Injections
• Knowledge of anatomy and
physiology
• Medical terminology
• Medications and pharmacology
• Taking patient history and vitals
• Triage and evaluating symptoms,
including abnormal lab values
Gaps that are important to the efficiency
and effectiveness of the practice.
• Coding and billing
• Communication skills and abilities,
including tailoring communication to
audience (e.g., providers, patients
from diverse backgrounds)
• Computer skills, including database
management
• Multi-tasking
• Prioritization and managing work
load and patient flow; time
management
• Professionalism in all aspects –
behavior, presentation, punctuality,
interactions with staff and patients,
meeting office expectations
• Teamwork
• Telephone skills and etiquette
• Writing ability, including grammar
and spelling

9. Elevating the Profession
• Education
• Credentialing
• Partnerships
• Team Based Care
• Career Laddering

10. Why are we focusing on career laddering?
• Is the need being expressed by employers or MAs?
• What is the driving force to implement a career ladder?
• What % of MAs are able/motivated to move forward in their careers?
• What kind of post-onboarding training, assessments, or certificates do you offer your
MAs today?
• What training are you currently offering, will be offering – is it voluntary or required?
• What is your training philosophy around MAs? Is it valued and is budget allotted for
training?

11. Career Laddering Examples
• North Shore Physicians Group
– Lean Transformation
– Enhanced Medical Assistant Role
– Clinical Curriculum Redesign
– MA as flow manager
• Union Health Center
– Health coaching for chronic patients
– Curriculum Design
– Career Ladder: PCA’s, Health Coach, Floor Coordinator
• Southcentral Foundation
– Nuka Model of Care
– Performing to Top of License
– “Grow-your-own” strategy
– Career Steps: CMA I, CMA II, and CMA Supervisor
• Northwestern Memorial Physicians Group
– Clinical Career Ladder Program for MAs
– Requirements: 1 year of employment, must be certified,
must be in good standing
– 3 Levels: MA, MA I, and MA II

12. Team Based Care Examples
• Cabin Creek Health System
– Preventative medicine and chronic disease management
– Senior Medical Home
– MAs as health coaches
• University of Utah Community Clinics
– Team-based model of care
– 5:2 ratio of MAs to providers
– MAs as Ambassadors
• Massachusetts General Hospital
– MAs as Clinical Partners
• Kaiser Permanente – Northern California
– Population Management Assistant
• Cambridge Health Alliance
– Planned Care Site Coordinators
• St. Peter Family
– Diabetic Care Manager
• University of Utah Hospital and Clinics
– Medical Practice Assistant

13. Benefits and Outcomes
• Increased professional engagement/team work
• Maximize practice/operational efficiency
– Increased patient load
– Higher patient engagement
– Reduced ER visits/Re-admits
– Lower no show rates
• Consistent and standard skill training
• Increased employee retention
• Increased employee and patient satisfaction

14. NORTH SHORE PHYSICIAN GROUP
LINDSAY GAINER, RN, MSN
DIRECTOR OF CLINICAL SERVICES AND INNOVATION
Career Laddering and Team Based Care

15. • Multi-specialty, multi-location
physician group
• 11 Primary Care, 8 Specialty
offices, 1 Urgent Care, 1
Extended Care program
• Locations - 8 mile radius of
NSMC
• Diverse patient population:
income, ethnicity, education
• Group employs inpatient and
outpatient specialties – 365
Physicians
NSPG Practice Profile

16. North Shore Physicians Group

17. The Perfect Storm

19. Providers Medical Assistants
Burden of Work

20. Care Model Redesign
Standard Clinical Training Lean Transformation Expanded MA Role
Team-based Care

21. Medical Assisting Training
• No standard education upon practice entry
• Needed consistent, baseline competencies
for all MAs
– Clinical Curriculum Redesign
• Increased need for clinical skills (PCMH)
• Physicians needed more assistance
• Needed fundamental redesign of care model
Enhanced Responsibilities
• MAs as Flow Managers
• Expanded Rooming Process
• Ancillary Services
• Population Management
• Health Coaching
• One Call Resolve
Focus on Medical Assistants

22. Goals of Training
• Create baseline standard competencies for all MAs
• Utilize MAs more effectively in patient care delivery
• Empower MAs as critical members of the care team
• Improve MA job satisfaction and retention
• Impact MA quality and performance
• Improve provider work-life balance and satisfaction

23. Best Practices
Flow Manager
Provider and MA work side-by-side at flow
station
Single piece flow for all work –No Batching.
MA is the gatekeeper for all work at the flow
station
MA is empowered to ensure provider is in
flow and on time
Huddles Level Loading
Redefining Roles
New MA responsibilities performed by
providers or nurses in the past
Practicing to “Top of License”

24. Leadership and Professional Development
Medical Assistant
Council
Employee Education
Assistance Program
Recognition of
National Certification
Career Ladder

25. NSPG Medical Assistant Council
• Formed in 2010
• MA representative from each
site
• Focused on standardizing and
improving clinical processes
• MA Council members serve as
Process Advocates
Employee Education Assistance
Program
• Launched in 2011
• Funds may be used for a variety
of job-related professional
development or continuing
education activities
• Lifetime maximum of $2500
• Employee commits to 2 years of
employment
• NSPG physicians contribute to
the fund annually

26. • National certification recognized in 2011 • MA Career Ladder launched in Fall 2013
Career Ladder

27. Career Ladder Requirements

28. • All current staff received training
• Training was highly rated by staff
• Managers report improved
teamwork
• Increased staff involvement with
patient care
• Trustworthy and credible clinical
skills
• Strengthened professionalism in
clinical relationships
Outcomes

29. UNION HEALTH CENTER
AUDREY LUM, RN, MPA,
CHIEF CLINICAL OFFICER
Career Laddering and Team Based Care

30. • Comprehensive primary and
specialty care center in New
York, New York
• 10+ PCPs and 30+ specialists
• Received NCQA Level 3
recognition in 2010
https://www.youtube.com/watch?v=2qDd-eUDMzw
Union Health Center Practice Profile

31. Recognizing a Need
Secured 2
Grants
Developed
its own 12
month
didactic
and clinical
curriculum
Trained
MAs to
take on
patient
education
and
coaching
activities

32. Initial MA Training Curriculum
• Dedicated two-hour weekly sessions
help during clinic workday over nine
months
– Defined scope of MA role in
patient care
– Identified gaps in MA
communication and clinical skills
– Reviewed basic MA curriculum,
tailored to current skill levels
– Taught basic interviewing skills
and principles, motivational
interviewing, techniques of self-
management support
Ongoing Commitment to Education
• Weekly Team Refreshers
– Two-hour session every other week for
PCAs and health coaches
• Continuous Process Improvement
– Teams encouraged to identify inefficient
processes and protocols, pilot potential
solutions, successful solutions can be
rolled out across the practice
• Health Coach Shadowing
– Opportunity for select PCAs with
advanced knowledge to learn from
health coaches, train to earn promotion
Training Opportunities

33. Training Topics for MAs
Health
Coach
Chronic Disease
Management
Medical
Terminology and
Charting
Communication
Motivational
Interviewing
Self-
Management
Support

34. Career Ladder Empowers MAs
• 1 floor coordinator per team
(6 providers)
• 27% pay increase
Floor
Coordinator
• 2.5 health coaches per
team (6 providers)
• 13%-20% pay increase
Health Coach
• 1 PCA per
provider
Patient Care Assistant
(PCA)
https://www.youtube.com/watch?v=01MD4o5jGng

35. Floor Coordinator
•Manages patient flow in clinic across all provider teams
•Reviews scheduled patients with PCP each day during huddles
•Closes communication gap between PCP and care team
Health Coach
•Works one-on-one with patients (12-19 patients/day) to establish self-
management goals, conduct telephonic follow-up
•Leads group visits for patients with chronic conditions
•Meets with social worker and RN case manager to discuss complex cases
Patient Care Assistant (PCA)
•Assist PCP with managing patients on the DM registry
•Provides basic patient education on chronic conditions, self-management
•Works with care team to review charts for preventative protocols
•Manages vital signs, rooms patients, pre-visit planning
Career Ladder Levels

36. Challenges
• Gaining the trust and support of providers
• Training PCAs to implement the care model
• Building PCAs confidence in expanded role
• Changing patient base

37. Strategies to Improve Provider, Patient Buy-In
Engaging in Program
Development
•Clinical staff actively involved
in ongoing training
development and supervision
•Care team RN ensures MAs
are performing designated
duties effectively
•Nutritionist attend a “train-
the-trainer” program to learn
effective teaching techniques
and share with the team
Fostering Ongoing
Collaboration, Teamwork
•Providers lead group visits,
encouraged to share any
patient concerns with health
coach and rest of the team
•Team meetings to discuss
potential adjustments to
health coach role, address
inefficiencies, barriers in
workflow
•Task forces formed to pilot
potential solutions and
provide update on progress at
subsequent meetings
Educating Patients and
Caregivers
•Providers encouraged to
mitigate patient resistance to
new model through warm
handoffs to health coaches
and PCAs
•Patient education materials
detail the benefits of the PCA
and health coach involvement

38. Outcomes
Operational
Efficiency
Reduced wait
time, no
shows, and
walk-ins
Positive
Patient
Experience
Increased
Patient
Satisfaction
Improved
Employee
Retention
Increased
Clinical
Outcomes
+3500
Patients
served in
2014 vs. 2010

39. 1. Create the incentive for change/sense of
urgency - staff turnover, staff satisfaction,
professionalism, career development within the
company.
2. Assess financial impact of salary increases to
organization to get Executive buy-in.
3. Assess baseline competencies, educational
preparation, and certification of current employees.
4. Design an internal educational program to
assure standard competency across organization.
5. Design the requirements for the career ladder /
Re-write and create new job descriptions.
6. Educate managers on the process of promotion
and the application process so that they can coach
their staff who wish to advance on the career ladder
7. Go-live with ongoing central support and coaching
of managers
How can you start thinking about creating a career
laddering program?

41. • This research is supported by The
Hitachi Foundation as part of its
Pioneer Employers Initiative
• ©2014 The Advisory Board Company.
All rights reserved.
Resources

42. 42
Thank you!
277h Annual PAHCOM Conference
Jessica Langley, MS
Exec. Dir. Of Education and Provider
Markets
National Healthcareer Association
Jessica.langley@nhanow.com
(913) 661-6587
Lindsay Gainer, RN, MSN
Dir. Of Clinical Services and Innovation
North Shore Physicians Group
lgainer@partners.org
(978) 573-4361
Audrey Lum, RN, MPA
Chief Clinical Officer
Union Health Center
alum@unionhealthcenter.org
(212) 812-3562