CP43 - Care Transformation: Care Team Roles and Realignment
Poster Type: Innovation
Issue or Challenge: Community Health Care is working to transition to value-based care and alternative payment models. Care team transformation and the reevaluation of staff roles and responsibilities is a critical part of this transition. In addition, provider and staff administrative and clerical tasks are a large contributor to burnout, leading to lower job satisfaction and engagement. CHC established a centralized team for medication, referral, diagnostic and document management that focused on medical assistants working to the top of their license. Many administrative and clerical tasks were shifted from patient-facing staff members to this centralized team, increasing staff satisfaction while improving patient care.
Description of Innovation: A Patient Access Center (PAC) was developed to address medication management (medication refills and prior authorizations), referrals (tracking and closure), diagnostics (prior authorizations, scheduling and tracking), chart updates and document management. These tasks were all originally part of each care team members’ responsibilities, which led to multiple workflows and inconsistencies as patient facing staff were interrupted often during the day. PAC shifted this work to a centralized team of MA experts without patient facing responsibilities. Medication refills are now automatically routed to the team who follows an algorithm to refill medications or reassign back to the provider when indicated. Referrals ordered as part of a visit are automatically routed to the PAC team for processing and tracking to completion. Similarly, diagnostics are automatically routed to the team for tracking and any necessary prior authorizations. Patient charts are updated by PAC team members via a validated algorithm to ensure updated chronic problem lists, medication lists, immunization records, as well as medical/surgical histories. Lastly, PAC team members process and scan documents into patient charts as they arrive, so they are available to the care teams when needed.
Impact or Result: Mediation Management: An average of 2,500 medications are refilled per month by the PAC team which is ~46% of all refills. This has decreased each providers’ after-hour work time 4-6 hours per week. Referrals: The PAC team processes ~4,500 referrals per quarter and tracks these for completion. Diagnostics: The PAC team processes ~3,500 diagnostics per quarter and ensures prior authorization completion and timely processes. Chart Updates: PAC team members follow an algorithm to update patient charts for all consultant referral notes. This improves patient safety with more accurate charts and increases UDS measure documentation compliance. Soon, ER and hospital notes will also be part of this algorithm.Document management: The PAC team scans ~20,000 documents per month into charts. Overall: The average number of items in each MA inbox decreased from 21 in August 2020 to 8 in December 2020. Provider engagement increased 7% and nursing staff engagement increased 10%.
Replicating this Innovation: We suggest approaching a transition like this as a partnership between leadership and key stakeholders. We formally documented all care team members’ tasks in order to determine which tasks should remain with the care team and which could be transitioned to the centralized team. We then did multiple time studies to determine the expected amount of work produced per centralized PAC team member (number of completed medication refills/hour for example). We then prioritized the parts of the PAC team and transitioned one aspect at a time, transferring 2-3 FTEs every few months to the centralized team.
Rebecca Hayes, MD, MEHP, CMO - Pediatric and Internal Medicine Physician, Community Health Care
Theresa Jennings, DNP, ARNP, FNP-c, Family Nurse Practitioner, Clinical Assistant Professor, Community Health Care, Inc; University of Iowa College of Nursing