Setting an Organizational Agenda

Presenter: James Demopoulos

Transcript

1. © 2017 Lehigh Valley Health Network Setting an Organizational Agenda Our Journey to Solve Patient Access Through Applied Science PATIENT ACCESS EXECUTIVE SUMMIT James Demopoulos MHA, MPH Sr. Vice President of Operations Lehigh Valley Physician Group
2. ▪ Lehigh Valley Physician Group ▪ 1,450 employed providers ▪ 200 practices ▪ 2.5 million annual visits ▪ 3,500 colleagues ▪ Lehigh Valley Health Network ▪ Top 30 U.S. NWR, Top 50 Healthgrades, MSK Partner ▪ 8 Campuses, 18,000 employees Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 2
3. 3 • In 2015, a network wide goal was established to improve access and the patient experience overall • A critical priority for the success of our ACO, our PCMH model, overall growth, clinical outcomes, population health, coordination and continuity of care, payer and employer partnerships, colleague satisfaction and the patient experience/value-the Triple Aim- Better Health, Better Care, Better Cost Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
4. 4 • LVHN is improving their patient access and experience challenges using a bundled solution set • By affinitizing patient survey results with selective solution bundles Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
5. 5 3. Telecom Standard Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
6. Templates, Telecomm, Clinical ATC, MyLVHN engagement, practice profiles, enterprise scheduling, advanced practitioner utilization, Exceptional Experience staff training: Implement countermeasures & leverage collaborative leadership of practice triads across all practices MPC FY16 LVPP LVPP - SP Children's Neurology Endo Oncology Women’s Med 2. Focused Replication: 50-75 practices with greatest opportunity 3. Broad Improvement: Patient experience teams in all practices (QMAP) 1. Pilot Practices: Deep Dive - Implement access solution bundles Clinical Intelligence/Epic Optimization/Capacity Mgmt: Implement Epic Welcome, Pre-Visit Planning, Rx Management, e-visits, provider efficiency profiles, MyLVHN self-scheduling, expanded hours, TBD pilots Three-Prongs (Project Scope) FY 16 Accelerated LVPG Strategic Plan 6 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
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8. . Telecom Standardization Bundled Solution Number 3 8 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
9. Project Name: Access Always - MPC Process Owner: Joane Young Prepared by: Naser Chowdhury Contact: naser_m.Chowdhury@lvhn.org Team Members: Creation Date: 5/1/15 Revision Date: 5 Sept 2016 Jean Daversa, Joan Young, Naser Chowdhury, Molly Thompson, Dr. Michael Ehrig, Denise Hylton Process Step/Input Potential Failure Mode Potential Effect(s) of Failure S E V Potential Cause(s) / Mechanism(s) of Failure Input Variables (X's) O C C Current Process Controls to Prevent Failure Mode Current Process Controls to Detect Failure Mode D E T R P N Recommended Actions Person Responsible for Actions Target Complet ion Date Actions Taken S E V O C C D E T R P N Scheduling Phones a,. Patient Satisfaction b. Process Efficiency c. Volume & Revenue 10 Ratio of personnel on phone to volume of calls 10 None None 8 800 1.Clinical air traffic controller 2.Auto attendant br. logic 3. E-Scheduling 4. Time study - Balance call volume/cycle time/takt time/FTE Jean Daversa & Joan Young 05/29/15 1. Phone tree standard established 2. Observation data being collected 10 6 3 180 Scheduling Phones a,. Patient Satisfaction b. Process Efficiency c. Volume & Revenue 10 Patients call about medication refill errors 8 None None 8 640 1. Advanced clinical intelligence 2. EMR optimization Jean Daversa/ Joan Young 06/15/15 1.Current and future states: mapping and standard work created 2. RX refill policy to be attached 3. Approval needed by Dr Ehrig 10 5 3 150 Rooming Arrived Status a,. Patient Satisfaction b. Process Efficiency c. Volume & Revenue 10 Provider recognizes patient has arrived to practice but still registering at front. 8 None None 6 480 1.Deconstruct provider template 2.Advanced clinical intelligence 3. EMR Optimization 4.Patient arrival time & scripting work Jean Daversa/ Joan Young 06/15/15 1. Pilot underway with Dr. ; initial results positive; 2.Standard work drafted and will be communicated to providers May 27 10 6 3 180 Failure Mode and Effect Analysis (FMEA) Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 9
10. Countermeasures Implemented 1. Standard Phone Tree - Standard scripting implemented 2. Reduce Wrong Calls - Express Care line removed 3. Analysis of Calls – Volume, types, cycle time, takt time, TOD variations (time of day) 4. Staff Optimization – Peak staffing; addition of 2 front office staff + clinical air traffic controller 5. My LVHN Portal – Marketing and tracking 6. Training - Front line staff trained to optimize cycle time 7. Control Plan – Assigned process owner to maintain call metrics via visibility wall & daily huddle 10 39% 49% 46% 37% 22% 14% 0% 10% 20% 30% 40% 50% 60% Feb Mar April May June July % Abandoned Abandoned Calls Target=9% Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
11. . Deconstructing Provider Template Bundled Solution Number 1 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 11
12. JOB AID: Deconstructing Provider Templates Why? Resons for key points Who? Primary Care: Follow Standard Visit Types Established by LVPG Leadership (Link to documentation) LINK TO EPIC REPORT Specialty Care: 1) Look at which visit types are being used most often. 2) Remove visit types that are not frequently used. Discuss with practice leadership what visit types are necessary for scheduling accuracy. Create standards on when each visit type should be used. Practice Manager/Pract ice Lead/ Office Coordinator 1) Standardize length of each visit type 2) Standardize how/when visit types are scheduled throughout the practice 3) Follow Standard Work for scheduling patients with those established visit types. INSERT EXAMPLE DOCUMENT LINK Practice Manager/Pract ice Lead 1) Review the actual cycle time compared to visit duration in EPIC DAR. 2) Visit duration includes the actual clinical time a patient interacts with a provider. INSERT LINK TO MPC EXAMPLE Practice Manager/Pract ice Lead 1) Reduce blocks in schedule for administration, meetings, and chart prep. 2)Track the number of open appointment blocks being saved for acute appointmemts INSERT SAME DAY ILL TRENDING REPORT LINK (EA PUBLIC NCG DATA) Utilize the Daily Management System to review open slots on a daily basis. Communicate open slots with providers. Practice Manager/Phys ican Lead 1) Open schedule templates to allow for any visit type at any time, based on patient preference Practice Manager/Pract ice Lead 1) Compare contractual clinical time to what is built in EPIC template LINK TO DASHBAORD REPORT WHEN AVAILABLE Practice Manager/Pract ice Lead Job Aid Bundle: 1.0 Deconstructing Provider Templates Countermeasure: 1.1 Streamline Visit Types What? The logical steps to advance the work. 1.1.1 Optimize Number of Visit Types 1.1.2 Standardize Visit Types Why 2.1.3 Balance Clinical FTE and NON Clinical FTE time Role 2.1.1 A nalyze scheduling slots and blocks. 2.1.2 Reduce Provider Preferences Variations in scheduling practice create more burden for enterprise scheduling. Providers may request longer durations for visits. Durations should be close to actual time. Multiple visit types create a more complicated template and barriers to finding an appointment. Reasons Key Points/Best Practice Multiple visit types create a more complicated template and barriers to finding an appointment. Creates a stremlined process for enterprise scheduling. Components Provider preferences often create scheduling blocks for certain types of appointments. This blocks patient access. Block in schedules are direct obstacles for patient access. 1.1.3 A nalyze actual duration vs. slot duration A lternative Solution(s) How? Tips that will make or break, avoid injury, make it easier 12 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
13. Schedule Capacity - SAMPLE Expected Clinical Hours Potential Capacity Epic Scheduled Hours (OP Practice) Cancel, Bumps, No- Show Hours Epic Completed Hours (OP Practice) Legend Blue: Key columns Green and Orange: Potential capacity in schedule 13 1 2 3 A B Clinical FTE cFTE Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
14. 14 Data Source: Epic April/May 2015 Check In - Check Out (Epic data) Provider Encounter (est.) Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
15. . Advanced Clinical Intelligence Bundled Solution Number 9 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 15
16. Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 16 F&S History, Chief Complaint, Clinical Interview Allergies Meds ROS Duplicate Clinical Intake Written Static Questions Verbal Intake Process Clinical Staff Prov Inter- view Dup Data Entry MA’s LPN’s Physicians Frequent Flyer Chronic Risk for CC F&S Hist/Factors Healthy Patient Clinical Staff Provider Waiting Rooming Provider Care Planning Discharge Chief Complaint Drill Down Critical Thinking and Follow Up Prospective Review of CI Current State Future State eCare Document Critical Thinking Prospective Review of CI Future State Increased Throughput
17. JOB AID: Advanced Clinical Intelligence Why? Reasons for key points Who? Every colleague has the ability to promote and encourage patients to sign up for MyLVHN, our patient portal. From patient scheduling, front- desk registration, rooming, provider encounter and check-out colleagues should discuss the benefits such as prescription refill requests, scheduling well check-ups, paying copays, etc. A good opening to start the conversation with patients is simply asking "Do you have a smartphone or computer at home?" to identify if a patient would have access to this tool. All reference materials including FAQs, talking points, best practice recommendations and tipsheets are available via the Epic Transformation Share Point Site Understanding not every patient may be comfortable with using technology, a good opening question to start the conversation can be "Do you have a smartphone or computer at home?" This sets up if MyLVHN is an option. However, patients can also have a "proxy" assigned in a caregiver/guardian would like to help manage care for their loved one via MyLVHN. If a patient still refuses, respect their decision. SharePoint site • Utilize standard workflow for PEQs (PDF & Tip sheets – Epic Transformation SharePoint) For some practices, especially high volume, there were some concerns for the impact of PEQs on workflow. As one pilot practice suggested, they started with just piloting the tablet usage in one of their many pods at check-in initially to monitor the impact, get patient/staff satisfaction and then slowly rolled out to all areas of check-in. Clinical Support Staff/Provid ers/Patient Service Reps. Allows patients to complete registration items in advance of appointment. What can they do: – Verify and update demographics – Verify and update meds and allergies – Answer patient questionnaires – Pay copayments • Utilize standard workflow for PEQs (PDF & Tip sheets – Epic Transformation SharePoint) Again, not all patients may not welcome signing up for MyLVHN. In the case where a patient does not have MyLVHN, in the future, a patient may use the tablets currently used for PEQs to complete aspect of registration/check- in. Currently, if a patient does not have MyLVHN, please follow your normal instructions for patients to check-in. Patient Services Representa tives and clinical support staff Pilot Practices Only • E-visits can replace in-person visits for routine issues like pink eye or sinus infections, freeing up your providers for more complex appointments. Role Why • Complete most of check-in process from the convenience of home via MyLVHN • Save patients time when they arrive at practice • Extension to our expanded online scheduling and questionnaire capabilities • Registration process benefits for patient services representatives • Better patient experience at the office front desk -Minimizes arrival “paperwork” -Minimizes concerns about privacy 1.1.4 Utilize E-Visits (Pilot Practices only) • Patient entered questionnaires allow patients to answer questions prior to their visit. This saves valuable charting time for the clinical staff and provider, who now only needs to verify the answers, rather than enter the answers at time of visit. • Pilot practices have benefits from decreasing average encounter times from 3-12 minutes. How? Tips that will make or break, avoid injury, make it easier Reasons Key Points/Best Practice Components • Increase patient satisfaction: allows providers to more frequently interact with patients who are able to communicate directly to their providers. • Improve practice efficiencies: since patients can view results online, schedule appointments, message providers, etc. it decreases the amounts of calls to the practice and relieves time for staff and providers to focus on direct patient care appointment. • Patient engagement: patients are involved in their care outside the walls of LVHN, messaging their care teams, viewing their health histories and results, and taking a proactive stance to manage their health. A lternative Solution(s) 1.1.3 Utilize eCheck-In Job Aide Bundle: 9.0 Advanced Clinical Intelligence Countermeasure: 1.1 What? The logical steps to advance the work. 1.1.2 Utilize Patient Entered Questionnaires (PEQs) 1.1.1 Promote use of MyLVHN All Colleagues 17 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
18. . EMR Optimization Bundled Solution Number 10 18 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
19. Patient Engagement Strategy – Year 1 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 19
20. Patient Engagement Strategy – Year 2 20 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
21. LVPG Operations Dashboard • By Department Specialty Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos 21
22. 22 • The overall improvement in patient experience at LVHN’s Physician Practice Group increased from 87.2% to 91.0% over a 12- month period • Equates to moving up from 37% to 64% national ranking Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
23. 23 • Improving patient Experience goes hand-in-hand with patient Access • LVHN increased completed appointments by 13% over a 9-month period Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
24. 24 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos Results Achieved - Operations Dashboard ▪ New Patient Lag-best practice is one decile improvement within one year - Primary Care: 23% to 44% (two deciles) - Specialty Care: • 9 specialties moved at least two deciles • 5 specialties moved at least one decile ▪ New Patient Visits-normalized for provider growth, increased 49% year over year ▪ Enterprise Visits scheduled-79,178 ▪ Provider Schedule utilization-APC’s 68% to 76%, Phys. 87% to 92%
25. 25 Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos ▪ 111,001 patients activated on our patient portal in just over one year (fastest rate of any Epic client)-presented at Epic UGM Summer 2016 ▪ In network referral capture rate reached 84% ▪ Outpatient practice visits (exclusive of new providers) increased by 10.5% or 120,276 visits ▪ Same day block utilization-APC’s 33% to 63%, Physicians from 64% to 74% Results Achieved - Operations Dashboard
26. 26 Beg QMAP Template/ Solution Bundles Develop Action Plan/ Countermeasures Define and Report Improvement Metrics Implement Changes Report Progress/Did the Metric Change? 1 4 3 2 1 5 Yes No 1. Survey Results 2. VOC/QFD Analysis 3. ID Solution Bundles 4. ID Countermeasures Aligned with Solution Bundles 5. Define Process Metrics for Each Countermeasures 6. Develop Job-Aids for implementing Countermeasures Begin Next Cycle Ops & Physician Practices Development Team Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos
27. Action Plan LVPG Neurosurgery – CC/MH (Care Team - Schedule & Structure) Item # Date Issue Action Who When Update 1 11.22.16 Inability to respond to patient concerns in a timely manner Increase training of MA team to better handle questions which are typically forwarded to RN or provider. Clinical Manager, RN 12/5/16 MAs are handling more calls and working to respond more quickly to clinical concerns. Additionally, MAs are better utilizing APCs and RN to retrieve information rather than waiting for answers. Increase clinical support staff by adding an RN to assist in call triage and clinical responses Practice Leadership FY18 Approved for FY18. Recruiting will begin when budget is final. Target of start of FY18 2 11.22.16 Inconsistent rooming process causing less efficient rooming and unnecessary delays. Work with HR to fill all vacant MA positions. Increase speed of interview and screening process to improve selection process. HR, Practice Leadership Prior to formal action plan All MA Positions currently filled. 2 newest MA’s in training process. Return to more standardized clinical teams to ensure improved efficiency Clinical Manager, Practice Director Upon full compliment of MA support With all MA positions filled we now focus on aligning MA, APC and surgeon to return to a more care team focused approach. No longer a need to pull from one team to cover another as all teams are currently fully staffed. Effective Countermeasures:  Successfully recruited for all budgeted MA positions.  Approved for increase in clinical support to provide more timely response times  Improved stability of MA assignments in alignment with provider schedules Barriers:  Limited pool of strong MA candidates  Difficulty creating consistent workflow without full compliment of clinical support staff.  Increasing volume and demand with increase of surgeons Patient Experience Summit/Cleveland, OH/22May2017/Chowdhury & Demopoulos