Transforming the Role of Medical Assistants A Key

Transforming the Role of Medical Assistants: A Key to an Effective Patient-Centered Medical Home Slides developed and presented by: Regina M. Neal, MPH, MSUP, Consultant, Primary Care Development Karen Nelson, MD, MPH, CEO/Medical Director, UNITE HERE Health Center Audrey L. Lum, RN, MPA, Chief of Clinical Services, UNITE HERE Health Center Jenny Tsang, MD, Assistant Director of Clinical Services, UNITE HERE Health Center Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Session Objectives By the end of this session you will be able to: Build a medical home care team with specific & high impact roles for medical assistants Develop a training program for your medical assistants to ensure a high degree of competence and consistency in performance Use huddles, team meetings and provider-medical assistant partnerships for panel management & sustainable improved outcomes Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Current Context Lot’s of interest in new roles for medical assistants in primary care practice Approximately 1. 5 million items in a google search Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Why the Interest? Improve patient care Meet the growing demand for primary care Best use of provider & all the team members Key in building a medical home Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

The Unite Here Health Center Story…How We Saw Opportunity and Seized it Karen Nelson, MD, MPH, CEO/Medical Director, UNITE HERE Health Center Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

UNITE HERE Health Center 275 Seventh Avenue, New York, NY Freestanding Article 28 Diagnostic and Treatment Center Est. 1914 by the ILGWU; now serves members of the UNITE HERE union, their families, and retirees 12 primary care providers, 40 specialists, >50 support staff Multilingual/cultural staff 54 exam rooms, physical therapy, radiology, and pharmacy. Lab services in the same building. EMR and Patient Portal Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

UNITE Health Center 10, 000 active patients 1, 100 DM 85% <200% FPL 60% Spanish-speaking, 66% women Union members insured through Health and Welfare Fund; capitation for a majority of union members Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Transforming Medical Assistant (MA) Roles Donna Lawlor, FNP-C, Primary Care Provider; UNITE HERE Health Center Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Transforming MA Roles For 12 PCP’s and 40 specialist, there are 2 RNs ~ MAs have an important function Gradual process of change Recruitment from select MA schools Multiple roles based on competency: medical assistance, health coach or floor coordinator Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

First Steps – DM Collaborative Basic curriculum for DM Education MAs trained using patient education handouts and a focus on ABCs Review latest lab results (ABCs) with patients while waiting for PCP Monofilament foot exams yearly Pneumovax and annual ophthalmology exams Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Next Steps – SCC and Health Coaches Daily huddles Chart review by MAs Define gaps in current MA curriculum Determine which communication and clinical skills are needed Develop written curriculum and evaluation tools Train and evaluate the staff Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Communication Skills Basic interviewing skills Self-management support, including: Readiness to change assessment Goal setting Motivational interviewing Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Training in Communication Skills NYC DOHMH for self-management support Outside consultants for basic and motivational interviewing Interactive sessions with follow-up based on patient cases Training was tailored to the skill level of medical assistants Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Self-Management Support Training Eight 2 -hour sessions Didactic portion, video clips, and role playing Relationship building – reflective listening, empathy, and non-verbal communication Stages of change Techniques of motivational interviewing Confidence scale Collaborative Goal Setting Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Self-Management Support Training Follow-up after each session to practice with a patient Report brought to next class Techniques tried from last week’s session Example of what went well Example of a challenging patient Questions for clarification Additional follow-up sessions in 2 -3 months Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Self-Management Evaluation Written quiz after completing the 8 sessions Self-management evaluation is included in the evaluation for each clinical topic Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Health Education for Chronic Disease Management Diabetes Hypertension Cholesterol Asthma Smoking Cessation Cancer Screening and Adult Immunizations Healthy Eating/Obesity/Weight Management Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Curriculum and Templates For each topic, templates developed for EMR by PCP staff with MA input Templates refer to handouts that are given to patients MAs are trained using the templates and the handouts Self management is included in each template Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

UHC Training and Evaluation Training by UHC staff Written test Observation for effectiveness of communication skills, delivery of health education, use of motivational interviewing skills and self management goal-setting techniques Skills assessment – monofilament test, peak flow meter and home BP monitor use Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Health Coaches MAs who demonstrate competency in all areas are promoted to health coaches Two health coaches on each Primary Care Team Integral team members Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Health Coaches Follow individual patients Health coaches see scheduled patients for in-office visits and phone follow-up BP checks, goal setting, chronic disease management, smoking cessation, and blood sugar checks Close communication with PCPs and rest of team Review their scheduled patients with PCPs at daily huddles to update plan Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Health Coaches Troubleshoot patient issues Lead patient support groups Center-wide health education campaigns Some health coaches progress to floor coordinators Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

Floor Coordinator Medical Assistant Health Coach Facilitate patient flow and cluster workflow by troubleshooting PCP, MA, and patient needs Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

PCP Buy-In PCPs must be willing to give up tasks and trust MA’s abilities Involve PCPs in template development and training sessions PCP observation of competency for monofilament exam Ongoing team interaction Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community

MA Engagement Increased patient contact and clinical responsibility Outside consultants Nursing support Health coach meetings Slides from IHI's 12 th Annual International Summit on Improving Patient Care in the Office Practice and the Community