CHALLENGE

Primary care patients at a large health network in the Southeast could rarely see their known provider for acute visits, and usually resorted to competing urgent care centers for such needs. In addition, regularly scheduled patient visits meant long lines in the waiting room and equally long wait times in the exam room.

Management desired to expand patient access but recognized that demanding more effort from their overworked providers and staff would simply push them across the line into full-fledged burnout. Management also wisely recognized that small incremental steps would not achieve the desired result; deep-seated process transformation and culture change would be required. So, they turned to Team Care Medicine (TCM) to help expand patient access.

ENGAGEMENT

Consultants from TCM partnered with executives and with practice managers to develop a customized TCM Model™ transformation program to maximize the performance of each primary care exam room team. Over the course of three months, all aspects of the practice’s operation were considered, including staffing levels, workflow processes, facility constraints, EHR settings, and provider incentives.

TCM consultants and trainers then executed the launch plan, working with each provider-led team to transform the patient visit through interactive classroom sessions as well as coaching in the exam room during live patient visits. Over the next few weeks, the Medical Assistants (MAs) expanded their activity to practice up to the limit of their license as Team Care Assistants (TCAs). Their role in each patient visit expanded to include many new tasks, including independent collection of the patient’s preliminary medical data, scribing of the provider’s physical exam and care plan, and management of the visit.

In parallel, providers learned to become team leaders that delegate non-physician tasks, relying more heavily on their newly empowered and expanded support staff. With greater team efficiency, they were able to take on additional visits each day and to move through each examination on schedule and with greater focus. And with the EHR tasks delegated to the TCA, providers went home each night with their charts fully up to date.

IMPACT

The custom TCM Model transformation project achieved the desired expansion in patient access.The initial pilot program training group enjoyed an increase in wRVUs per provider FTE of 17% in the first year and 38% by the third year, compared to the baseline control. Meanwhile, total costs per wRVU have held steady. Providers and staff enjoyed better quality of life, too; as one physician put it: “I have no reservation offering my wholehearted endorsement of the TCM Model. It has benefitted my patients, my practice, and my personal life.”

Seeking to further increase patient access, improve financial performance, and enhance staff well-being, management recently partnered with TCM to expand the transformation program across the enterprise, with similar results being reported across the system.

CHALLENGE

Though already exhibiting solid patient satisfaction scores in most categories, leaders at a regional health system in the Upper Midwest recognized that, in the spirit of continuous improvement and in pursuit of the Quadruple Aim, further improvement was needed. Patient satisfaction scores for ‘Access’ and for ‘Visit Efficiency’ were the weakest of all categories surveyed. Patients wanted more punctual appointments and more capacity to schedule urgent visits with the patient’s own physician.

However, with many of their providers already facing burnout from long hours, management recognized that it would be essential to work smarter, not harder.

Perceiving that truly meaningful change to the exam room process would require cultural change, technical training, and new tools, management turned to Team Care Medicine (TCM) to help drive the patient experience to the next level.

ENGAGEMENT

TCM developed a customized TCM Model™ transformation program to maximize the performance of each primary care exam room team. Over the course of three months, all aspects of the company’s system were considered, ranging from staffing levels to workflow processes to facility constraints to EHR settings to provider incentives.

Once the plan was developed, TCM worked with each provider-led team to transform the patient visit. Over the next three months, the Medical Assistants (MAs) were trained to practice up to the limit of their license as Team Care Assistants (TCAs). Their role in each patient visit expanded to cover many new tasks, including independent collection of initial patient data, scribing of the provider exam, and management of the visit.

In parallel, providers learned to become team leaders that delegate non-physician tasks, relying more heavily on their newly empowered and expanded support staff. With greater team efficiency, they were able to take on additional visits each day and to move through each examination on schedule. And with the EHR tasks delegated to the TCA, providers once again looked their patients in the eye, rather than staring at the computer screen.

IMPACT

A year later, proprietary patient satisfaction scores were consistent with the objectives of the transformation. Patient surveys revealed the desired improvements in ‘Access’ and in ‘Visit Efficiency’. The newly-minted TCAs were thrilled to see a leap in patient satisfaction with the ‘Nurse Assistant’ category, pushing them to the top of all survey categories. Executive sponsors were pleased to see the gains in patient access and visit efficiency translate into stronger revenues, with wRVUs climbing 41% per provider leading to a strong ROI from launch of the TCM Model.

CHALLENGE

Forward-thinking leaders at a regional health clinic recognized that the trend toward value-based care would be disruptive to their mission and finances. Though many of their providers faced burnout from long hours, patient access for acute visits was limited and panel screening rates were subpar. The company believed that transforming the exam room process could improve patient health outcomes by way of better patient access and increased provider focus on the patient’s care.

However, management knew from experience that lasting transformation can be elusive. Therefore, it asked Team Care Medicine (TCM) to help with this problem.

ENGAGEMENT

Over the course of three months, TCM developed a customized TCM Model™ transformation program to strengthen the company’s primary care practices. All aspects of the company’s system were considered, ranging from staffing levels to workflow processes to facility constraints to EHR settings to provider incentives.

Once the plan was developed, TCM worked with each provider-led team to transform the patient visit. Over the next three months, the Medical Assistants (MAs) were trained to practice up to the limit of their license as Team Care Assistants (TCAs). Their role in each patient visit expanded to cover many new tasks, including the collection of initial patient data as well as chronic disease screening and management.

In parallel, providers learned to become team leaders that delegate non-physician tasks, relying more heavily on their newly empowered and expanded support staff. With greater team efficiency, they were able to take on additional visits each day and to provide higher quality care.

IMPACT

Within the nine months, the TCM Model transformation accomplished the following:

• Increased panel screening rates for diabetes (+10%), cervical cancer (+8%), and colorectal cancer (+6%), pointing toward measurable long-term health gains

• Increased visits per hour by 28.5%, reflecting better access for patients

• Ensured all charts were complete at the end of each shift, reducing error rates

• Reduced provider after-hours work by 75%, greatly improving job satisfaction and provider work/life balance

• Received enthusiastic endorsement from management, providers, and staff