Federally Qualified Health Centers in Cleveland NFP is one of 5 - - PowerPoint PPT Presentation

Federally Qualified Health Centers in Cleveland

 NFP is one of 5 FQHCs in

Cleveland; 43 in Ohio

Neighborhood Family Practice

 Founded in 1980  6 locations serving the near west

side

 Served 16,092 patients in 2014  Bilingual staff & providers  Integrated Primary Care and

Behavioral Health

 30 Medical & BH Providers on

staff--9 Family Practice MDs, 10 Family Practice CNPs, 3 Certified Nurse Midwives, 1 Psychiatrist, 1CNS, 6 LISWs or LPCCs, 1 Psychologist

 Focus on the medically underserved

population

Neighborhood Family Practice - Facts

 Recognized by NCQA as a Patient

Centered Medical Home (PCMH)

 Accredited by the Joint Commission  Focus on families  Growing midwifery program  Sole refugee provider for Cuyahoga

County

 30% of patients are Hispanics  Patients are able to access services on a

sliding scale

 Over 60% patients are on Medicaid  Uninsured rate has dropped from 23% + to

10% with the ACA and Medicaid expansion in Ohio through the work of our Patient Benefits Department

Neighborhood Family Practice

 Primary Care  Behavioral Health  Midwifery  Refugee Clinic  School Based Health

Why Care Teams?

 Working from NFP’s 2009-2011 Strategic Plan, NFP identified

the following areas to be addressed:

 Implementation of EMR system in 2010  Improvement of patient’s health and safety  Improvement in NFP’s financial performance  Increased provider, staff and patient satisfaction  Becoming an NCQA Patient Centered Medical Home

Care Teams

 A Care Team has been defined as: A panel of patients who

usually see or choose a particular group of providers for their care AND the group of staff who generally work together for the care of that panel of patients.

Care Team Composition

 Two to Three Providers—combination of Family

MDs, Family CNPs, and one Midwifery Team with 3 CNMs

 Two RNs  One Patient Advocate  Medical Assistant for each Provider  Front Office representative at each team meeting  Behavioral Health representative at each team

meeting

NFP Circles of Care

Patient

Contract IT Staff OCHIN/ Epic

Information Technology

NFP IT Staff & Medical Records Nurses, MAs, Patient Advocates

Clinical

Providers, CNMs & Behavioral Health Community Agencies Front Office Billing & PBS

Administrative

Management & Executive Leadership

Care Team Innovations

 Enabling Providers to practice at highest scope. Professionals will work at

the top of their licenses if:

 They have people they can delegate to. At NFP this was done by increasing the skill set

• f:

 Medical Assistants  Patient Advocates

 There are effective communication methods

 Ex: In-basket messages within the EMR to make clinical communication efficient  Fostering a Culture of Improvement and Change  Team trainings help decrease hierarchical systems (TEAMSTEPPS, Practice Coaching)  Team meetings for peer and cross professional feedback  Tracking and monitoring operational and clinical goals of the Health Center  Developing policies and procedures for EMR system and Care Teams at NFP

 Developing new procedures around scheduling, registering patients & directing

phone calls to teams

Staffing Innovations

 Medical Assistants

 Train Standard duties  Increase EPIC entry fields and consistency  Train to be proactive and anticipate provider needs, and increase assessment and

documentation skills

 Patient Advocates

 Use of standing orders and protocols allow PAs to unload the provider and nursing

workload and address health disparities

 Use registries to identify gaps in healthcare  Identify high risk patients for case management by nurses  Increase patient’s access to the Care Teams by helping with patient communication and

correspondence

 Nursing Role

 Redesigned nursing staff structure to provide individual nurses to care teams.  Work at the top of their license as a member of the Care Team

Support Services

 Available In-Office Support includes:

On-site Behavioral Health On-site Clinical Pharmacist RNs provided by insurance companies Wellness Coordinator Medication Assistance Program

NFP Behavioral Health Services

 NFP offers BH services to established patients  Psychotherapy, Psychiatry, Therapy with Children &

Families

 Services offered at all locations  Integrated approach—

 Therapists are included as members of the primary

care team

 Therapists are steps away from the primary care

providers and are available for warm and hot hand-

• ffs

 7,349 visits provided in 2014

NFP Midwifery Program

 NFP's Certified Nurse Midwifery Program has been

providing a unique birthing option on the near west side of Cleveland since 2006.

 Prenatal care, education for the mother and family,

nutrition education, and supportive, healthy births are all important components of the Midwifery Program.

 CenteringPregnancy is a group model of care

• ffered at NFP with excellent outcomes for

participants.

NFP and the Refugee Population

 Sole refugee screening provider in Cuyahoga

County

 Consists of two visits:

 Health history, appropriate screening labs, immunizations  Complete physical exam  NFP is the only site in Ohio able to see (former)

refugees for regular primary care after the screening process is complete (80% of which do return).

 NFP welcomed approximately 700 refugees in

2014 alone

NFP School-Based Health

 NFP began exploring school-based health in

summer 2014 and initiated mobile van services at a local elementary school in February of 2015

 Services offered

 Immunizations  Urgent/sick visits  Sports physicals  Routine office visits  Medication management  Routine bloodwork  Follow-up care

 LEAN/Six Sigma Efficiency Project  3 year partnership with GE in their Developing Health Program to seek solutions that can help the

health center increase efficiency and standardization

 Decreasing Wait Time  Integrated care at current sites and a new behavioral health agency  Working on a new partnership to offer primary care in a behavioral health agency setting  EMR optimization  Continuously examining the system and its utilization to drive improved workflows

 Optimizing Care Management

 Continuously examining the roles of MAs, Patient Advocates and Nurses to ensure that NFP is

• perating with the highest level of support to the provider

 Patient engagement via the use of technology  Signing up patients for MyChart/educating them/testing tools such as p thx questionnaires

and piloting MyPreventative care which provides health personalization and self management tools.

 Collaboration and Partnerships in the community  Optimizing the Clinical Pharmacist & Wellness Coordinator Roles

What we are currently working on

What are we measuring ?

 Clinical Outcomes

Chronic Disease Management—specifically measurements around DM and HTN

control

 Financial Performance

Patients per hour No show rates

 Patient Satisfaction

Efforts to decrease waiting time Overall satisfaction with NFP and providers

Questions ???