B uilding Blocks for Effective Primary Care for the Underserved: A Bold New Curriculum? Walt Mills, MD UCSF Natividad FMR Monterey, California Jeremy Fish, MD John Muir FMR Walnut Creek, California April 2015

Disclosures Dr Mills and Fish have nothing to disclose

Learning Objectives Upon completion of this session, participants should be able to: Access the UCSF Center Excellence in Primary Care online programs, research, models as well as the UCSF Primary Care Leadership Institute. Use the Building Blocks for Effective Primary Care self assessment tool. Describe some of their academic institution's curriculum that already fit the Building Blocks (QI, Leadership, Team Based Care, Chronic Care, Coordinated Care, etc) and start to develop new ideas on curriculum to address identified gaps in curriculum.

Joint Commission on PCMH Principles (2007) Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, and continuous and comprehensive care Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or arranging care with other qualified professionals Care is coordinated and integrated across all elements of the complex healthcare community- coordination is enabled by registries, information technology, and health information exchanges Quality and safety are hallmarks of the medical home- Evidence-based medicine and clinical decision-support tools guide decision-making; Physicians in the practice accept accountability voluntary engagement in performance measurement and improvement Enhanced access to care is available - systems such as open scheduling, expanded hours, and new communication paths between patients, their personal physician, and practice staff are used Payment appropriately recognizes the added value provided to patients who have a patient- centered medical home- providers and employers work together to achieve payment reform Joint Principles of the Patient Centered Medical Home: published on:

What is a PCMH model trying to achieve? The “Triple Aim”  Improve Patient Experience of Care  Improve Health of People and Populations  Reduce Cost per Capita  Joy in practice!

Effective Team Structure AND Culture Helps Mitigate Burnout Willard-Grace R, et al. “Team Structure and Culture Are Associated With Lower Burnout in Primary Care”. J Am Board Fam Med 2014;27:229–238

How do we build our home?

“The Building Blocks of High-Performing Primary Care: Lessons from the Field” Rachel Willard, MPH; Tom Bodenheimer, MD, et al 2012 Center for Excellence in Primary Care, UCSF

The Harvard Medical School Academic Innovations Collaborative: Transforming Primary Care Practice and Education Early evidence of benefit of a "foundational building block" transformative process Model of 1.5 days collaborative gatherings 3 times per year Used four foundational Building Blocks: –Engaged Leadership and Team-Care –QI methodologies Academic MedicineSeptember Volume 89 - Issue 9 - p 1239–1244September Volume 89 - Issue 9 - p 1239–1244

National Collaborative of Collaboratives Our National “conversation” Webinar: Collaboration and Practice Transformation in Residency Education Mar 2015 “PCPCC/Primary Care Progress webinar about the Collaborative of the Collaboratives – 4 residency program collaboratives on practice transformation (Colorado, Pennsylvania, I3 Carolinas, AIC Harvard).” Teaching clinics in each of these programs.

L177 Team Based Care in Academic Practices Tom Bodenhiemer and Kate Dube Poster Session: Pacific Hall after this meeting!

PCMH e-Learning Curriculum Modules

UCSF Greater Bay Area FM Education Collaborative UCSF Santa Rosa FMR UCSF Natividad FMR UCSF Fresno FMR Contra Costa FMR Kaiser Permanente Vallejo FMR Stanford and Touro Medical Schools; Stanford O’Connor FMR

UCSF Center for Excellence in Primary Care

BUILDING BLOCKS OF PRIMARY CARE ASSESSMENT (BBPCA) Survey to assess the organizational change of a primary care practice as measured against the 10 Building Blocks of High Performing Primary Care. The instrument is a modification of the Patient-Centered Medical Home Assessment Tool (PCMH-A) –developed by the MacColl Center for Health Care Innovation. –The BBPCA incorporates all of the original items from the PCMH-A, reorganized into the framework of the 10 Building Blocks –includes a number of supplemental questions to examine areas not addressed by the PCMH-A.

Report Out Describe some of your academic institution's curriculum that already fit the Building Blocks –(QI, Leadership, Team Based Care, Chronic Care, Coordinated Care, etc) Start to develop new ideas on curriculum to address identified gaps.

Your plan to address curricular “gaps” identified Empanelment still vague Facilitative Leadership “fatigue”; Kotter Leading Change…Anchoring/culture….Residency taking on “ownership” for FMC Data Driven Improvement….need optimization of EHR; Faculty Role Modeling Needed….Engaged Leadership! Coordinating QI w Leadership/Institution

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