An Interdisciplinary Curriculum for Multi-faceted and Innovative Team- based Care in a Residency Program and Beyond Paul Misch, M.D. Anne Van Dyke, Ph.D., ABPP Lori Lackman-Zeman, Ph.D. Elena Kline, PharmD, CGP Elie Mulhem, M.D.

Disclosures The speakers have no actual or potential conflict of interest in relation to this presentation.

Objectives 1.Define the key players in team-based care(TBC) and inter- professional education/training (IPE). 2.Identify the components of multi-faceted team-based curriculum. 3.Develop a preliminary plan to implement/expand upon multi-faceted team-based care in your residency program.

Interdisciplinary Curriculum: Why? Changing Health Care Environment – Increased Complexity – Population Health – Social Determinants of Heath – PCMH – Triple Aim / Quadruple Aim ACGME / RRC Requirement

Develops Relationships & Effectively Communicates with Health Professionals and Health Care Teams Level 1 – Understands the importance of the health care team and shows respect for the skills and contributions of others Level 2 – Demonstrates consultative exchange that includes clear expectations and timely, appropriate exchange of information – Presents and documents patient data in a clear, concise, and organized manner Level 3 – Communicates collaboratively with the health care team by listening attentively, sharing information, and giving and receiving constructive feedback – Effectively uses Electronic Health Record (EHR) to exchange information among the health care team Level 4 – Sustains collaborative working relationships during complex and challenging situations, including transitions of care – Effectively negotiates and manages conflict among members of the health care team in the best interest of the patient Level 5 – Role models effective collaboration with other providers that emphasizes efficient patient-centered care

Coordinates Team-based Care Level 1 – Understands that quality patient care requires coordination and teamwork – Participates as a respectful and effective team member Level 2 – Understands the roles and responsibilities of oneself, patients, families, consultants, and interprofessional team members needed to optimize care, and accepts responsibility for coordination of care Level 3 – Engages the appropriate care team to provide accountable, team-based, coordinated care centered on individual patient needs – Assumes responsibility for seamless transitions of care – Sustains a relationship as a personal physician to his or her own patients Level 4 – Accepts responsibility for the coordination of care, and directs appropriate teams to optimize the health of patients Level 5 – Role models leadership, integration, and optimization of care teams to provide quality, individualized patient care

Definition of Interprofessional Education “ Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. – Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. – This is a key step in moving health systems from fragmentation to a position of strength.” World Health Organization (WHO). (2010).

IPE is NOT: Students from different health professions in a classroom receiving the same learning experience without reflective interaction among students from the various professions A faculty member from a different profession leading a classroom learning experience without relating how the professions would interact in an interprofessional manner of care Participating in a patient care setting led by an individual from another profession without sharing of decision-making or responsibility for patient care

Key Players Dependent on the following factors: – Requirements of the target patient population – Site-specific model of care Clarify differences between similar roles to avoid duplication of efforts

Patient & Family OT/PT Dietician Health Coach Complementary & Alternative Medicine Data Analyst Pharmacist Psychologist Psychiatrist Social Work Case Manager/Navigator Financial Advisor/Support Primary Care Physician Specialty Care

Pharmacist IPE: Next Steps to Consider Collaborate with Oakland University William Beaumont (OUWB) Medical School Pharmacologists – Medication Adherence Day Patient case review with clinical pharmacists – Simulation Lab “Buddy system” between medical and pharmacy students – Module development To address topics in which students experience the most difficulty – Lecture(s) Clinical pharmacist to review clinical pearls of common disease states with students on rotation at the site

How are Pharmacist Clinical Services Justified in a Hospital-based Outpatient Clinic?* Medicare Annual Wellness Visits (AWVs) – Initial visit (G0438) – Subsequent visit (G0439) Comprehensive Medication Management – Incident-to physician; facility fee billing (G0463) Transitional Care Management (TCM) – Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Moderately complex w/in 14 days of discharge (99495) Highly complex w/in 7 days of discharge (99496) *In the state of Michigan, pharmacists do not currently have provider status

Average Charge/Reimbursement Associated with Coding Method of Reimbursement Billing CodesPotential Reimbursement/ Charges Notes Annual Wellness Visits (AWVs) Initial G0438 $274/visit Fully covered by Medicare No copay for patients Subsequent G0439 $183/visit Comprehensive Medication Management G0463$90/visit Avg national reimbursement $207/visit Charged by our facility Collaborative practice agreement recommended (unclear if required) Bill incident-to physician Transitional Care Management (TCM) Moderately complex $135 Avg national reimbursement Payment allowance will vary geographically Highly complex $197 Avg national reimbursement

Interprofessional Curriculum Components What are the components that make up inter- professional education and team-based care? – What curriculum pieces are needed to effectively teach IPE and TBC? – How do we promote learning beside each other and about each other?

How We Promote Interdisciplinary Learning Learning from various team members about their role in the curriculum List team members, how to contact, how to strengthen team relationships Meet team members at new residents orientation Be present in precepting room, listen and step in – “I can help with that”

Reverse shadowing during Community Medicine, Psychiatry and FMC months Attend diabetes education class Attend Workability program Join morning hospital rounds Join huddle at beginning of office How We Promote Interdisciplinary Learning

Making It Work In Your Setting What is needed to expand IPE and TBC in your setting? – What is needed to enhance teaching IPC and TBC? – What would you like to see added to your curriculum?

Our Residents’ Ideas List resources in chart note along with interventions from team members Tape visits with patient consent for resident to review (allows learning from other team members) Role playing at lecture (resident takes patient role) Pharmacy teaching about use of insulin pens, etc Monthly IPE conference with various team members

Summary Define the key players in team-based care(TBC) and inter- professional education/training (IPE). Identify the components of multi-faceted team-based curriculum. Develop a preliminary plan to implement/expand upon multi-faceted team-based care in your residency program.

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Paul Misch, M.D. Anne Van Dyke, Ph.D., ABPP Lori Lackman-Zeman, Ph.D. Elena Kline, PharmD, CGP Elie Mulhem, M.D.