MATEC HIV Practice Transformation Update National Practice Transformation Community of Learning October 6, 2016

Mile Square Health Center – South Shore IL FQHC No Partner Clinic LP Funding PCMH? Mile Square Health Center – South Shore IL FQHC No Regional Care Association Ryan White Part A funded CHC Eskenazi Health Center at Grassy Creek IN Yes Shalom Health Care Center Community Health Centers of SE Kansas KS Genessee County Health Department Primary Care Clinic MI Ryan White Part A and B funded CHC Wayne County Health Communities West Side Community Health Center – La Clinica MN Ryan White Part A and B funded FQHC Myrtle Hilliard Davis Comprehensive Health Center MO Health Partnership Clinic One World Community Health Center NE McMicken Integrated Clinic OH-CIN Free Medical Clinic of Cleveland OH-COL Outreach Community Health Center WI

Our Roadmap: 10 Building Blocks of High Performing Primary Care Here’s the model we plan to use in working with you… It was developed by a team of researchers and clinicians at UCSF Center for Excellence in Primary Care. They identified practices using a snow ball approach, asking leadership from the site to recommend other high-performing sites (defined as High levels of staff and patient satisfaction, Clinical quality metrics that had improved over time, Stable financial base © 2013 UCSF Center for Excellence in Primary Care. Bodenheimer T., Ghorob A., et al. The 10 Building Blocks of High Performing Primary Care

MATEC Practice Transformation Timeline Review Assessment data and develop & present initial project goals/ recommendations Introduce Data & Performance Measures May June July August September October PROJECT WORK Baseline Organizational Assessment deadline (5/26) Building Blocks Assessment/Probing Questions deadline 7/31 Aggregate Data & Performance Measures deadline (10/31)

Partner clinics’ highest priorities related to delivery of patient-centered care include: More effectively engaging patients on clinical decision-making regarding their care (92%). Periodically checking the practice registry to identify patients who are due for routine services (83%). Creating teams with well-trained clinical support staff to add primary care capacity (83%). Enhancing the coordination of care through the use of provider teams and improved referrals (75%).

Partner clinics’ highest priorities related to HIV Care and Treatment include: Providing primary medical care to patients with HIV (75%). Initiating antiretroviral therapy (67%). Conducting adherence counseling and monitor adherence (67%). Initiating care to prevent and treat co-morbid conditions (e.g., opportunistic infections, cancer, etc.) (67%). Achieving viral suppression among patients receiving HIV medical care (67%).

Other Identified Needs from review of Baseline Organizational Assessments: Developing comprehensive individual HIV care management training, mentoring, and development plans for clinical providers and key support staff to enable the provision of HIV care management of PLWH (100%). Developing and/or expanding the development and implementation of formal written procedures for HIV-specific care (83%). Exploring and/or expanding the use of standing orders (67%). Optimizing the clinic referral relationships to improve coordination and continuity of care (58%). Standardizing HIV care workflows to ensure that they have been documented, are used, and are evaluated and monitored on a regular basis to promote efficiency and quality of care (50%).

Project Coordination Monthly Coaches’ Learning Community Meetings (3rd Wednesday each month) Online Project Management Tool – Basecamp Coach Online Forum Document Library Calendar Google Calendar HPTP ListServ Emails (reminders, meeting notes) Project Update Survey (Piloted in July)

Bi-Monthly Project Update Survey Time spent on project is allocated to various practice transformation coaching activities

Bi-monthly project update Survey (cont) A free form narrative provides an overall description and assessment of progress during the tracking period. (Note things such as milestones achieved, lessons learned, changes in focus or direction, or areas needing further attention.) Tracking surveys are reviewed by coordinator to: Monitor and assess individual and overall project progress Determine where additional coach coaching may be merited Identify possible peer coach collaboration Measure individual and overall project effort and use of time

Coach Development - Training Initial Training - 3-day intensive Practice Transformation Coaching/Building Block of High Performing Primary Care training in November 2015 presented by UCSF Center for Excellence in Primary Care. Practice Coach Professional Development Training Plan Assessment was completed in July/August to assess coach development existing knowledge and development priority

Assessment Categories –Ranked By development priority Empanelment Team-based Care Health Care Environment Quality Improvement Data Collection Management Organizational Development Practice Facilitation Background Health Information Technology Work Flows

Top 10 (11) Development topics Development of protocols to support continuous improvement Best practices in team-based care Training panel manager and creating protected time Optimization of an electronic health record to support practice transformation Core competencies of practice coaches

Top 10 (11) Development topics (cont) Typical stages of facilitation process General knowledge of panel management/population Optimizing data reports to support panel management Ability to use multiple electronic health records Coaching leaders, clinicians, or staff on roles in change General background on practice facilitation/coaching

Coach Development Strategies Coach Basics – conference and workaround plan for those not attending Monthly Coaches Collaborative Call Monthly Coaches Learning Community Call – mini trainings Lightning Learning - To be introduced 10/12/16 Webinars – Ask the Expert Q & A’s Mini Collaboratives Project Goals Electronic Health Record Assessment Low Capacity High Priority Findings Ryan White vs FQHC Low incidence vs high incidence states Culturally specific challenges Resource Library – https://hptpcoachlearningcorner.wordpress.com/

PROJECT BARRIERS Retention of leadership, clinical staff, and support staff Time and resources Participation and representation Competing demands Training Funding Cultural Barriers Literacy Provider interest in providing HIV care management Capacity Resistance to chance

Lessons learned Establishing regular meeting times Importance of vertical and horizontal buy-in Fragile relationships burdened Project delays Incomplete/staggered assessment rollout Initial assessment burden Establishing regular meeting times Gain early successes building on coach strengths Observation Regional Collaboration