Care Coordination & Implementing Services Rachel Bakersmith Practice Administrator, Children First Pediatrics

Goals: Deciding to implement Steps taken to implement Resources Patient and practice benefits  

What to implement? Concussion Testing Lactation Nutrition Therapy Cardiology (co-locate) Long term plan? What else are your patients looking for that you can provide?

Care Coordination Goes hand in hand with new services But can be just as valuable alone Can be new staff or restructure current Can be part time/full time Types of care coordination we use: Referral tracking Lab tracking Patient education Crisp follow up Asthma teaching/educaton Mental health With implementing new services or on it’s own this can improve patient care, improve processes in your office and overall improve costs

Why Integrate? Barriers we currently face: Lack of Patient compliance when you refer out Insurance limitations with community specialists Insurances are rating you Limited availability or timeliness of appointments Knowing if patient complies/adheres to plan with specialist Stigmas associated with certain services Not knowing the specialist so less invested/compliant Smaller practices can’t necessarily afford a full time specialist or even part time Other reasons: Higher patient satisfaction Patients routinely come to PCP office so why not make services more accessible and improve quality of care? Successes from Integration Patient satisfaction will increase Costs to insurances may be more controlled More control over where your patients are going and for what Better outcomes Better tracking of your patients and knowing they are actually scheduling appts

Why now? Insurances are rating you on some of these services Patients want them Patient compliance much higher Less Insurance limitations and great when negotiating More availability or timeliness of appointments or ability to create a waiting list and track pts Better follow up from specialist and PCP going forward-knowing the plan/adherence Stigmas mostly eliminated if they come to their PCP They see familiar faces and trust the specialist more and their opinion Smaller practices CAN have these services. We share our therapists with other offices to help those smaller practices have the same services as larger ones. See me sometime today and I can explain more. Patient satisfaction increases OVERALL QUALITY OF CARE IS IMPROVED

Starting point… Anytime we implement a change in our practice we asks ourselves 2 questions: 1. Will it improve the quality of patient care? Is it financially sustainable? Start with one or two that are doable for your practice and consider: Space/cost (not just salary/benefits but EMR fees, license fees, etc.)/staff training/how will you find the person? Consider breakeven point and utilization How long will it take you to make your costs back? What are your patients asking for? What is giving your practice the most trouble?

Now what? Do your research: national/local organizations, other practices Will you fully integrate or co-locate Decide on Goals Decide on timeline Insurance Implications Who needs additional training? Who will lead training? What roles will each employee have? Does the schedule need to be adjusted? What space/materials we will use? Reassess all of these

Our experience Concussion Testing Nutrition Cardiology (co-locate) We use IMPACT testing (same as the NFL, NBA, etc. use). Minimal cost –computers, trained 2 physicians to interpret, purchase tests (baseline and Post-injury) Easy to bill and most insurances cover post-injury. Self pay for baseline Little follow up time from a billing perspective Minimal space-can use an IPAD for 11yrs and younger and a desktop or laptop for over 11yrs Lactation important to know the different types of coding some billing quirks and nuances for certain insurances received well by patients Volume can be tricky-slow weeks and busy weeks Nutrition challenging Insurance difficult Tough buy in from families Hard to fill schedule because families don’t want to miss school/work for this visit Cardiology (co-locate) We do the scheduling in our EMR but minimal resources Provide the space and referral/demographic information

Most recent integration? Therapy 1 Psychologist and 3 LCSW-C (know the licenses) Challenges: By far the most challenging, time intensive and REWARDING Took the most time and planning Takes the most employee training and implementation Most “learning curve” and growing pains Most labor intensive to continue but benefits outweigh the costs

Therapy integration Successes: Psychologist and 3 LCSW-C All perform various types of CBT, play therapy, etc. Real time Collaboration between PCP and therapist to close the loop on a patient ER/Inpatient admissions for mental health reasons dropped by 50% in one year More than 280 patients in one year that would otherwise likely not have seen a therapist Compliance Getting intervention before the crisis Less stigma and more utilization Bill insurances –easiest to bill More proactive in creating policies/procedures

Overall We have developed better protocols How to handle the emergencies for mental health How to utilize BHIPP and other resources better Handouts on nutrition to give pts during well visits Better education for the staff in all of these areas Change in morale of the staff We give our patients more complete care and can close the loop

And now???? Would we do it all again? Now pick one!! Take the leap! All offices small/large can make some of these work

Resources www.aap.org -Pediatric Practice Management Alliance (PPMA)….join! www.mdbhipp.org –Maryland Behavioral Health Integration in Pediatric Primary Care. For mental health assistance including speaking with a psychiatrist www.apa.org –American Psychological Association www.iblce.org IBCLC information and resources

Questions? Rachel Bakersmith, Administrator Cynthia Fishman, MD Cell: 301-938-6342 doctors@childrenfirstpediatrics.com cindy@hsgear.biz