1. SHARED MEDICAL APPOINTMENTS Achieving Better Patient Outcomes and Organizational Efficiencies Part 2 Provided as an educational service by Pfizer Inc. NPC0149B1 © 2010 Pfizer Inc. All rights reserved. April 2010 1

2. 2 Agenda SMA Effectiveness Next Steps

3. 3 SMA Studies CHCC-model SMAs have the same patients participating in the SMA, making it easier to determine outcomes –Randomized trials have demonstrated fewer hospital admissions and emergency room visits DIGMA and Physicals SMA studies have tracked their positive impact on access and productivity –Some clinical outcome data is becoming available Patient and physician satisfaction with SMAs is also evident SMA Effectiveness Source: Schmucker D. Group Medical Appointments. 2006:63-64.

4. 4 CHCC Randomized Trial In a study of 1 group-visit model, participants had: –Fewer hospital admissions –Fewer emergency room visits –Lower use of professional services –Lower rate of switching to a nonstudy PCP Based on a survey (78% return rate), CHCC members had: –Higher patient satisfaction with PCP –Better communication with the physician and pharmacist –Better management of medications and conditions Cost of care per patient per month was $41.80 less for group participants (1998 dollars) Source: Scott JC et al. J Am Geriatrics Soc.. 2004:1464-1468. SMA Effectiveness

5. 5 DIGMA Access Study 22-month study (September 1997-June 1999) at large staff model HMO Physician had a backlog of 273 patients past due (ie, who could not get a timely return appointment) vs a 14-patient average past due for other MDs Physician conducted 1 90-minute DIGMA per week from January to mid-December 1998, with past due patients dropping to 101 Physician further decreased backlog to 16 in next 3 months by instituting 2 60-minute DIGMAs/week Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:249-251. SMA Effectiveness

6. 6 DIGMA Productivity Study A pilot study was conducted with 4 physicians at 2 sites of Sutter Medical Foundation in northern California Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:260, 269. Percent increased productivity per MD after 6 weeks Dr. A311.1% Dr. B300.0% Dr. C228.6% Dr. D202.1% SMA Effectiveness

7. 7 Patient Satisfaction DIGMA patients at Cleveland Clinic: –85% scheduled their next appointment in another DIGMA –Over 2 years, patient satisfaction surveys showed 75% rated their SMA experience as “excellent” vs 59% having individual appointments SMA pilot at Sutter Medical Foundation –212 patients gave an average rating of 4.67 (where “5” was high) on satisfaction with their SMA experience Patient comment: “It was good to hear how others are managing their diabetes. There were people there who have lived with the disease for longer than me… I learned a lot from the issues and questions that others had.” Source: SMA Workshop, 2005; Noffsinger EB. Running Group Visits in Your Practice. 2009:272, 286; Wellspan® Health. Diabetes patient:2. SMA Effectiveness

8. 8 Physician Satisfaction Physician satisfaction with SMAs is reflected in these comments: “I look forward to [SMA] day every week. It’s a change of pace, and we have fun. We do medicine, but it’s on the lighter note. People say more about themselves, and they stick to their regimens better. I love the groups, and am going to do more of them.” “Since beginning my groups in 2001, I have rediscovered the joy and satisfaction in providing healing care for my patients. What I see in group astounds me. Patients that I had been working with for years on an individual basis began to show improvement and stability.” Sources: Schmucker D. Group Medical Appointments. 2006:25; Noffsinger EB. Running Group Visits in Your Practice. 2009:295. SMA Effectiveness

9. 9 Our Goals Improved patient outcomes Quality care delivery Higher patient and physician satisfaction Enhanced reputation Who we are

10. 10 Implementing an SMA How an SMA can help meet our goals How an SMA could benefit our patients How an SMA can help improve access How an SMA can address physician challenges Next steps

11. 11 Implementing an SMA Program needs: Meeting room and adjacent exam room(s) Training space Staffing Budget allocation for marketing materials Next steps

12. 12 Sources 1.He W, Sengupta M, Velkoff VA, DeBarros KA. US Census Bureau, Current Population Reports, 65+ in the United States: 2005. Washington, DC: US Government Printing Office; 2005. 2.Noffsinger EB, Scott JC. Understanding today’s group-visit models. Permanente Journal. 200:48(2). http:xnet.kp.org/permanentejournal/spring00pj/model.html. Accessed January 19, 2010. 3.Schmucker D, Group Medical Appointments: An Introduction for Health Professionals. Sudbury, MA: Jones and Bartlett, Inc; 2006. 4.Shared Medical Appointments: An Innovative Approach to Improving Clinical Outcomes Workshop, 2005. 5.Noffsinger EB. Running Group Visits in Your Practice. New York, NY: Springer Science+Business Media, LLC; 2009. 6.American Academy of Family Physicians. Group visits (shared medical appointments): introduction. http://www.aafp.org/online/en/home/practicemgt/quality/qitools/pracredesign/january05.html. Accessed January 20, 2010. 7.Patient-Centered Primary Care Collaborative. PCMH: Vision to reality. http://pcpcc.net/content/pcmh-vision-reality. Accessed January 20, 2010. 8.American Academy of Family Physicians. Patient-Centered Medical Home Checklist. http://www.aafp.org/online/en/home/membership/initiatives/pcmh.html. Accessed January 20, 2010. 9.Scott JC, Conner DA, Venohr I, et al. Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatrics Soc. 2004;52:1463-1470. 10.WellSpan Health. Shared medical appointments. http://www.wellspan.org/body.cfm?id=677&oTopID=677. Accessed January 19, 2010.