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

2. 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

3. 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

4. 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)

5. 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%).

6. 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%).

7. 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%).

8. 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 s (reminders, meeting notes)
Project Update Survey (Piloted in July)

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

10. 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

12. 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

13. 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

14. 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

15. 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

17. 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 –

19. 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

20. 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