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Transformation through Teamwork & Co-creation
Every Voice Heard: Transformation through Teamwork & Co-creation Meryl Moss, MPA, EMHL Chief Operating Officer May 3, 2018 Limor Spalt Senior Strategic Practice Advisor Andi Srabian-Winsor Practice Manager, Adult Primary Care
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About Coastal Medical Primary care-driven Accountable Care Organization (ACO) Value-based payment model 30% of revenue is based on risk arrangements 80% of payers have some form of risk built into their contract Added 250 clinical staff over last six years Add # of employees?
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We’re Building the Primary Care Practice of the Future
PAST FUTURE
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Our CAHPS Scores (2016)
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Our Quality Scores 95% 100% 99.6% 2014 2015 2016
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Breaking the Cost Curve: Coastal’s Performance as a Medicare ACO
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A Culture of Co-creation
Coastal is built on a foundation of teamwork We wouldn’t have experienced this success with a top-down approach We needed input from everyone at Coastal
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A Culture of Change 2013 – Process redesign:
Centralized Clinical Services Diabetes Management Prescription Refills Pre-visit Planning Prior Authorization Centralized Document Management Lab/Diagnostic Imaging Tracking Transitions of Care Team Quality Team
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A Culture of Change 2016 – The need to further redesign:
Patient Experience Cost Containment Physician Recruitment & Retention Excitement and involvement grew at Coastal 150 employees attended our meetings
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20 Redesign Projects Emerged
Customer Service – Real Value Expanding Access Patient Education Phones (scripting) Specialty & Leakage Preferred Provider Referral List Centralized Services Financial Advocate New Patient Pre-registration Pre-visit Planning Referrals & Referral Tracking Physician Recruitment & Retention Onboarding new physicians
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20 Redesign Projects Emerged
Leveraging Technology Online Forms/Booking Telemedicine Kiosks Phone Overhaul Portal Use & Education Palliative Clinician Education on Palliative Care Patient Education on Palliative Care Behavioral Health New Screening Tools & Provider Training Other Care Quality Credit Card On File/Collections
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Who would lead these projects?
Asked if anyone would like to lead 20+ employees from all different areas in the company jumped at the opportunity Needed to give them the necessary tools/resources to lead effectively
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Developing Our Leaders
Started with one-on-one meetings with each project leader Helpful, but not enough hours in the day Continuing to develop our leaders was essential, so we found a new way
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Leadership Academies The first academy was created for our Practice Managers Meetings addressed: Setting concrete goals Implementing leadership concepts in the practice Themes: Management by wandering Getting into the work Overcoming Corporate vs. Practice barriers Today’s work today Auditing
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New Leaders take on New Changes
Identified the following priorities as part of the technology redesign project: Kiosk implementation Centralized Phones Increased Patient Portal Usage These have caused unexpected challenges
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Total Disruptive Change in the Offices
Workflows, roles and the way we deliver customer service have changed Phone centralization has uncovered previously hidden issues Kiosk navigators require a certain personality and level of confidence Increasing Patient Portal usage requires engagement across the practice
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Third Phase of Redesign
3 First we tried to redesign one of our offices all at once …but that didn’t work We had to receive buy-in and get involvement from other practices and teams to be successful 2 1
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All Practices Now Engaged in Redesign
11/12/2018 All Practices Now Engaged in Redesign Practice managers have the tools and resources from the academy to lead this third phase of practice redesign Taking an organized, measured approach to managing change (bite-size pieces) Started to provide visual workflows to staff Standardized kiosk setup Focusing on the 90%, not 10% of exceptions
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Trusting our Teamwork Relying on teamwork more than ever before
Strengthening corporate relationship and trust with practices Financial meetings with physicians on regular basis Staff engagement meeting facilitation We take a disciplined, diligent and factual approach Allows us to work together without being reactive
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From a Practice Manager’s Perspective
Andi Srabian-Winsor Coastal Medical Practice Manager Adult Primary Care Leader of one of the 20 practice redesign groups
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From a Practice Manager’s Perspective
Formerly a practice manager for pediatric practice Volunteered to lead the Online Booking/Online Forms workgroup Leadership support and training gave confidence to switch to adult practice MGMA NERC 2017 was a turning point
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From a Practice Manager’s Perspective
I had to become an organizational leader Guiding the practice through disruptive change Supporting staff concerns about change Enhancing practice communication Leading corporate teams
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From a Practice Manager’s Perspective
Leadership development integrated into the daily work Practice manager academy Used tools to manage new practice Getting into the work Crucial conversations Welcoming corporate through the door Give context with EG – it ha MGMA Regional Conf – Confessed, needed more to be challenged
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From a Practice Manager’s Perspective
Establish Goals Redesign process Management by wandering Engaging staff in change Getting into the work Audit, Audit, Audit Persistence and Resilience
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From a Practice Manager’s Perspective
Six months later… Unified team of practice and corporate personnel Successful kiosk implementation has improved practice finances Navigator role has brought customer service to a new level Centralized phones have brought calm to the practice Quality scores have improved significantly Improved patient care and satisfaction
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We’re Still Learning… This work is not easy – we have a long way to go
Weekly practice redesign meetings Weekly calls for all staff Monthly leadership academies (Practice Managers, Corporate, MA/MS) Implementing workflow changes Planning all staff event Measuring our efforts
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Resilience, Passion, Persistence!
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Questions?
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