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

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

3. 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?

4. 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

5. 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

6. 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

7. 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?

8. 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

9. 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

10. 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

11. 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

12. 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

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

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

15. Questions? Rachel Bakersmith, Administrator Cynthia Fishman, MD
Cell: