1. The Harvard Vanguard Medical Associates LEAD Story

2. Continuously Building Upon Innovation…. Pt. Centered Med. Home Shared Med. Appts. Leadership Academy Lean Process Clinical Innovation Engagement Cell Med LEAD Patient Centered Care Model Clinical Unit Since HCHP opened the doors in 1969, we have a strong history and culture of innovation…with an emphasis on the delivery of high quality care

3. Hypothesis for Health Care Transformation Payment & Coverage Reform (Finances/Economics) Redesign Clinical Care Delivery (Care Model Paradigm) Transformational Change in Health Care Engagement of Multiple Stakeholders + + =

4. Clinical Outcomes Goals Measurably improve outcomes of our patients with: (1) Obesity (2) Cardiovascular Risk –Hypertension / Diabetes / Dyslipidemia /Tobacco Use (3) Depression

5. The Case for Redesigning Ambulatory Care Schroeder S. N Engl J Med 2007;357:1221-1228

6. The Case for Redesigning Ambulatory Care  Patients’ behaviors are most critical determinant of health.  Patients’ behaviors are most costly determinant of health care. Engage patients in healthful behaviors

7. The ‘3rd Paradigm’ of Care & Between Visit Care H ospital Clinic Home/Work/Play (1 st Paradigm) (2 nd Paradigm) (3 rd Paradigm) Late Stage & Acute Care High Complexity High Cost Less patient participation Early & Mid Stage of Care Less Complexity Less Cost Moderate patient participation LEAD

8. Changes in Pre-Visit, Visit & Post-Visit Pre-Visit –Labs –Demographic & PCP Verification –Medication Reconciliation & Health Maintenance Update Streamlined & Service-oriented Check-in Process –Included improvements to the “late patient” process, printed receipts, insurance card scanning, welcome packets for new patients, kiosks… Visit –Medical Assistant Medication Reconciliation & Allergy Verification –Use of “walkie talkies” for clinician-MA handoffs Post-Visit –After Visit Summary (also available on MyHealth) –Care Coordinator Role –Cross-booking into specialty appointments & radiology

9. Health Risk Assessment Tool Administer behavioral risk assessment at all physicals –Physical Activity58% sedentary –Depression 33% dysthymic or depressed –Nutrition 74% risky nutritional behavior Provide EPIC supports to document plan of care Deliver personalized, written instructions after patient visit Match patient to appropriate treatment option Monitor progress between visits

10. Clinical Outcomes Interventions Prescriptions for Healthy Living Health Coach Virtual Nutritionist

11. Use of the After Visit Summary: 2008

12. MyHealth Enrollment

13. 13 LEAD Clinical Outcomes 0.420.170.0910.0420.5P Value =

14. 14 LEAD principles, approaches to change, operational processes and clinical tools have become integrated and infused into Harvard Vanguard Medical Associates... Transformation & Sustainability

15. 15 LEAD and HVMA 2009 Strategic Goal Development

16. Charles Handy The Age of Unreason The future we predict today is not inevitable. We can influence it, if we know what we want it to be… We can and should be in charge of our own destinies in a time of change. Reflections...