1. PATIENT ALIGNED CARE TEAM AT The va sierra nevada health care system Uche S. Uchendu, MD. Associate Chief of Staff, Ambulatory Care  Goals set at the PACT Summit - Met To all the Veterans, we hear you and we salute you!  Future Plans  Sustain  Specialty spread  Stay Tuned …  Background  VASNHCS has 69,000 square miles of mostly rural area of 31 counties  With 116,000 veteran residents and 26,000 unique patients  Primary care provided at the main facility is in Reno Nevada and  Four CBOC’s : Auburn & Susanville CA; Minden & Fallon NV  Outreach clinic in Winnemucca, NV  ACP Home builder Patient Aligned Care Team Access  Offer same day appointments  ^ shared medical appointments  ^ non-appointment care Access  Offer same day appointments  ^ shared medical appointments  ^ non-appointment care Care Mgt & Coordination  Focus on high-risk patients  Improve care for: o Prevention & Chronic disease  Improve transitions between PACT &: Inpatient ; Specialty; Broader Team Care Mgt & Coordination  Focus on high-risk patients  Improve care for: o Prevention & Chronic disease  Improve transitions between PACT &: Inpatient ; Specialty; Broader Team Practice Redesign  Redesign team: o Roles & Tasks  Enhance: o Communication& Team  Improve Processes: o Visit & Non-visit work Practice Redesign  Redesign team: o Roles & Tasks  Enhance: o Communication& Team  Improve Processes: o Visit & Non-visit work Patient Centeredness: Mindset and Tools Improvement: Systems Redesign, VA TAMMCS Resources: Tech, Staff, Space, Community In reality all PACT items should be standard operations : Plan, operation, directive,execution = success. Phone calls should be returned timely. PACT Principles *Patient Driven *Team based, *Efficient *Comprehensive *Continuous *Communication *Coordination Medical Home Builder ACP MHB Results reviewed January 2010 Primary Care Module Management Staffing and Room Utilization review PACT readiness assessment Identify current Primary Care staffing gaps Facility Gap analysis done February 2010 Funding allocation and spending plan 15 teamlets in Reno, Auburn -4 Minden-3, Fallon-2 & Susanville -1 with Extended Team gap deferred to next fiscal year Partnering with HR to reach hiring goals Plan for Impleme ntation Financial :Staffing sustainment analysis discussion with leadership February 2010 Operational: Space and support gap analysis - March 2010 PACT Home team – involving all services and other key stake holders Education- plan for staff and veterans to lay the foundation Vigorous HR recruitment of teamlet staff started Approval of New PACT positions HBC, HPDP, MHV Coordinator Space redesign Plans mapped, approved and in progress Other Key PACT Implementation staff recruitment in progress VA PCMH launch in Las Vegas April 2010 and birth of Collaborative Team thereafter Sprung into action with goals and timelines from education to staffing and dissemination Committed to 6 regional collaboarative sessions with interim reports and projects Training Process changes resource allocation DiSC tool June – July 2010 for team building - 100% Motivational interview with MINT certified trainer July 2010- all PC staff on board Discussions at weekly meetings, National fireside charts and PC Current Happenings materials Primary Care meetings with expanded team members 2x monthly, PACT/PCMH related Journal reviews and Local presentations by ACOS AC Training Champion Pilot > spread Whole teamlet PACT learning centers training Travel team engage in 6 learning sessions over 18 months-July 2010 through January 2012 Pilot team used to iron out kink then spread to all teams All teams assigned as of February 2011 at all sites PSA Check in LPN Vitals Waiting Room PCP visitCheck out D OMINANCE INFLUENCE S TEADINESS C ONSCIENTIOUSNESS The DiSC will help you : Identify your behavioral “comfort zone Capitalize on your behavioral strengths Increase your appreciation of others’ behavioral “comfort zones” and behavioral strengths Be more effective when working with others People are always courteous Good People No complaints Auburn CBOC Minden CBOC Fallon CBOC Susanville CBOC Medical Home + VHA = PACT ACP scoring methodology on 127 questions: 0-33%: Weak Performance 34%-67%:Average performance 67%-100%: Strong Performance You Guys are good to me  PACT collaborative Goals – Met/Exceeded PACT COMPASS Same Day Appt. with PCP PACT COMPASS 2 day Contact Post Hospital PACT COMPASS Ratio of Telephone to all Encounters PACT COMPASS PCP Continuity  Challenges Staff turnover Buy-in Competing demands Continuity and Space  Voice of the Customer FEB 2012 ≥ 10 <10 and ≥ 5 < 5 TOTAL POINTS (MAX 14) Facility 10 Reno PC 9 Auburn 12 Minden3 Fallon 14 Susanville 8 PACT West Collabo rative LS 1: July 2010 Access LS 2: Oct 2010 Care Coordination LS 3: Jan. 2010 Practice Redesign LS 4: April 2011 PACT Principles LS 5: July 2011 Team Roles LS 6: Jan 2012 PACT + specialty PACT+ Teleheath PACT Sustainment  PACT Fairs at all sites PACT Recognition for 5 Teams 2011! Winnemucca TEACH training- All PACT staff