Transcript Kaiser Specialty Care Access Initiative

Kaiser Specialty Care Access
Initiative (SCAI)
Future of the Safety Net Yolo County
Future of the Safety Net Yolo County
(FSNYC)
CommuniCare Health Centers serving as
Lead Agency for SCAI
FSNYC Membership:
CommuniCare Health Centers
Community Medical Centers
First 5 Yolo
Kaiser Permanente
Redwood Community Health Coalition
Sierra-Sacramento Valley Medical Society
Sutter West Medical Group
Sutter Davis Hospital
UC Davis Medical Center
Winters Healthcare Foundation
Woodland Healthcare
Yolo County Board of Supervisors
Yolo County Health Council
Yolo County Health Department
Implementation Team
• Chief Executive Officer, Robin Affrime
• Medical Director, David Katz, MD
• Chief Operating Officer, Daniel Albano
• Nurse Manager
• Program Manager, Amy Jean Ham
• Case Manager, Patricia Perez
Staffing
• Program Manager, Amy Jean Ham
• Case Manager, Patricia Perez
• Nurse Manager
• Medical Director, David Katz, MD
• Information Systems, Kristie Stanley
Five Primary Care Sites
• CommuniCare Health Centers
Davis Community Clinic
Salud Clinic
Peterson Clinic
• Winters Healthcare Foundation
• Esparto Family Practice
Four Medical Care Systems
• Kaiser Permanente
• Sutter Davis Hospital/
Sutter West Medical Group
• Woodland Healthcare
• UC Davis Medical Center
Three Strategies to Increase Access to
Specialty Care:
1.
Build/Expand Specialty Networks (Fair Share)
Specialty care physicians to provide care in their medical offices
for uninsured patients and the uncompensated care is
distributed according to a ‘fair share’ method agreeable to the
participating medical care systems
2. Telemedicine
Improve access through spread of existing or new applications
of telemedicine
3. Expand Primary Care Provider Capacity (Scope of
Practice)
Increase the specialty care knowledge level capacity of safety
net primary care providers
Fair Share Distribution
• Kaiser Permanente
(Endocrinology, Rheumatology and Neurology)
• Sutter Davis Hospital/Sutter West
Medical Group
(Gastroenterology, Orthopedics)
• Woodland Healthcare
(Gastroenterology, Orthopedics)
• UC Davis Medical Group
(Trauma and Tertiary Care)
3. Expand Primary Care Provider Capacity (Scope
of Practice)
Increase the specialty care knowledge level capacity
of safety net primary care providers
Activities:
• Identifying Key Competencies
• Integrating Scope of Practice and
Patient Care
• Building Relationships
• Provider Commitment
Identifying Key Competencies
• Survey of Skills
– Based on template provided by San Mateo Medical
Center and Ravenswood Family Health Center
– A National Survey of Procedural Skill Requirements in
Family Practice Residency Programs - Josie L. Tenore
MD, SM; Lisa K. Sharp, PhD; Martin S. Lipsky, MD
• Data collection from referrals
– Identifies common referral diagnosis.
Survey Outcomes
Identifying key competencies for training
•
Majority of providers identified competency in casting and joint
injections but also requested more training.
•
While 83.3 % of providers stated competency in identifying
indications for referrals of headaches – have large volume of
headache referrals.
•
Majority of providers wanted more training in evaluation and
treatment of seizures.
•
Majority of providers requested training in management of
disease altering medications for Rheumatology. Determined
that this training was most appropriate for MDs.
•
Providers suggested training in Parkinson’s Disease treatment
which was not on additional skill list.
Integrating with Patient Care
• Imbedding Guidelines
– Using InterQual Criteria to ensure referral is
appropriate prior to authorization.
– “Passport” into specialty care
– Challenge: changing referral process, getting provider
buy-in.
• Case Management
– Meet weekly to discuss referrals. Use meetings to
determine how to best use resources including
internal expertise. Also used to identify high-volume
areas and training potential.
• Building Relationships
Organizational Relationships
• Representation
– All health systems represented in planning
process, coalition and workgroups
– Support from administrative and clinical leaders
• Benefits
– Simplifying referral process, case management,
monitoring referral volume, decreasing noshows, ensuring complete resources
• Memorandum Of Understanding
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Formalized Commitments and Roles
Health Systems
YCHIP
Ancillary/Diagnostic Services
More to come
Provider Relationships
• Phone Consults
– Prior to referral, PCPs have phone consultation with
Kaiser specialist to discuss case, testing and options
for care within the “medical home”.
• Case Management Discussions
– Regular meetings are scheduled with specialty care
providers to discuss cases and treatment options.
• Mini-fellowships
– Providers accompany patients to specialty care
appointments.
From the Medical Staff
• Provider Commitment
– Ease in referral
– Case management lightens provider load
– Decreases primary care liability
– Increased retention/recruitment of providers
• Productivity Implications
– Some referral activity non-reimbursed
– Decrease in face to face patient care may result from
phone consultations
• Scheduling changes
– Telemedicine
– Phone consultations
– Extended visits for procedures
QUESTIONS?