Testing a New Model of Care

April 21, 2016

Ensuring access to care for everyone who needs it is a major challenge across the nation. As an Accountable Care Organization, it is incumbent upon OSF HealthCare to find innovative ways to address this problem in a cost-efficient manner that maintains quality.

One option would be to construct more buildings and hire more clinicians to serve this need - at considerable cost. However, there is also a lack of primary care physicians available to meet the needs of the growing population. OSF has instead determined their current model of primary care needs to be a focus of innovation for its healthcare system.

Leadership and clinicians from six primary care clinics who directly work with patients have been working collaboratively to create a new vision for how OSF primary care clinics will operate in the future. The ongoing Care Transformation process seeks to transform the patient experience, while increasing value, expanding access and creating a better work place environment.

How is Care Transformation Changing Care?

At the heart of the new model is the concept of team-based care, meaning all members of the primary clinic care team share responsibility for the health, wellness, and outcomes of our population. The current model depends heavily on physicians to make care decisions, leading to bottlenecks in access to the system.

Care Transformation allows Advanced Practice Providers, Registered Nurses, and Medical Office Assistants to deliver patient care to the full extent of their training. It also expands the team to include Behavioral Health, Pharmacists, Health Coaches, and our Complex Care Managers for more comprehensive care.

Another component of the new care model is the development of "Nurse clinics" within the primary care setting. Patients with straightforward, simple medical concerns like sore throats, the flu, or strep throat would be directed to nurses who have the training to care for these types of issues. Creating nurse clinics to serve some acute minor illnesses will allow physicians to focus on the most complex problems patients face.

Care Transformation is also changing the way primary care clinics communicate with patients before their official visits. Pre-visit planning includes a member of the care team calling patients to confirm the reason for the visit, identify any preventive care that's needed, and review any changes in care that have taken place. Pre-visit planning ensures the care team is better prepared for patient visits.

The new model requires primary care clinicians to learn and adapt to new changes in processes and workflows, but they won't be expected to make the transition immediately. OSF will roll out Care Transformation at test sites to collect data and measure how the model is working.

In the meantime, the Ministry is providing in-seat education and simulation to train care team members at participating sites for this future state.

Preparing for a New Model of Care

In collaboration with system educators, faculty at Jump are responsible for training clinicians in their newly expanded roles using in situ simulation, or simulation that occurs in the real clinical space. The focus is on understanding care team roles, new processes, and communication both among each other and between care providers and patients.

A portion of participating clinic offices will be reserved for training . Standardized Patients (SP) from Jump will be utilized to act as patients who will check in the way they normally would, get roomed by staff, and have a normal visit. The scenarios will touch on a variety of patient needs.

Some SPs will have minor complaints that nurses can handle, and others will be more complicated than they initially appear. Let's say a patient comes to the clinic with a cold and is assigned to the nurse clinic; the nurse determines the cold is a symptom of something more severe. The on-site simulation will allow the nurse to practice transitioning the patient to an Advanced Practice Provider or physician.

Or perhaps, a patient is scheduled to see a physician, but indicates he/she is suffering from depression. An in situ simulation would give that physician an opportunity to rehearse incorporating a behavioral health provider into the visit.

The simulations will also provide an opportunity for clinic staff to run through conversations with patients on the new model of care and what they can expect in the future. Our Standardized Patients will provide feedback along the way and potentially identify any barriers patients may perceive before Care Transformation goes live.

The Value of Simulation

There are significant changes coming to primary clinics, and it's not going to happen overnight. We have to make sure our clinicians are fully prepared for the transformation in store.

Bringing simulation directly to the clinics allows care team members to practice implementing the new care model in their own environment before the real launch takes place.

Training for Care Transformation helps OSF assess the readiness of clinic staff and continue to evolve the process as needed to make sure it's as functional as possible with the goal of serving our patients and improving their experiences.

Lisa Barker, MD Dr. Lisa Barker is chief medical director at the Jump Trading Simulation & Education Center and clinical associate professor of Emergency Medicine at the University of Illinois College of Medicine Peoria.

Dr. Barker chairs the Jump Value Analysis Model (VAM) Committee, a multi-disciplinary group of health care system professionals with representation from Finance, Healthcare Analytics, Performance Improvement and Education in addition to Jump.