Powerpoint Slides - Family and Community Medicine

Center for Excellence in Primary Care
“Primary Care at the Crossroads:
New Models for the 21 st Century”
San Francisco, April 25-26, 26, 2006
Carolyn Shepherd, M.D.
Clinica Campesina, Colorado
Primary Care Teams

Clinica Campesina
• Federally Qualified Community Health Center
• 29,000 Active Patients
• 70% of our patients are at or below poverty, 70% of
adults have at least one full time job.
• 30% have Medicaid, 68% have no insurance
• We see approximately 2100 patients a week, 100,000
each year, and we deliver 1700 women a year
• We have had tremendous growth over the last 5 years
• Primary Care - FP, OB, Peds, MDs, DOs, NPs, PAs

The challenge: : Make our micro-system (pod)
deliver care as a patient centered team.
Clinica’s Organizational Chart
Patients
Pecos Lafayette Thornton
Directors
Executive
Team
BOD
Patients

Micro-system Approach
“Power to the Pods”
• Continuity is “king” for staying patient
centered. Maximize at each interaction.
• We strive to have every patient care
service available on the pod.
• Team members are collocated to
facilitate information sharing and
seamless handoffs.
• Every team member has the opportunity
to be the resource person for the patient.

Who is on the pod
• 3 FTE of provider time
• 3 Medical Assistants
• 1 RN or LPN
• 3 office techs (2 front desk, 1
medical records)
• 1 case manager
• Services the pods share: referral
case manager, LCSW, office
manager, financial screening

Collocation
• Picture of the co location

System Design: Huddle

System Design
• Employ the Chronic Care Model to
improve care to patients with
chronic illnesses and to provide
prevention interventions
• Registries to facilitate population
management
• Alternative visits (i.e. group visits)
very effective with our patients
• Staff roles change significantly
within the pod

Impact of the innovation
• Continuity
• 90% of well care is with the PCP
• 77% of acute asthma visits are with the
PCP.
• 83% of diabetes care is with the PCP
• Access
• Time to the third next appointment is
under 2 days in 2 of our 3 clinics
• Outcomes
• Improvement in A1cs, % asthmatics on
controller meds, trimester of entry to
care, immunization rates

8.5
8.4
8.3
8.2
8.1
8.0
7.9
7.8
7.7
7.6
Outcomes
Trimester of Entry
100%
% 1st Trimester
% 3rd Trimester
80%
60%
40%
20%
0%
32%
41% 41%
62%
38%
46% 42%
50%
12% 9%
4%
9% 4%
8% 11% 7%
41% 45% 49% 58%
50%
62%
63%
66%
14% 15% 12% 10%
13% 10% 10% 8%
1989
1990
1991
1992
1993
1994**
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
7.9
7.8 7.8
Dec-05
Jan-0 6
8 8
Oct-05
Nov-05
8.1
Sep-05
Pecos-Red
Average A1c
8.2
8.1
8
7.9
Jul-05
Aug-05
May-05
Jun-0 5
Month
8.1
Apr-05
8.3 8.3
Feb-05
Mar-05
Jan-0 5
Percentage
Percent of Preg nant
100%
90%
Persistant Asthma on Controller Meds
80%
70%
60%
50%
40%
30%
20%
10%
0%
9/1/2003
11/1/2003
1/1/2004
3/1/2004
5/1/2004
7/1/2004
9/1/2004
11/1/2004
1/1/2005
3/1/2005
5/1/2005
7/1/2005
9/1/2005
11/1/2005
100
90
80
70
60
50
40
30
20
10
0
1yr 3222
Missed O
2 yr 43133
Missed O
Lafayette Pecos Thornton Organization
O ct 2005
Apr 2005
O ct 2004
Apr 2004
Thornton
O ct 2003
Apr 2003
O ct 2002
Apr 2002
O ct 2001
Apr 2001
Aug 2000
Apr 2000
%

Impact of the innovation
• Clinicians initially very uneasy about
collocation
• Improved efficiency by 21%
• More growth than if we had paid for
an additional pod
• No provider would return to our old
process and structural design
• Significant decrease in top of the
line turnover

Barriers to Success
• Demand is growing
• Lack of a health care SYSTEM
• Specialty care
• Hospital services
• Medicaid reform
• Primary care clinicians
• NHSC rural focus

Key Lessons Learned
• 1. Care for the underserved is complex.
That relationship is also the most
rewarding part of working in safety net.
• 2. Share with all staff the opportunity to
help patients.
• 3. Collocation is critical to improve
efficiency and empower staff.
• 4. Measure, celebrate and reward the
teams when there is improvement.