Air Force Medical Operations Agency
Excellent Healthcare, Clinical Currency
The Family Health Initiative
The Air Force Pathway to Medical Home
Briefing to TRO-W MTF Leadership
26 Feb 2009
Commander
1
Primary Care Baseline
Med Tech and nursing staff not utilized to full potential
Nurses engaged in phone triage solving access issues
Frustrations leading to poor retention of family physicians
Narrow scope of practice
Deficient support
Inefficient clinic processes
Inflexible scheduling
Difficulty managing complex patients
Access generally satisfied with providers, but:
Patients dissatisfied with continuity
Inconsistent access
Deficient team focus on population health and disease management
Excellent Healthcare, Clinical Currency 2
Challenges
Life in a 15-minute Appointment
Socialize with patient
History and Physical Exam
Chart Review
Update Summary of Care
Computer Order Entry
Address Age-appropriate
Prevention Issues
Code Properly
Referrals, excuses, profiles,
quarters “It has been estimated that it would take 10.6
hours per working day to deliver all
Disease Management recommended care for chronic conditions, plus
7.4 hours per day to provide evidence-based
Patient Education preventive care, to an average panel of 2500
Document & Bill for encounter patients (the mean U.S. panel size is 2300)” –
NEJM 2006
Excellent Healthcare, Clinical Currency
Clear Family Health Goals
“Air Force Medical Home”
Improve health of our beneficiaries – focus on prevention
Create enjoyable and productive practice environment
Promote and deliver quality, evidence-based care
Retain current physicians and recruit new physicians
Deliver greater spectrum of care to our population by optimally
using all skills of clinician and support staff
Excellent Healthcare, Clinical Currency
Family Health Team
The New Promise
Family Health Team
Family Practice Physician
Physician Assistant
Nurse
5 – Medical Technicians
8 Medical Personnel
Flight Optimizations
2500 empanelled patients
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Family Health Provider Schedule
When present in clinic – minimum 90 appts/week/provider –
Must have team appts available M-F
Cannot be limited (frozen, clinic book only, etc)
Chief of Medical Staff authority for cancellation & rescheduling
Team control of flexible centrally booked schedule
Weekly target allows team providers to group short appts and
create time for procedures, complex care, other activities
Team providers may coordinate schedules
Schedule beyond 90 appts/week booked only by provider team
Minimum enrollment 1250 per FTE Family Practice Provider
Excellent Healthcare, Clinical Currency
Nursing in Family Health
Team nurses engaged in patient care, patient education, disease
management
Enabled by improved access and continuity
No longer solving access problems or doing phone triage
Additional disease management nurses based on chronic
disease prevalence in population
Excellent Healthcare, Clinical Currency 7
Implementation
Initiated once manpower mix is in place
Programmed in FY10 POM
Implementation began in 2008, will extend into 2011
Implementation team from AF Medical Ops Agency
Multiple disciplines
Participate in clinic ops during initial week
Stages
Education of clinic managers and leaders
Preparatory visit
Implementation visit
Measures of success “turned on” upon implementation
Monthly push reports
Excellent Healthcare, Clinical Currency 8
FHI Metrics
Provider Metrics Facility Metrics
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Provider Family Health Metrics
Excellent Healthcare, Clinical Currency 10
MTF Family Health Metrics
Excellent Healthcare, Clinical Currency 11
Medical Home IQ
Medical Home Intelligence Quotient (MHIQ)
Web-based, no-cost self-assessment tool
Coincides with American Academy of Family Physicians
(AAFP) accepted model for Medical Home
Assesses 8 areas of practice
Used by AF MTFs to monitor progress while implementing Family
Health Initiative
Estimates NCQA qualification
Excellent Healthcare, Clinical Currency 12
AFMOA
13 Excellent Healthcare, Clinical Currency
Behavioral Health Optimization Program
Minimizing Mental Health Barriers To Care
Provides Primary Care Services
Not traditional mental health (MH) services
Taught in all psychology/social work residencies
BHOP services are active in 61% of AF MTFs
FY 08 64 providers on-site at 31 MTFs
Hired 17 of 22 Red Cell funded full-time BHOP contractors
14983 appointments AF-wide
FY07 cost recapture $927,112
Excellent Healthcare, Clinical Currency
Access Measures
Excellent Healthcare, Clinical Currency 15
Patient Satisfaction Measures
Excellent Healthcare, Clinical Currency 16