McKesson Medical-Surgical
Webinar Wednesdays Series
Medical Assistants at the Epicenter of Coordinated
Care: Knowledge – Patient Engagement – Improving
Outcomes - Reducing Cost
March 15, 2017
Guest Presenter:
Brian S. Williams, MHA, MBA
Vice President, Medtrainer
Medical Assistants at the Epicenter of
Coordinated Care
Knowledge – Patient Engagement – Improving Outcomes - Reducing Cost
Presented by: Brian S. Williams, MHA, MBA
Brian S. Williams, MHA, MBA
Medtrainer, Inc.
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Mr. Williams, MBA, has more than 25 years of director-level
healthcare management experience, specializing in staff
management, process improvements, infection prevention,
performance measurement metrics, and healthcare compliance.
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He has served on the MedTrainer Education and Development Board
for the past four years, authored numerous compliance courses and
works closely with major clients on custom courseware and
compliance toolkits.
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Brian is a self-proclaimed lifelong learner and has recently graduated
form the Masters of Health Administration program at the University
of Southern California, where he has been learning and applying the
principles of population health management and value-based care.
Mr. Williams also holds a Masters of Business Administration from
the Peter F. Drucker and Masatoshi Ito Graduate School of
Management, and certificates in Strategy and Management.
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His passion for the teaching and the development of others has been
a long-standing hallmark of his award-winning career.
Webinar Objectives
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Become familiar with the CMS overall strategy for healthcare - the "Road Forward“ and
the potential for changes in direction.
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Changes in our healthcare delivery system appear to be certain; however, let’s look
beyond the politics of the delivery “system” and focus on how to improve patient
outcomes.
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Gain an understanding of the alignment of payment and performance for healthcare
providers and how Medical Assistant’s can make a significant difference to the bottom
line, by participating in MACRA activities that are value-added.
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Get a closer look at highly integrated care teams and the strategic role of the Medical
Assistant.
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Discover the opportunities for Medical Assistants in a value-based care (VBC) model
(even if it is modified) and beyond.
Once Upon a Time, Healthcare was Changing
Millennials were becoming pre-teens (1982–2004)
& Apple was trading for $4.14 a share.
As of 12/1/14 – Apple (IPO) shares are up over 21,000%
1,000 shares ≈ $3.6 million The Motley Fool – 8/9/2016
2017 There is a lack of consensus on how to provides the
best care at the lowest possible cost.
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1990 - Managed care briefly slows down this
growth by requiring 3rd-party pre-approval of all
treatments, adding incentives for family doctors
to not refer patients to specialists, utilization
reviews of medical practices, and enforced
discounts with hospitals.
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1993 - President Clinton proposes that all
citizens would be enrolled through governmentrun regional alliances to regulate costs and
quality of managed care.
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1997 - Food and Drug Administration creates
rules that allow drug companies to advertise
directly to consumers
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1999 - Medicare covers 39.5 million people
(14.5% of population). Medicaid covers 37.5
million (13.8%)
How Much Has Changed in Healthcare?
Healthcare organizations of all types have made large
investments, absorbed costs, and had to care for patients
regardless of the environment. What hasn’t changed?
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Technology
The Economy
National Security
EHR Adaptation
Health Care Market Consolidation
Affordable Care Act Implementation
ICD 9 to ICD 10
Accountable Care Organizations
Population Health Management
The Medical Home
Significant increase in urgent care and FHCHC’s
Baby boomers continue to adapt to new delivery methods
New Administration is highly committed to making changes
Millennials represent more than one quarter of the nation's population (83.1 million)
Their size exceeds that of the baby boomers (75.4 million), according to new U.S. Census Bureau - Jun 25, 2015
The Reality for Healthcare, is that Resources
are Scarce…
A few things to consider…
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10,000 Americans turn 65 (Medicare eligible) everyday for the next 20+ years.
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The cost of healthcare for those who do not have access is significantly higher for tax payers
and employers in the absence of a comprehensive plan.
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There is currently not a consensus for alternative plan to the Affordable Care Act (ACA), nor a
comprehensive plan for reducing cost of healthcare – however, there is certainty that there will
be changes to the ACA.
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Premiums for insurance are quickly outpacing income and is increasingly costing employers,
employees and others, a greater share of profits and disposable income.
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By 2025, demand for physicians will exceed supply by a range of 46,000 to 90,000. There is a
high expectation of growth in non-physician providers, and widespread adoption of new
payment and delivery models such as Patient-Centered Medical Homes (PCMHs), Accountable
Care Organizations (ACOs), and Value-Based Care.
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Current spending combined with increased future demand is non-sustainable.
Primary Care Shortage Areas Adversely
Affect Approximately 58 Million
Who is
going to
meet the
demand for
Primary
Care
Services?
Who is
going to
improve
patient
outcomes?
Source: KFF.org – Tapping Nurse Practitioners to Meet Rising Demand for Primary Care (June 20, 2015)
CMS Strategic Plan 2013 though 2018
Goal 1: Better care and lower costs.
Goal 2: Prevention and population health.
Goal 3: Strengthen consumer protections.
Goal 4: Expand coverage.
Goal 5: Improve payment models.
Goal 6: Strengthen program integrity.
What is Value-Based Care?
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CMS moving(ed) away from Fee-for Service model.
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The MACRA 2017 vision is based on Value-Based Care
(VBC).
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MACRA began measuring on January 1, 2017 with
payments beginning in 2019.
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CMS Incentive programs have been updated and
transitioned into new programs and measures to
focus on innovation & continuous improvement.
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The consensus is that MACRA was passed with strong
bi-partisan support and it is unlikely to be
dismantled.
In the very BUSY days of healthcare professionals the PATIENT is what matters the most.
Medicare Access & CHIP Reauthorization
Act of 2015 (MACRA)
Combines PQRS, Value and Value-based Modifier, and EHR
Incentive Program into a single program:
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Payment reform through the Quality Payment Program
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Merit-Based Incentive Payment System (MIPS)
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Alternative Payment Models (APMs)
Avoided a 2015 mandated 21.2% reduction in physician payment rates under the SGR formula.
FY 2015 - 2025, CMS Office of the Actuary estimates that MACRA will increase combined Federal spending for
Medicare, Medicaid, and the health insurance marketplace by $102.8 billion.
CMS Strategy Affects Your Provider (Financially)
The Quality Payment Program has two tracks:
o Advanced Alternative Payment Models (APMs) or
o The Merit-based Incentive Payment System
(MIPS)
For MIPS, you must also be a:
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Non-participation = definite reduction in Medicare payments
Physician
Physician assistant
Nurse practitioner
Clinical nurse specialist
Certified registered nurse anesthetist
Everything We Do for a Patient Involves a
Process…
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How can we determine the greatest possibility for a
positive patient outcome for a cancer patient?
o That lives in a rural or inner city?
o That has significant language and cultural barriers?
o Which are fully engaged in their health opportunities.
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How many methods can be used for assessing a patients
general health?
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What will it take to reduce teen smoking by 50%?
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There are Many Types of Process Improvement
Activities (with similar goals)
o Plan Do Check Act - PDCA
o Six Sigma – Reduce Variation
o Lean – Create Value With Fewer Resources
o Institute of Medicine – STEEP
o Safe (Avoid injuries)
o Timely
o Effective
o Efficient
o Equitable
o Patient Centered
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The American Medical Association (AMA)
o Step Forward
Decrease
Patient
Waiting
Time
Increase
Provider
Time with
Patient
Maximize
Patient
Throughput
Performance/Process Improvement Activities
are often measured by reduction in expenses
and improvement in patient outcomes.
Use Evidence-Based Strategies
Medical Assistants Core Competencies
o Data Entry (understanding the inputs)
o Coordinating test results
o Asking probing safety and self-care questions
o Inquiring/assisting with medication refills
o Health screenings / patient education
o Filling in communication gaps
Medical Assistants are Involved in Many
Healthcare Delivery Processes
“Completion of administrative and clinical tasks in the offices of physicians, hospitals, and
other healthcare facilities. Their duties vary with the location, specialty, and size of the
practice”.
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Record patient history and personal information.
Measure vital signs, such as blood pressure.
Help the physician with patient examinations (being a scribe).
Give patients injections or medications as directed by the physician and as permitted by
state law.
Schedule patient appointments.
Prepare blood samples for laboratory tests.
Enter patient information into medical records/EHR.
They DO NOT examine, diagnose or treat patients.
The New CMA Swiss Army Knife (Chronic
Care Management)
o Organized into CLEARLY defined teams.
o Engaged in population health management.
o Be empowered to “own” key quality measures.
o Fulfill role as health coaches and participate in
outreach initiatives.
o Assist on the “information aspect” for high-risk
patients and their family members.
Image Source: Family Practice Management
IT IS IMPOSSIBLE TO BE EVERYTHING TO EVERYONE
THERE ARE LIMITS THAT SHOULD BE CLEARLY DEFINED.
The AMA Model - StepsForward™
Stanford Coordinated Care team-based care model includes Medical assistant (MA) care
coordinators are a central part of the team and are responsible for their own panel of patients
o Performing routine health maintenance and
chronic disease monitoring tests
o Answering initial patient phone calls and emails
o Scribing patient visits
o Advising patients on action plans
o Acquiring authorizations
o Facilitating referrals
Source: American Medical Association
Standing orders/protocols under the close supervision of the physicians
based on federal & state guidelines
How much money can your practice save?
Source: AMA StepsForward
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The Success of the Patient Centered Medical
Home (PCMH)
No More “Catch and Release”
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Shared goals. The team — including the patient and, where
appropriate, family members or other support persons — works to
establish shared goals that reflect patient and family priorities and that
can be clearly articulated, understood and supported by all team
members.
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Clear roles. There are clear expectations for each team member’s
functions, responsibilities and accountabilities, which optimize the
team’s efficiency and often enables the division of labor, thereby
accomplishing more than the sum of its parts.
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Mutual trust. Team members earn each other’s trust, creating strong
norms of reciprocity and greater opportunities for shared achievement.
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Effective communication. The team prioritizes and continuously refines
its communication skills (consistent channels for candid and complete
communication by all team members).
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Measurable processes and outcomes. The team agrees on and
implements reliable and timely feedback on successes and failures in
both the functioning of the team and achievement of the team’s goals.
Medical Assistants – the Knowledge Workers
are at the Center of Patient Data
1909 - 2005
Drucker declared that increasing the
productivity of knowledge workers was “the
most important contribution management
needs to make in the 21st century.”
“An adequate information system” must lead
executives “to ask the right questions, not
just feed them the information they expect.
My Favorite Drucker-ism
Self-Inventory
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There are many career paths for a Medical Assistant
What are my strengths?
How do I work?
What are my values?
Where do I belong?
What should I contribute?
Have I arrived or just started
my journey?
The Employment Outlook for Medical Assistants
Medical assistants are not required to be certified in most
states – many employers prefer to hire certified assistants
o Certified Medical Assistant (CMA)- American Association of Medical Assistants
o Registered Medical Assistant (RMA) - American Medical Technologists
o National Certified Medical Assistant (NCMA) - National Center for Competency
Testing
o Certified Clinical Medical Assistant (CCMA) - National Healthcareer Association
o Certified Medical Administrative Assistant (CMAA) - National Healthcareer
Association
Employment Projections for Medical Assistants 2014 through 2024
Occupational Title
SOC Code
Employment 2014
Projected Employment 2024
Change 2014-2024
Medical Assistants
31-9092
591,300
730,200
138,900 + 23%
Source: United States Department of Labor – Occupational Outlook Handbook
The Employment Outlook for MA’s is Strong
Perform administrative and certain clinical duties under
the direction of a physician. Administrative duties may
include scheduling appointments, maintaining medical
records, billing, and coding information for insurance
purposes. Clinical duties may include taking and recording
vital signs and medical histories, preparing patients for
examination, drawing blood, and administering
medications as directed by physician. Excludes "Physician
Assistants" (29-1071).
The Road Forward for Medical Assistants
o Healthcare has great
capacity for more MA’s
& licensed clinical staff.
o Creating a learning and
thriving environment is
healthy for everyone.
o Participate in your
future.
Mentors can make the journey easier…
Summary
The healthcare delivery and payment system is in a significant period of transformation
The Fee-for-Service structure is evolving from volume to value-based pay for performance
model
Baby-boomers are dramatically increasing the demand for healthcare services
The Patient Centered Medical Home model helps to complete the continuum of care
The Electronic Health Record is rapidly becoming interoperable
The demand for Certified Medical Assistants is significantly increasing
The abilities for CMA’s to develop new skill sets and earning capacity is exciting
MedTrainer Compliance Resources
Want to learn more about Medtrainer?
Click here: https://medtrainer.com/schedule-demo/
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Unlimited access to learning library
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Custom courseware to provide specific organizational focus
for specific topics and quality improvement initiatives.
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Distribute policies and procedures and receive electronic
acknowledgement from staff.
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Secure electronic incident report with escalation features to
manage all types of incidents in a closed-loop process.
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Provide job-aides to simplify processes for individual quality
improvement activities.
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Maintain electronic Safety Data Sheets.
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Manage contracts and equipment with electronic reminders
for renewals and preventative maintenance.
Wrap-up and Questions
How can your organization benefit from the tools provided today?
For more information regarding this webinar please feel free to visit
www.Medtrainer.com or contact us at 888-337-0288
Sources
Lisa Brandenburg, Patricia Gabow, Glenn Steele, John Toussaint, and Bernard J. Tyson, Innovation and Best Practices in Health Care Scheduling, Feb 2015
Troy Parks, Medical Assistants Take Central Role in Team-based Health Care: One Stanford Practice, Apr 12, 2016
Centers for Medicare & Medicaid Services Strategy, The Road Forward 2013-2017, Published Mar 2013.
Amerinet White Paper: Transforming the Healthcare Organization through Process Improvement Infographic, Betty Carson, Healthcare Finance News 2014.
Centers for Medicare & Medicaid Services, Regulations and Guidance, EHR Incentives Programs, Data and Program Reports, CMS.gov, June 2016.
National Quality Strategy (NQS) Webinar Best Practices to Improve Community Health, Aug 6, 2015.
Dana Naughton, LCSW, Alan Adelman, MD, MS, Patricia Bricker, MBA, Michelle Miller-Day, PhD, and Robert Gabbay, MD, PhD, Envisioning New Roles for Medical Assistants:
Strategies From Patient-Centered Medical Homes, Family Practice Management, Mar-Apr 2013 Issue
Lisa Brandenburg, Patricia Gabow, Glenn Steele, John Toussaint, and Bernard J. Tyson, Innovation and Best Practices in Health Care Scheduling, Feb. 2015
Troy Parks, Medical Assistants Take Central Role in Team-based Health Care: One Stanford Practice, Apr 12, 2016
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, Medical Assistants, on the Internet at:
https://www.bls.gov/ooh/healthcare/medical-assistants.htm.
The American Medical Association, StepsForward, Web Access https://www.stepsforward.org/resource, Mar 1, 2017
Questions?
Thank You!
Brian Williams, Medtrainer
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Please join us next month!
Value Based Care – Maximizing CMS
Incentives and Improving Patient
Outcomes
Brian S. Williams, MHA, MBA
April 19, 2017 @ 2:30pm Eastern
www.mms.mckesson.com/educational-webinars
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