View the slides from NIMAA's Webinar about a groundbreaking new way to train key primary care team members featuring national leaders, including: Thomas Bodenheimer, MD, MPH, UCSF School of Medicine, California Edward Wagner, MD, MPH, MacColl Center, Washington Mark Masselli, CEO, Community Health Center, Inc; Chairman, NIMAA

1. PLEASE STAND BY
The webinar will begin shortly

2. Get the Most Out of Your
Zoom Experience
 Send in your questions using the Q&A function
in Zoom
 Presentation video
and slides will be
available after on
our website:
nimaa1.org
 Answers to all
questions will be
posted to the
NIMAA website

3. Welcome
Mark Masselli
President and CEO
Community Health Center, Inc.
Connecticut
Board Chair, NIMAA

4. Team-Based Care Model
The Curriculum
Host Clinics
Role of Preceptors
A Students Perspective
Strategic Steps
What We Will Cover

5. Ed Wagner, MD, MPH
MacColl Center
Washington
Tom Bodenheimer, MD, MPH
UCSF School of Medicine
California
Why does NIMAA Matter?

6. Tom Bodenheimer, MD
Center for Excellence in Primary Care
University of California, San Francisco
Well-trained MAs
are essential for
primary care teams

7. Competence
• I want my
physician to
have the
knowledge
needed to
help me
Empathy
• I want my
physician to
care about
me
Familiarity
• I want to
know my
physician;
I want my
physician to
know me
Continuity
• I want to see
my personal
physician
when I need
help
It doesn’t have to be a physician. It could be a NP, PA, RN, behaviorist,
pharmacist, physical therapist, or medical assistant.
What do patients want from physicians?
Detsky AS, JAMA 2011;306:2500; Safran DG, Ann Intern Med 2003;138:248

8. Stable team structure: teamlets
Patient
panel
1 team, 3 teamlets
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
RN, behavioral health professional, social worker,
pharmacist, complex care manager

9. Definition: stable team/teamlets
1
• The same people always work together
2
• Patients empaneled to a teamlet are always
cared for by that teamlet
3
• The teamlet is responsible for the health of
its patient panel and only sees patients on
its panel

10. Why should teams be stable?
1
• Patients: “I want to know the people caring for me”
and “I want the people caring for me to know me”
2
• Clinicians working with the same MA every day tend
to have lower levels of burnout than clinicians working
with different people on different days
[Willard- Grace et al, J Am Board Fam Med 2014;27:229].
3
• Research shows that patients prefer small practices.
A stable team/teamlet divides a large, impersonal
practice into small, comfortable units that feel like
small practices [Rubin et al, JAMA 1993;270:835].

11. Patient
panel
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
Patient
panel
Clinician + MA
teamlet
Panel management and health coaching
MAs taking responsibility
for panels of patients

12. Sharing the care with MAs:
Panel Management
•Preventive care: immunizations, cancer screening (cervical,
breast, colorectal)
•Chronic care: e.g. diabetes: all lab tests are done in a timely
fashion
Medical assistants identify
patients overdue for
routine services and
arrange for those services to
be performed
Physician-written standing orders are needed to empower the medical assistants
Quality of preventive services improves [Chen and Bodenheimer, Arch Intern Med 2011;171:1558]
An estimated 50% of all preventive care activities could be performed by
medical assistants [Altschuler et al, Ann Fam Med 2012;10:396-400]

13. Sharing the care with MAs:
Health Coaching
Health coaching: assisting patients develop the knowledge, skills and confidence to
become informed, active participants in their care [Ghorob, Family Practice Management,
May/June 2013]
In RCT, patients with MA health coaches had significant drop in A1c and LDL-
cholesterol compared with controls [Willard-Grace et al, Ann Fam Med 2015;13:130]
Estimated 25-30% of chronic care activities could be performed by MA health coaches
[Altschuler et al, Annals of Family Medicine 2012;10:396]
For health coaching curriculum and 4 videos, see the Center for Excellence in Primary
Care website, cepc.ucsf.edu, Tools for Transformation, Health Coaching

14. Primary Care Team

15. Team Structure:
Major Findings from Site Visits

16. MA Involvement in
Key Functions or Competencies

17. http://www.improvingprimarycare.org
Improving Primary Care

18. Mary Blankson, DNP, APRN, FNP
Chief Nursing Officer
Community Health Center, Inc.
Mark Splaine, MD, MS
Education Director
Weitzman Institute
The Curriculum

19. Traditional Content
Medical career workforce skills
Health, disease processes, and prevention
Practice in a community health center
Core skills & Externship
NIMAA-specific Content
The health system and community
Team-based care (health coaching, panel mgmt)
Quality improvement
Developing as a professional
NIMAA skills
What is the content?

20. National Curriculum
Everyone does same online work
Experience at sites is also coordinated
Site-based Learning
Learning specific skills
Participating in clinic setting from Day 1
Close work with preceptors and mentors
How does the curriculum work?

21. NIMAA Participant
Incremental learning with hands-on clinical
application
Socialization to the MA role on the care team
Explore possibilities for academic progression
What is the impact?

22. Host Clinic Site
Opportunity for existing staff to solidify
commitment to train the next generation
Enhances current QI activity
Enhances current staff development
programming
What is the impact?

23. Nationally
Creates a knowledge network between centers
Promotes a new standard for MA education
Enhances the interprofessional collaborative
practice team
What is the impact?

24. Tillman Farley, MD
Chief Medical Officer
Salud Family Health Center
Teri Brogdon, M.Ed.
Education and Training Design Director
Salud Family Health Center
The Role of the Host Site

25. Train students to your center
Hire students that you know
Reduce training costs
Increase efficiency
Improve care to your patients
Improve the health of your community
What are the benefits for a host site?

26.  Commitment to the PCMH team-based healthcare
delivery model
 Recruit and select students
 Identify staff to be trained as preceptors
 Support the training model
 Communicate with NIMAA
 Help graduating students find a job
In the communities you serve!
Key Expectations of Host Site

27.  Skills based learning
– students are helpful from day 1
 Students are assigned a weekly skill to practice
 Students are not assigned to an individual MA
 Every skill is taught, then repeated until mastery
 No lost opportunities for practice
NIMAA Additive Skills Training Model

28. Productive
Effective
Limited
Graduation
Orientation
NIMAA Additive Skills Model

29.  Provide curriculum and content
 Provide on-line training
 Playbook to guide the host clinic
 Preceptor trainings and support
 Technical assistance
NIMAA Role in Supporting
The Host Clinic

30.  Recruitment of students
 Identifying a NIMAA liaison/Site director
Releasing preceptor time for training
Involvement in skills training each week
Providing evaluations and feedback to
NIMAA
Helping students find a job after graduation
What are the costs for a host site?

31. NIMAA host clinics transform health care,
one MA at a time!

32. Natasha Quinn
Senior Medical Assistant
Community Health Center, Inc.
The Role of Preceptors

33.  Role of the
Preceptor
 Training
NIMAA
Participants
 Benefits
of being
a Preceptor
The Role of the Preceptor

34. Jenn Deprey
NIMAA’s Pioneer Class
Community Health Center, Inc.
A Participant’s Perspective

35.  Differences
between NIMAA
and standard MA
education models
 NIMAA provides
a better way of
learning
 Working in
Team-Based Care
A Participant’s Perspective

36. David Aylward
NIMAA Project Lead
What’s Next?

37. Characteristics of a NIMAA Host Clinic:
 Strong support and involvement of top leadership
 Share NIMAA’s dual goals: better care through trained workforce; better student
careers
 Implementing model of care where MAs are becoming key members of the
PCMH team
NIMAA Provides to Host Clinics:
 Experienced faculty and Instructional staff: regular live, taped lectures and
discussions
 Complete online curriculum and program with textbooks, supporting IT systems
 Preceptor training program, with guidance for teaching and measuring specific
traditional and PCMH skills; available to all staff during Phase II
 Support for host clinic leader and preceptors
 Manage all enrollment, grading, certification and grievance issues.
Phase II “Get”

38. Responsibilities of a NIMAA Host Clinic:
 Interview, help select, host MA candidates for the 7 month
training session
 Appoint a NIMAA program leader
 Select qualified preceptor for each medical assistant candidate
 Host candidates 4 hours daily as they assist a care team and learn
from preceptors
 Organize weekly coordination and feedback meeting for
candidates
 Support NIMAA in obtaining state teaching licensure
 Provide feedback
 Pay tuition
Phase II “Give”

39. Survey for all of you
 What are your pain points? Interests in workforce
development?
NIMAA
 Host clinic for full Phase II program (9/17)
 Host clinic for full Phase III program (4/18)
 Contributor to program content
 Upskill existing staff: apprentice programs
Other workforce development/
transformation training
Next Steps Pathways

40.  February: Fill out survey
 February: Conversations
 Early March: Virtual workshop
 April and May: Selection of Phase II partners
 June and July: Recruit and qualify students
 Summer: Host clinic selects, NIMAA trains site lead
and preceptors
 July and August: Select students
 September: Training begins
NIMAA Full Program Phase II

41. Any Questions?

42. Contact us:
nimaa@chc1.com
www.nimaa1.org
Thank you for attending!