This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.

1. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
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2. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
Introduction and Overview
Academic Medical Centers have unique and specific issues to address in regard to the
coordination of care for patients traveling from out of state and out of the country. Many
coordination of care models have been tested with varying results. This specific care
coordination model addresses the needs and concerns of those patients who travel from afar.
The original charge of the Destination Program at the University of Michigan was to create a
Destination Program (DP) strategy to address coordination of care for those patients coming
from a distance. Patients who travel from over 90 to 100 miles or over one hour have different
needs than those patients who live near their care institutions.
Our charge was to determine what specific issues needed to be addressed that were different
and unique to this population. A culture change to create a new way of thinking was a primary
goal. The desired outcome was to move the Healthcare System into being a “Destination
Hospital.”
A second goal was to increase the number of patients with complex diseases requiring acute
care to travel from farther distances to receive this care at the University of Michigan.
Marketing alone may increase the number of patients but added volume could cause capacity
issues.
Our task was to determine what those issues were and to create a plan to address the issues.
In turn, to create an “Ideal Patient Care Experience”, for those patients coming to the
Institution for care. If the patient and referring physicians’ experience was not excellent, the
plan would fail. A prerequisite for this goal was to provide travel-­‐sensitive, coordinated care
for this population. By creating a “Temporary Medical Home,” during the intake period we
would able to ensure accountability at intake.
It was also anticipated that improvements in the system, and processes to care for such
patients, coupled with enhanced marketing efforts (that highlight the expertise and clinical
research) would increase patient activity and provide a “halo” effect for enhancing brand
recognition.
The ultimate outcome would be:
1.
Increased patient volumes for groups of patients with favorable payer mix,
2.
Improved revenue to support the healthcare missions, and
3.
A greater potential number of patients to enter innovative clinical trials.
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3. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
In addition, it was expected that the improved systems and processes developed would diffuse
throughout the health system to enhance the care provided to all patients. The Destination
Program Office also had a vision of serving as the ‘clinical laboratory’ for better processes of
care.
With this effort, metrics of success were determined by:
•
Increased patient volumes from out of state and internationally
•
Digital campaign metrics showing dollars spent versus returns on patient activity
with positive ROI
•
Long term metrics showing favorable ROI, calculated by tracking patients through
episodes of care and dollars associated with that patient activity over months, years,
and
•
An increase in clinical research activity
Using Lean techniques with the Gelb Patient Experience Mapping, the University of Michigan
DP’s were able to identify “best practices” among the clinics and create a new standard of care
for the institution. The next step in the new standard of care involved identifying a
“Temporary Medical Home” for each patient to create coordination along the entire episode of
care.
Standards created for Phase I of the pilot program:
Temporary Specialty Medical Home Pilot Program
•
Each patient is assigned a “Home Center” based on his or her primary
medical/surgical/cancer site.
•
The home center is responsible for coordination, financial clearance, and all
appointments for that patient during the “episode of care.”
•
The Central Access, Call Center, collaborates on patients that cross home centers.
The current flow of the patients through the pilot system was characterized by multiple
handoffs and specialized functions by many teams, an example of which are, call centers,
registration, insurance verification, scheduling, physician triage, evaluation by physician
extenders, treatment or procedure scheduling, inpatient teams, discharge planning, and post
acute transition care. Care coordination in Destination Programs was focused only on new
patient entry into the institution up initiation of care for Phase I. A Journey Coordinator
position was proposed, as an enhancement to the pilot but will be discussed in a companion
White Paper.
© 2013 Endeavor Management. All Rights Reserved.
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4. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
Review of Care Coordination
Many institutions use specially trained nurses combined with clerical staff to service new
patients seeking care. However none of the institutions reviewed use the same resources for
treatment navigation. Similarly, teams responsible for coordination or care during a
hospitalization or transition care are distinct from those interacting with the patient on entry
into the system. A model which takes advantage of the relationships with the patient and
family from the first contact throughout the treatment and transition had not to our
knowledge, had not been piloted.
Rationale for Action
Health care reform will require better coordination of
Coordination of care has been
care. The spectrum of coordination of care can range
defined by AHRQ as:
widely from health maintenance to diagnosis to
treatment to follow up care of a disease.
Care coordination is the
deliberate organization of
The numerous touch points within the system make
patient care activities between
the very effort of care coordination complex. A review
two or more participants
of the “episode of care” was plotted out in a Value
(including the patient) involved
Stream using Lean techniques. Due to the varying
in a patient’s care to facilitate the
levels of experience with Lean work, we decided to
appropriate delivery of health
make the Value Stream very basic so that all levels of
care service. Organizing care
the health care staff could easily see and understand
involves the marshaling of
the work.
personnel and other resources
needed to carry out all required
We started the Value Stream with the intake phone call
patient care activities, and is
to the “Central Destination Call Center.” The patient
often managed by the exchange
was then triaged to the Patient Financial Counselors
of information among
for clearance and simultaneously to the clinic for
participants responsible for
medical acceptance. Once accepted, and if financially
different aspects of care.
cleared, the patient was given a tentative appointment
two weeks out. This timing was decided based on
administrative needs for insurance verification, clinical needs for medical records and patient
needs for scheduling flights, travel and getting their affairs in order.
© 2013 Endeavor Management. All Rights Reserved.
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5. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
Once the “Home Center” was selected, which occurred by service line or multidisciplinary
specialty clinic, that “Home Center” became the “Temporary Specialty Home” for that
Destination patient. This effort created accountability for the Destination Patient and assisted
in smoother hand offs to other departments.
See Diagram 1.
Diagram 1
Designate
Temporary
Specialty
Medical Home
Diagram 1 shows the number of steps from intake to clinic scheduling and beyond. The “C” recognizes tasks that can
be done by clerical staff, and “N” by nursing staff. The red clinical decision tree boxes note that major clinical
decision in care is necessary before moving on to the next step. Physician review is needed at these touch points. The
Patient Financial Counselors verify insurance and in many cases have a separate appointment with the patient prior
to the clinical appointment. Metrics were measured on the episode of care during this pilot, evaluating the timing
standards for scheduling the clinic appointment and for scheduling surgery once the patient was assessed. Discharge
home was classified as to the patients home state or county because many patients stayed in the Ann Arbor area for a
period of time after discharge from the hospital for follow up and further evaluation needed before returning home.
It was from this value stream exercise that accountability was needed to improve the patient care experience. This
was also verified by the Gelb Experience Mapping results.
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6. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
In summary, improved coordination of care for Destination Patients from the first patient
contact though the evaluation, treatment planning, treatment, and transition care addressed
many of the deficiencies in current care process, and improved performance. This unique
coordination of care model was piloted for four years. It also transitioned with a new EMR.
The capabilities and synergism of which were not yet discovered.
The “lessons learned” from this model included a need for a person to step in during hand offs
to ensure that patients flowed smoothly through their experience, at least in the transition
period. The Destination Program Office performed this function during the pilot.
The next step, Phase II, was to explore the “Temporary Specialty Medical Home” concept using
of a team of clerical and advanced nursing personnel to coordinate care for patients with
complex diseases requiring acute care and using a Journey Coordinator to oversee the care
during the hand off touch points. Please see White Paper “Using Journey Coordination for an
Ideal Patient Care Experience.”
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7. Using A Nursing Coordination Of Care Model
To Create A “Temporary Medical Home”
About Endeavor
Endeavor Management, is an international management consulting firm that collaboratively
works with their clients to achieve greater value from their transformational business
initiatives. Endeavor serves as a catalyst by providing pragmatic methodologies and industry
expertise in Transformational Strategies, Operational Excellence, Organizational Effectiveness,
and Transformational Leadership.
Our clients include those responsible for:
• Business Strategy
• Marketing and Brand Strategy
• Operations
• Technology Deployment
• Strategic Human Capital
• Corporate Finance
The firm’s 40 year heritage has produced a substantial portfolio of proven methodologies,
deep operational insight and broad industry experience. This experience enables our team to
quickly understand the dynamics of client companies and markets. Endeavor’s clients span the
globe and are typically leaders in their industry.
Gelb Consulting, a wholly owned subsidiary, monitors organizational performance and designs
winning marketing strategies. Gelb helps organizations focus their marketing initiatives by
fully understanding customer needs through proven strategic frameworks to guide marketing
strategies, build trusted brands, deliver exceptional experiences and launch new products.
Our websites:
www.endeavormgmt.com
www.gulfresearch.com
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