Transforming the Role of Medical Assistants: A Key
to an Effective Patient-Centered Medical Home
Slides developed and presented by:
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Regina M. Neal, MPH, MSUP, Consultant, Primary Care Development
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Karen Nelson, MD, MPH, CEO/Medical Director, UNITE HERE Health Center
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Audrey L. Lum, RN, MPA, Chief of Clinical Services, UNITE HERE Health Center
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Jenny Tsang, MD, Assistant Director of Clinical Services, UNITE HERE Health Center
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Session Objectives
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By the end of this session you will be able to:
 Build
a medical home care team with specific & high
impact roles for medical assistants
 Develop a training program for your medical assistants
to ensure a high degree of competence and consistency
in performance
 Use huddles, team meetings and provider-medical
assistant partnerships for panel management &
sustainable improved outcomes
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Current Context
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Lot’s of interest in new roles for medical assistants in
primary care practice
 Approximately 1.5 million items in a google search
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Why the Interest?
Improve patient care
 Meet the growing demand for primary care
 Best use of provider & all the team members
 Key in building a medical home
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Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
The Unite Here Health Center Story…How We
Saw Opportunity and Seized it
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Karen Nelson, MD, MPH, CEO/Medical Director, UNITE HERE Health Center
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
UNITE HERE Health Center
275 Seventh Avenue, New York, NY
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Freestanding Article 28 Diagnostic and Treatment
Center
Est. 1914 by the ILGWU; now serves members of
the UNITE HERE union, their families, and retirees
12 primary care providers, 40 specialists, >50
support staff
Multilingual/cultural staff
54 exam rooms, physical therapy, radiology, and
pharmacy. Lab services in the same building.
EMR and Patient Portal
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
UNITE Health Center
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10,000 active patients
1,100 DM
85% <200% FPL
60% Spanish-speaking, 66% women
Union members insured through Health and Welfare
Fund; capitation for a majority of union members
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Transforming Medical Assistant (MA) Roles
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Donna Lawlor, FNP-C, Primary Care Provider; UNITE HERE Health Center
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Transforming MA Roles
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For 12 PCP’s and 40 specialist, there are 2 RNs ~
MAs have an important function
Gradual process of change
Recruitment from select MA schools
Multiple roles based on competency: medical
assistance, health coach or floor coordinator
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
First Steps – DM Collaborative
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Basic curriculum for DM Education
MAs trained using patient education handouts and a
focus on ABCs
Review latest lab results (ABCs) with patients while
waiting for PCP
Monofilament foot exams yearly
Pneumovax and annual ophthalmology exams
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Next Steps –
SCC and Health Coaches
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Daily huddles
Chart review by MAs
Define gaps in current MA curriculum
Determine which communication and clinical skills
are needed
Develop written curriculum and evaluation tools
Train and evaluate the staff
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Communication Skills
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Basic interviewing skills
Self-management support, including:
 Readiness
to change assessment
 Goal setting
 Motivational interviewing
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Training in Communication Skills
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NYC DOHMH for self-management support
Outside consultants for basic and motivational
interviewing
Interactive sessions with follow-up based on patient
cases
Training was tailored to the skill level of medical
assistants
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Self-Management Support Training
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Eight 2-hour sessions
Didactic portion, video clips, and role playing
Relationship building – reflective listening, empathy,
and non-verbal communication
Stages of change
Techniques of motivational interviewing
Confidence scale
Collaborative Goal Setting
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Self-Management Support Training
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Follow-up after each session to practice with a
patient
Report brought to next class
 Techniques
tried from last week’s session
 Example of what went well
 Example of a challenging patient
 Questions for clarification
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Additional follow-up sessions in 2-3 months
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Self-Management Evaluation
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Written quiz after completing the 8 sessions
Self-management evaluation is included in the
evaluation for each clinical topic
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Health Education for Chronic
Disease Management
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Diabetes
Hypertension
Cholesterol
Asthma
Smoking Cessation
Cancer Screening and Adult Immunizations
Healthy Eating/Obesity/Weight Management
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Curriculum and Templates
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For each topic, templates developed for EMR by
PCP staff with MA input
Templates refer to handouts that are given to
patients
MAs are trained using the templates and the
handouts
Self management is included in each template
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
UHC Training and Evaluation
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Training by UHC staff
Written test
Observation for effectiveness of communication
skills, delivery of health education, use of
motivational interviewing skills and self
management goal-setting techniques
Skills assessment – monofilament test, peak flow
meter and home BP monitor use
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Health Coaches
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MAs who demonstrate competency in all areas are
promoted to health coaches
Two health coaches on each Primary Care Team
Integral team members
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Health Coaches
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Follow individual patients
Health coaches see scheduled patients for in-office
visits and phone follow-up BP checks, goal setting,
chronic disease management, smoking cessation,
and blood sugar checks
Close communication with PCPs and rest of team
Review their scheduled patients with PCPs at daily
huddles to update plan
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Health Coaches
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Troubleshoot patient issues
Lead patient support groups
Center-wide health education campaigns
Some health coaches progress to floor coordinators
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
Floor Coordinator
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Medical Assistant
Health Coach
Facilitate patient flow and cluster workflow by
troubleshooting PCP, MA, and patient needs
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
PCP Buy-In
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PCPs must be willing to give up tasks and trust MA’s
abilities
Involve PCPs in template development and training
sessions
PCP observation of competency for monofilament
exam
Ongoing team interaction
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community
MA Engagement
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Increased patient contact and clinical responsibility
Outside consultants
Nursing support
Health coach meetings
Slides from IHI's 12th Annual International Summit on Improving Patient Care in the Office Practice and the Community