My Nurse Call Center:
Providing Care For Patients Outside Of The
Four Walls
Raedean VanDenover
Director, Care Management | UnityPoint Health
Dr. Stephanie Reyburn
Physician | Quincy Medical Group
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My Nurse Call Center
My Nurse Overview
• My Nurse is a free health information service for
the public
• Sponsored by Iowa Health System and it’s
affiliate hospitals
• Located in Sioux City, Iowa
• My Nurse is staffed by registered nurses
24/7/365
• 24/7 Staffing began in 1999
• Positioned to support the clinical initiatives of
the system
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My Nurse Call Center
Our Services: Triage
• Triage callers to determine appropriate level
of care
• Utilize RelayHealth Relay Care software
• Triage completed by RN’s only
• Medical director oversight and approval of
triage guidelines and call priority
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My Nurse Call Center
Our Results: My Nurse Call Center Overall
Key Performance
Indicator
2010
2011
2012
URAC
Standards
Call Volume
174,377
156,277
178,709
N/A
Calls Answered
140,768
120,142
131,389
Abandonment Rate
15%
18%
22%
Less than
5%
Average Speed of
Answer
0:53
0:59
1:03
30 Seconds
or less
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My Nurse Call Center
Our Results: Physician After Hours Only
Key Performance
Indicator
2010
2011
2012
URAC
Standards
Call Volume
51,868
55,552
85,119
N/A
Calls Answered
37,057
37,618
57,291
Abandonment Rate
29%
32%
32%
Less than
5%
Average Speed of
Answer
0:44
0:48
0:43
30 Seconds
or less
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My Nurse Call Center
25,000
Calls Offered, Answered, Abandoned
BY HOUR OF DAY
20,000
15,000
Calls Offered
10,000
Calls Answered
Calls Abandoned
5,000
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Note: Data range is March 5, 2012 thru March 31, 2013
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My Nurse Call Center
My Nurse Staffing
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17.0 FTE Registered Nurses
5.9 FTE Licensed Practical Nurses
4.9 FTE Non-Clinical Support Staff
0.5 FTE Report Analyst
1 RN Manager
1 Director
1 Medical Director
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My Nurse Call Center
Our Services: Physician After-Hours Calls
• Provide coverage for physician clinics after
hours
• 2012: 48% of all calls are PAH calls
• Currently serving 90 clinics and 405 providers
• Coverage is 5pm to 8am
• Triage calls and page the physician only when
necessary
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My Nurse Call Center
Our Services: Triage
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Top Adult Guidelines:
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Abdominal pain or discomfort
Post op problems
Chest pain/chest discomfort
Headache
Pregnancy and Pre-term labor (20-37 weeks)
Top Pediatric Guidelines:
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Fever
Cough
Vomiting
Cold symptoms
Trauma to the head
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My Nurse Call Center
Physician After-Hours Triage Description
Over 80% of Triage calls fall into one of
six dispositions:
24% Provide self care at home
5%
Call provider immediately
17% See the provider within 24 hours
(next day appointments)
13% See the provider within four hours
(urgent care if available)
20% Go to ED immediately
3%
Activate EMS 911
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My Nurse Call Center
Our Services: Post-Discharge Call
• Follow up to evaluate understanding of their
discharge instructions, pain management,
medication management and their need for
further health information
• Diagnosis specific questions to assess and
reinforce compliance with Evidence Based
Practice
• Presented in a “Teachback format”
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My Nurse Call Center
Our Services: Post-Discharge Follow up Calls
• Post discharge call is made within 24 hours of
discharge
• If patient is not able to teach back, My Nurse
will teach back key components from
discharge summary
• Second call is made post discharge day 2 to
assess understanding of discharge
instructions
• If unable to teach back a follow up referral is
made
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My Nurse Call Center
Post-Discharge Calls
2012 Results
31,819
Post-discharge calls schedule
67.1%
Successfully completed
17.5%
Could not teach back their discharge instructions
Monthly reports provided to each affiliate in order to
create action plans and drive process improvement
Supports reducing readmission efforts in the regions
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My Nurse Call Center
Quality
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90% benchmark
Quarterly Audits are completed for all staff
1% of all calls reviewed
Weekly review of all new employees as
needed
• QA/QI results for 2012 is 93%
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My Nurse Call Center
2012 Progress
• Completed Integrated Chronic Care Disease
Management Training for all call center staff
• Trained all staff on use of EHR
• Waterloo Triage transitioned to My Nurse
• Increased additional clinics to Physician After
Hours by 25%
• Focused on staffing and training to prepare for
2013 projects focused on continued clinical
integration of the call center
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My Nurse Call Center
2013 Progress
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Transitioned 1 additional clinic to Physician After Hour Service
Access to EHR for New Group patients
Training on use of EHR and GPMS
Launched Pilot with Central Iowa to schedule next day
appointments
Implemented Physician After Hours Services for Quincy Medical
Group (26 physicians)
Training and support for Iowa Health Home Care Triage process
Installed new phone system to allow for call recording
Began ED Post Discharge call for Fort Dodge Region
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My Nurse Call Center
Looking Ahead
• Continue to support clinical initiatives of the system
• Improve call center metrics to industry standards
• Capitalize on updated phone system technology and
reporting to drive process improvement and
performance
• Continue to expand post discharge calls beyond
inpatient discharge
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My Nurse Call Center
Looking Ahead
• Move additional clinics to after hours call service
• Continue implementation of scheduling next day
appointments
• Increase volume and focus of QA/QI program.
• Continue to consider additional expansion
opportunities
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My Nurse Call Center
New Brand, New Name
My Nurse becomes My UnityPoint Nurse
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My Nurse Call Center
New Website
myunitypointnurse.org
Physician-finder resource
Articles about more than 1,000 health-related topics
Customer satisfaction survey
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My Nurse Call Center
Project Innovation Team 3:
Value Based Healthcare
Reducing ER Visits and Admissions
Project Champion: Dan Evans, M.D.
Project Leader: Stephanie Reyburn, M.D.
Project Team:
Dan Evans, M.D.
Hrishikesh Ghanekar, M.D.
Stephanie Reyburn, M.D.
Raymond Smith, M.D.
Musab Saeed, M.D.
Aric Sharp, CEO
Patty Williamson, CFO
Project Coach: Mo Kasti
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My Nurse Call Center
Quincy Medical Group
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Quincy Population, 40,630
Service Area 112,000
Founded in 1937
135 providers 100/35 (Phys/Midlevel)
28 Specialties
50% Primary Care, 50% Specialty Care
All primary care under CRHC
Broad Ancillary Scope
McKesson EHR
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My Nurse Call Center
Quincy Medical Group
Location
Outreach
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My Nurse Call Center
Quincy Medical Group Leadership Institute
• Focused on Developing Change Agents
• Innovation Projects Aligned with the Triple Aim
• Value – Cost of Care
• Service – Patient Experience
• Quality – Measurement & Improvement
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My Nurse Call Center
Scoping Our Project
Value
Reducing Cost
Imaging
Quality
Admissions
Generic Rx
Readmissions
Emergency Room
Nursing Home
HP3 Project
Various Strategies
NP Care Project
Current 9.6%
Direct
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My Nurse Call Center
Selected Project Goals:
• Reduce Avoidable Admissions and
Avoidable ER Visits
• Increase outpatient services
• Increase access to care after clinic hours
• Improve coordination of care post-hospital
discharge and for chronic condition patients
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My Nurse Call Center
Our Project Plan Approach
1.
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3.
4.
5.
6.
7.
8.
Narrow Scope
Collect Data
Educate ourselves and benchmark
Pick early wins
Develop plans
Engage and secure stakeholder buy-in
Implement early wins
Evaluate what we have learned
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My Nurse Call Center
National Data on Admits and ER Visits
Potentially Preventable Admissions & Visits
• PPAs: 25% of all initial hospital admissions
• National annual rate -94 per 1,000 beneficiaries
• Heart failure most frequent clinical reason
• PPVs: 59% of all ambulatory ED visits (treat
and release)
• National annual rate -158 per 1,000 beneficiaries
• Infections of upper respiratory tract most frequent
clinical reason
MEdpAC October 5, 2012
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My Nurse Call Center
Other Causes of ED Admissions
1. Lack of after hours nurse triage
2. Poor coordination with Home Health Care
3. Limited Ambulatory Care Clinic and/or
primary care hours on weekends
4. Culture of taking all admissions from
Emergency Room
5. Poor transitions in care between inpatient &
outpatient
6. Lack of community education about
preferred access points
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My Nurse Call Center
Benchmarking Research
What Others are Doing to Reduce Cost
1.
Everett Clinic – Set goal to reduce total healthcare cost by
25% by 2016 through reducing admissions and moving to
generic prescribing, etc.
2.
Geisinger Health Plan – decreased hospital admissions by
approximately 15% by implementing a Medical Home model
utilizing nurse case managers targeting specific patient risk
panels.
3.
Mt. Kisco Medical Group – an on-call physician from the
group sees patients presenting to the ER to determine if the
patient needs to be admitted.
4.
CIGNA Medical Group – is increasing urgent care capacity,
implementing a nurse triage line, and educating patients in
order to reduce preventable ER visits.
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My Nurse Call Center
10 Proposed Initiatives
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2.
After Hours Nurse Triage Phone Service via Iowa Health System
Home Health Care via QMG-Iowa Health System
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Home Health Care, Home Medical Equipment, Palliative Care, InHome Hospice
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Expand ACC and/or primary care hours
4.
Expand infusion center hours
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Hospitalist assessing patient in Emergency Room
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Use Nurse Care Coordinator Model – BCBS Int. Medical Home
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Discharge Nurse to assure good transition to outpatient
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Nursing Home NP model of care
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Patient education about preferred access points
10. Educate physicians on preferred ER referral process
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My Nurse Call Center
Approach to Securing Buy-in
• Small Family Practice Call group meeting
• Large group meeting with Family Practice,
Internal Medicine, and Rural Clinic providers
• Presentation at Shareholder meeting
• One on One meetings with Physicians
throughout Primary Care
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My Nurse Call Center
Nurse Triage
• Nurse Triage call line launched
March 4, 2013 for 26 providers
• Provides Better customer Service
and access to a health professional
• Reduces avoidable ER visits
• Reduces physician after hours call
intensity
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My Nurse Call Center
Home Health Care
• Partnering with Iowa Health System
• Implementation underway - in process of hiring director
• Goals:
• Reduce readmissions
• Decrease the overall cost of care
• Capture a revenue opportunity for Iowa Health & QMG
• Medicare MSSP data average 406 visits/1000 lives
across Iowa Health System.
• Quincy at 127 visits/1000 lives
• Opportunity for increased community based services for
our patients
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My Nurse Call Center
Home Health MSSP Data
Visits Per 1000 Lives
1000
900
800
700
600
500
400
300
200
100
0
Visits
Cedar
Rapids
Quad
Cities
Peoria
Central
Iowa
Waterloo
Quincy
Muscatine Fort Dodge
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My Nurse Call Center
Expanded Hours
• ACC Hours (Walk In Clinic)
• New Physician hired – extending Saturday
hours to all day starting Summer 2013
• Primary Care Offices
• Exploring Sunday Hours via Rotation
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My Nurse Call Center
Hospitalist in ER
• Dr. Vardaros signed with a start date of
October 2013.
• Hospital Call Group to explore engaging with
the ER on a routine basis.
• Will reduce avoidable ER admissions.
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My Nurse Call Center
BCBS Medical Home Care Model
• Launched January 2013
• 37 super visits have been completed with another 10
scheduled
• Goal is 200 enrolled patients by August 2013
• Potential next step…
• Use MSSP data to identify similar high-risk Medicare
patients for care coordination
• Apply Iowa Health Advanced Medical Team Model
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My Nurse Call Center
Admission/Discharge Planner
• Launched October 2012
• Better transition of care from hospital to outpatient
including scheduled follow-up visits, ancillary capture,
med reconciliation and improved communication with
provider offices
• Next step – additional staff member has been hired to
meet face to face with every patient when admitted
and discharged
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My Nurse Call Center
Nursing Home Care Model
• Launched April 2012
• NP Onsite at all Nursing Homes in Quincy
• Has led to more satisfied patients, reduced
ER visits, and reduced avoidable admissions
• All primary care providers currently utilizing
the service
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My Nurse Call Center
Consistent Patient Education
• Reviewed Iowa Health System “Red, Yellow,
Green” care action plans for utilization with
patients
• Implementation Fall ‘13
• Action plans available for wound care, care,
stroke, pneumonia, high blood pressure, heart
failure, diabetes, depression, and COPD
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My Nurse Call Center
Transition Plan - Sustainability
Action
Owner
Nurse Triage Implementation
Kathy Harman / Dr. Reyburn
Home Health
Carol Lewis / Dr. Noble
ACC Expansion
Aric / Dr. Evans
Ancillary Expansion
Patty Williamson / Dr. Petty
Hospitalist in ER
Aric / Dr. Evans
BCBS Medical Home
Kathy Harman / Dr. Leimbach
Discharge Planner
Kathy Harman / Dr. Reyburn
Nursing Home Care Model
Kathy Harman / Dr. Schlepphorst
Patient & Physician Education
The Team
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My Nurse Call Center
Leadership Lessons Learned
• Teamwork
• Care Value is Big Work, Narrow the Scope, don’t boil the ocean
• Assign clear roles
• Leverage resources
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• Holding each other accountable
• Innovation = Idea + Execution
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My Nurse Call Center
Next Steps with My Nurse
• Allow My Nurse Access to EHR
• Begin scheduling next day appointments
• Expand Physician After Hours Service to
additional specialties
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My Nurse Call Center
Questions?
“My UnityPoint Nurse, how may I help you?”
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