Symposium: using panel management to improve primary healthcare practice and patient outcomes
In December 2013, decision-makers and leaders in Alberta’s primary healthcare system came together to reflect on the role of panel management, and challenges and strategies for moving ahead with successful implementation in Alberta.
Keynote speakers shared their experiences and perspectives on the potential of panel management to improve patient care and primary healthcare practice. Summaries and video links can be found below.
Panel-based Care from the Clinic Perspective
Carolyn Shepherd, MD – Vice-President of Clinical Services, Clinica Family Health Services, Boulder, CO Dr. Shepherd is the former medical director of Clinica Family Health Services, which provides primary healthcare through five clinical sites to a population of 41,000 low-income residents in the Boulder, Colorado area. They began a clinical redesign process in 1998, focusing on their ‘big six’ improvement priorities. Panel management has been a key strategy to improving the patient care experience, outcomes of care, and team functioning. In her presentation, Dr. Shepherd identifies opportunities, successes, challenges, and strategies for implementing panel management at the clinic level.
Panel Management — The Alberta Experience
Steve Chambers, MD – Allin Clinic, Edmonton Dr. Chambers has been a family physician at the Allin Clinic for 32 years. The Allin Clinic is a founding member of the Edmonton Oliver PCN and has approximately 130 physicians in 16 clinics providing primary healthcare to 130,000 patients. The biggest changes at the clinic have been due to team-based care and electronic medical record support for panel management. Team-based care has improved job satisfaction for clinicians, team members, and patients. The Allin Clinic plans to use panel data to support chronic disease management and to improve access for patients.
System Level Opportunities for Panel Management in Alberta
Tim Cooke – Health Quality Council of Alberta, Calgary Mr. Cooke is the senior health system measurement lead at the HQCA. He spoke to Alberta evidence about the potential impact of panel management on the health system and opportunities for panel management to address gaps in the system. Evidence about the potential benefit of panel management comes from findings of the HQCA primary care measurement initiative, which looked at healthcare service utilization rates of 1.7 million Albertans over a 36-month period.
Doug Stich – TOP (Towards Optimized Practice) Alberta, Edmonton Mr. Stich is the program director of Towards Optimized Practice (TOP), a quality improvement initiative supporting physicians and their teams. Its role is to develop and deliver services that engender best practices in the physician community and elsewhere in the health system. In his presentation, Mr. Stich asked the question – “Why do panels work?” Relationships are the answer, especially for patients with chronic conditions who benefit from an ongoing relationship with a family physician and supporting team to make and sustain the changes required to achieve desired outcomes. Panel management is essential for successful chronic disease management.
Strategies for Implementing Panel-Based Care: The Alberta Experience
Primary care providers in Alberta shared successes, challenges, and strategies for implementing panel based care based on their personal experiences.
Ann Makin – Bow Valley Primary Care Network, Canmore Ms. Makin is the Bow Valley Primary Care Network’s evaluation and office practice improvement consultant. Bow Valley PCN encompasses nine clinics with 37 family physicians providing primary care services to 26,000 patients. Foundations for success of panel management include 100 per cent utilization of an electronic medical record in all physician practices, the relatively small size of the PCN, and a commitment to working with each practice to identify change strategies that will work within that clinic.
Treena Klassen – Palliser Primary Care Network, Medicine Hat The Palliser Primary Care Network covers a large geographic area with a diverse population in southeast Alberta. Seventy-seven physicians, in 31 clinics, provide care to 98,000 patients. Family physicians are supported by eight staff in a central PCN office and more than 50 healthcare professionals, including nurses, social workers, physiotherapists, and pharmacists. Progress in improving care is primarily about relationships. At the Palliser PCN, implementation of panel management is a step-wise process that clinics move through at their own pace.
Tom Bray, MD – Fort Medical Clinic, Edmonton Dr. Bray established Fort Medical Clinic 40 years ago in an underprivileged area of Edmonton, and was a lead physician in the development of the Edmonton North Primary Care Network. He developed an interest in office efficiency and opportunities for change in the way family practice can be improved for the benefit of the patient, the provider and the system. Key strategies to improving efficiency included an introduction of a medical office assistant, electronic medical record support, panel management and ongoing measurement to demonstrate the impact of change.
Peter Lightbody, MD – East Calgary Family Care Clinic, Calgary Dr. Lightbody is the medical director of the East Calgary Family Care Clinic (FCC). The East Calgary FCC was formed on the principles of providing interdisciplinary team care with nurse practitioners acting as a most responsible primary care provider (PCP), extended hours, and access by the patient to the right provider without a family physician referral. The processes of the FCC have been reorganized around teams of family physicians and nurse practitioners; knowledge of practice panels allow providers to balance patients between PCPs. Benefits of the new system include cross coverage during absences and improved team effectiveness.