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Getting By With a Little Help From Friends

September 28, 2012
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Sometimes everyone, healthcare organizations included, needs a coach to achieve transformation

Everyone from time to time needs some help. A more-experience hand to help us along, be it in our personal lives, like a piano teacher, a basketball coach, a life coach. Others may need some assistance in their professional lives, perhaps in a work mentor or a skills trainer. What I’ve realized in my personal live, as well as what I’ve been hearing from those I’ve interviewed, is that at one point we all need a little help to move forward on our particular brand of  transformation.

I’ve been thinking a lot about coaches lately as I’ve been recently faced with a bill for re-upping my personal training sessions, and I’ve been assessing the value of what I’ve received over the past eight sessions. Earlier this summer, I was looking down the barrel of my upcoming wedding, and I realized I needed a little help to achieve those “Michelle Obama arms” I want for the big day.

I always thought having a personal trainer was more for motivational purposes, and since I have always exercised regularly, I didn’t think I necessarily needed an extra person in my corner rooting me on. Now several months into my personal training regimen, I’ve come to realize that training is not just about motivation, but also a transfer of knowledge. I’ve gained much from my trainer, from exercise tips (how not to inflame my bum shoulder) to nutritional information (protein is key, alcohol is not).

Recently, I was interviewing solo-practitioner Glenn Kotz, M.D., at MidValley Family Practice in Basalt, Colo., who is participating in the Comprehensive Primary Care (CPC) initiative, and he trumpeted the coaching from the Beacon Community program as being instrumental in his practice’s transformation. (The CPCP initiative is the public-private partnership to strengthen primary care that the Centers for Medicare & Medicaid Services (CMS) Innovation Center launched on Aug. 22.) Kotz said: “One of the things that goes on within Beacon, which is critical for transformation of healthcare, is the coaching they do. Until the healthcare system accepts the fact that transformation is a lot of work, we need to continue to have coaches; that financial support for all Beacons and all coaching around the country needs to continue.”

Kotz lamented that Beacon-provided coaching resources are indeed limited to Beacon participants. In his region, Kotz can access, for instance, cardiology notes from western Colorado’s health information exchange, Quality Health Network (QHN), but can’t see ED or operation room notes because area hospitals haven’t implemented the necessary documentation processes.

“Unfortunately, many people who do not want to participate are, at some level, barriers to information exchange,” he added. “So either they don’t create notes that are put into QHN, even if it is a hospital-based system that has that interface built in.”

During last week’s “Beacon Communities-Lessons Learned Part One” webinar, sponsored by the National Association of Community Health Centers, leaders from the Crescent City Beacon Community (CCBC) in New Orleans spoke about the importance of practice coaches in reaching their community’s goals of reducing the burden of chronic diseases like diabetes and cardiovascular disease. CCBC is implementing PCMHs enabled by HIT to reduce preventable ED visits, and engage patients in their care.

CCBC engaged the Primary Care Development Corporation (PCDC) practice coaching and learning collaborative throughout this year to provide hands-on practice coaching, meetings for goal setting, and regular learning sessions. According to the CCBC website, the PCDC is “working with practices on an individual basis to implement the chronic care management interventions in a manner tailored to the specific needs, resources, and structure of individual practices. In addition, PCDC is conducting five learning sessions that focus on the following topics: QI Foundation, Care Management Frame work, Clinical Decision Support, Process Workflow Redesign, Sustainability and Spread.”

“Through the help of the Beacon Community we had the practice coaches come in January and layout a plan for all of the clinics going forward,” said Keith L. Winfrey, M.D., chief medical officer, NOELA Community Health Center. “So the intent was to assign each clinic a practice coach that would assess where that clinic was in transformation process and in the implementation of the care management program and then help guide that clinic along to full transformation.”

“We realized working with our partners that some of these things [surrounding practice transformation] are easier said than done,” said Anjum Khurshid, Ph.D., M.D., project director, CCBC. “They require that while you are providing services within certain settings, you also have to continue to change and adapt your processes. So we partnered with the nationally-recognized Primary Care Development Corporation to provide intensive practice coaching to our partners. That included establishing implementation exchange teams that had weekly meeting and set targets. We had community learning collaborative sessions and regular visits by coaches to these clinics.”

Part of this transformation involved enhancing transitions of care that included ED/inpatient notifications and electronic specialty care referral management. “This was done by establishing a local information system that allowed for exchange of information between hospitals and clinics and allowed notifications of emergency departments and inpatient visits to go to the primary care physician in real-time, so they could follow up and understand how to prevent those visits that were unnecessary or preventable,” said Khurshid.

As much as we’d all like to transform ourselves and our healthcare organizations through our own hard work and sweat, sometimes we all need a coach to cheer and instruct us to make it to the finish line.

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