Florida Community Health Centers Increases Chronic Care Management Calls By 350% With Kure
Oteasa Townsend-Hardy
Senior Director of Quality Improvement (QI), Compliance, and Communications, Florida Community Health Centers
PROJECT SUMMARY
Business Case
In the last 3 months, the Chronic Care Management (CCM) 20-minute calls have declined to 206 per month. If the problem persists we reduce the continuity of care as a patent-centered medical provider. Improving the number of calls and patients supported results in an enhanced clinical experience and fosters care coordination activities. Improved services could also translate to increased revenue, as more calls add additional reimbursement.
Root Cause Analysis
Staff not knowledgeable of EMR system capabilities
Staff unaware of latest requirements
Number of manual steps
Solutions Implemented
Distribute educational materials
Validate reporting
Utilize System Care Plan Module
Project Results
Increased calls from 200 to over 1,000 consistently per month. Increased revenue an average of $30,000 per month.
The Challenge
In recent months, the number of Chronic Care Management (CCM) 20-minute telephone calls had declined to 200 per month, representing only 17% of the chronically ill patient population that Florida Community Health Centers (FCHC) serves.
In 2015, the Centers for Medicare & Medicaid Services (CMS) initiated the Chronic Care Management (CCM) program to decrease healthcare spending by focusing on the needs of patients with two or more chronic conditions. This program reimburses medical practitioners for contacting patients once a month for at least 20 minutes to meet the patient’s ongoing needs.
Since 1976, FCHC has been a healthcare leader in Florida. They provide comprehensive primary and specialty healthcare and patient support services through a network of centers surrounding Lake Okeechobee and across Florida’s Treasure Coast. Their mission is to ensure everyone in their communities has access to culturally competent, high-quality, affordable healthcare.
Project Team: Kerri Daniels, MD; Jeremiah Barham; Oteasa Townsend-Hardy; Christine Colby; Alejandro Miquel, MD
Otesea Townsend-Hardy is the Senior Director of Quality Improvement (QI), Compliance, and Communications at FCHC. She has extensive experience working with care providers, managed care, and payers. This expertise along with her nursing and QI background, uniquely qualifies her to lead FCHC improvement efforts. Otesea says,
“Our patients benefit from a ‘medical home’ model, where they may access our extensive array of healthcare clinicians and services in an atmosphere where they are treated with respect, care, and concern.
We are a Federally Qualified Health Center (FQHC) and we strive to meet the needs of an underserved area or population. The ultimate goal is to improve outcomes but also gain revenue. I did a baseline of the CCM calls and I coached the team that if we can improve our CCM call volume, we can change lives. That triggered a deeper dive into the chronic care management calls and the patient population that needs it.”
The Approach
Otesea’s unique background helps her see the big picture. She says, “Having dealt with hospitalization and utilization reviews, coordinating care plans combined with my background in QI and nursing, I saw an opportunity to make a real impact. I decided to take the GLSS Lean Six Sigma Black Belt Training & Certification to hone my QI skills and better pursue this opportunity. As a companion to the training, Kure the only automated workflow for process improvement infuses knowledge, guidance, and insights into process improvement projects. Kure follows the DMAIC process improvement methodology, a 5-step approach of Define, Measure, Analyze, Improve, and Control. Kure guides a project team through the methodology like a detective uncovering clues, and solving the mysteries hidden in the process.”
Define
The team’s improvement journey began by crafting a Charter, defining the Scope, and establishing a Timeline. The team established an aggressive goal of tripling the number of calls per month from 200 to 600.
Measure
When the team dug into the CCM call process, it became immediately clear there was a mountain of opportunities to address. Otesesa says,
“Process Mapping and the Process Walk were the most useful tools for this project. They helped us understand what was happening now. Later, they helped us create the new process.
Our process was not clearly defined. As we continued our investigation, there were a few surprises. CMS requires you to document and calculate at least 20 minutes of patient call time to be able to bill for the service. We were performing tasks that should be documented. For example, staff didn't realize that email communications counted towards the 20 minutes of call time. For the CCM calls, knowing the process requirements is essential.”
Analyze
Using the insights gained from the Process Walk, the team performed a Root Cause Analysis using the Fishbone Diagram and 5 Whys. The critical findings and root causes discovered included:
Several activities of call time that were performed were consistently missing CMS required documentation
Time wasted searching in the electronic medical record (EMR) for care plan notes because of disorganization
Excessive time and variation in the creation of patient care notes
Care Managers or Care Coordinators do not always complete the care plan
Improve
With the Solution Selection Matrix, the team collaboratively created the easiest, most waste-free, and effective way to perform the work by:
Educating everyone on the CMS and process requirements
Clarifying roles and responsibilities
Removing waste and inefficiencies
Reallocating staff to ensure key tasks were adequately covered
Cross-training staff to use an existing tool within the EMR that enables care providers to easily build personalized care plans, enter real-time updates, and manage care plan meetings
Identifying activities for calls in a central area within the EMR
Refining care plan guidelines to be user-friendly and consistent
After implementing the new process, the staff was able to increase the calls from 200 a month to 900 a month— a 350% improvement. Far exceeding their aggressive goal. The Medicare population in the FCHC service area is around 1,100 patients. Nine hundred calls a month is more than an 80% patient participation rate.
Also, the team saved time working in the EMR, allowing Care Managers to outreach to additional patients when volume requires more staff.
Control
The challenge lies not just in improving the process but in sustaining it. The Project Handoff effectively passes the baton to daily operations. To ensure the results are sustained, the Monitoring and Response Plan identifies how day-to-day operations can carry the improved process forward, and continue the pursuit of continually improving the call process. 100% completion. This best practice approach to project closure frees up the leader and team to focus on other improvement opportunities.
Conclusion
“Because we can make these calls, you have licensed nurses making sure that patients are getting the care they need. For example, on a recent call, the nurse noticed the patient hadn’t picked up their blood pressure medication. The nurse had our in-house pharmacy mail it to them. Now, the patient is taking their medication and they don’t need to get in a car and drive to the pharmacy.
The benefit to the patient is a better quality of care. The benefit to FCHC is serving this population in need and generating an additional $30,000 per month in revenue, enabling us to continue our mission to serve the underserved. It’s a Win/Win! Thanks to our improved ability to reach out to patients, many more are receiving the care they need.”
Kure helps you complete projects 3X faster with 10X the ROI than the traditional approach. Kure’s AI-driven workflow guides you through the DMAIC process to apply the tools used in this project so that you can create your own success story.
