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Even Manning Needs Coaching, by David Ehrenberger, MD

by Heather W. on 7/31/2015 11:07:00 AM

When Peyton Manning was recently questioned about his ability to be coached by new Broncos head coach, Gary Kubiak, the record-holding NFL quarterback simply stated, “I love being coached.” He went on to say that he was looking forward to learning Kubiak’s philosophies, and enjoys asking questions and continually learning. His response struck a chord with me to think that one of the most decorated and successful quarterbacks in history still relies heavily on coaching to stay on top of his game and continue developing his skills.
The culture of football is one where coaching is the norm. In fact, it would be very strange for any sports team not to have a coach. As primary care physicians, we’re trained early on by our professors and “coached” through residency, but once given the seal of approval to practice medicine on our own, we tend to take on the role of leader and coach for our practice and staff.
This model has served us well for many decades. However, we’re embarking upon a new era of healthcare where we’re being asked to change the way we practice medicine and demonstrate the quality and value of care we’re providing to our patients. As we move into this new phase of healthcare, I believe we can all use a little coaching.
That’s where leaders like Marjie Harbrecht, MD, who recently stepped down as CEO of HealthTeamWorks® after 18 years of service, have been instrumental to primary care practices. As physicians, we’re trained to diagnose and treat symptoms. But we need coaches like those on the HealthTeamWorks® staff who are well-versed in practice transformation to help us implement – and most importantly, sustain meaningful changes in the way we practice medicine. Changes that help us run a good business, effectively treat chronic diseases, and coordinate patient care.
Under Harbrecht’s leadership, HealthTeamWorks® was the first in the nation to pilot a Multi-payer, Multi-stakeholder Patient-Centered Medical Home (PCMH) program. The work was revolutionary because Dr. Harbrecht was able to bring together a group of unusual suspects – payers, providers, public health, health systems, and state agencies – to develop consensus on an approach to transform care and figure out an effective way to pay for it.
The Multi-payer project helped lay the groundwork for more rapid, widespread transformation efforts in future years. This project and many others across the nation resulted in various how-to guides to implement medical homes that providers and payers can use as a blueprint for change. But since old habits die hard, to be successful long-term, practice groups must continue to improve beyond simply checking off the boxes of a list of PCMH to-dos. That’s where on-going coaching services like HealthTeamWorks® provides will become more and more essential to ensure practices truly ingrain the culture of transformation in their practice.
I want to personally thank Dr. Harbrecht for her leadership and vision to take HealthTeamWorks® from where they started as Colorado Clinical Guidelines Collaborative to where they are today. I’m also excited for their future with new CEO, Bert Miuccio, taking the reins. Bert joins HealthTeamWorks® not only with a strong foundational background and understanding of PCMH and practice transformation, but also with skills in business development that can help HealthTeamWorks® continue to grow to meet the needs of providers in Colorado and across the nation.
Continual coaching is a concept that I hope my fellow practitioners begin to adopt into practice. I believe it’s necessary not only for us but also for our patients to thrive in the future. 


Where can we connect next?

by Kristen D. on 9/9/2014 7:05:23 AM

HealthTeamWorks is excited for the large line-up we have planned for this fall. We're traveling coast-to-coast to educate and connect with organizations looking to invest in proven quality improvement work to achieve Triple Aim objectives and get measurable results. We will be in more than 15 states this fall for national and regional conferences, including:

  • Inovalon Client Congress (Washington, DC)

  • NAACOs Fall Conference (Washington, DC)

  • Vail Engaging Communities in Education and Research Conference Conference (Vail, CO)

  • NRHA Critical Access Hospital Conference (Kansas City, MO)

  • MGMA Annual Conference (Las Vegas, NV)

  • ACO Leadership Conference (Nashville, TN)

  • AMGA Quality Leadership Annual Conference (New Orleans, LA)

  • PCPCC Annual Conference (Washington, DC)

  • STFM Conference on Practice Improvement (Tampa, FL)

  • IHI Annual QI Forum (Orlando, FL)

What educational resources could HealthTeamWorks develop to make your QI work easier? How can we support your organization to better manage the health of your patient population as you continue to grow your integrated communities of care? Reach out to us to schedule a call or in-person demo at one of these conferences.


HealthTeamWorks Co-Hosts First PCPCC Western Regional Conference

by Kristen D. on 7/16/2014 11:12:24 AM

Last month, HealthTeamWorks was proud to co-host the PCPCC Western Regional Conference with the Patient-Centered Primary Care Collaborative (PCPCC) and the Colorado Academy of Family Physicians  (CAFP). The three organizations welcomed more than 340 medical home professionals to Denver for a two-day intensive conference on the impact, opportunities and challenges of the medical home model of care.

This first-ever PCPCC 2014 Western Regional Conference, "Health Care Transformation: Overcoming Challenges to Reach the Summit," -- offered participants panel discussions and workshops focused on the critical role of patient-centered primary care in achieving delivery system reform. In all, participants from more than 20 states in the United States and Canada were challenged to expand their notions of what success has been achieved and will look like in the future for the PCMH model. 

The conference included opening remarks by HealthTeamWorks CEO, Dr. Marjie Harbrecht and HealthTeamWorks-coached physician, Rick Budensiek, DO. And closing remarks by Dr. Harbrecht and HealthTeamWorks Board of Directors President Dave Ehrenberger, MD.  

Keynote presentations featured New York Times bestselling author T.R. Reid delivering a synopsis of his book, The Healing of America, and University of California at San Francisco School of Medicine Chair of Family and Community Medicine, Dr. Kevin Grumbach, explaining some of the statistical support for a team-based model of care. 

We are pleased to have collaborated to provide such outstanding educational and networking opportunities for some of the community's greatest contributors. With such a thought-provoking inaugural conference, we're excited to have set a high standard for future PCPCC Western Regional conferences. 

To view pictures from this conference, follow us on Facebook.


Where Are We Next?

by Kristen D. on 5/20/2014 4:58:34 AM

LAKEWOOD, COLO. - As spring begins to draw to a close, HealthTeamWorks is encouraged by the great start to the year we've experienced. Our regional directors, program managers, coaches and CEO have met individuals interested in improving the cost, quality and clinical outcomes in their practices from the dozens of conferences they've spoken at, and workshops and learning collaboratives they've hosted across the country. We've been overwhelmed by the volume of people we've met who are not only eager to improve the outcomes seen in their practices, but they're also motivated to make changes to improve the satisfaction of their physicians, staff and patients. We couldn't agree more!

Here at HealthTeamWorks we are focused on providing our clinical transformation clients a summer packed with access to our staff and opportunities to improve their mastery of our methodology. In addition to our hands-on site visits, we're preparing to host three learning collaboratives for our Colorado-based programs this summer. These multi-day workshops are modeled after the Institute for Healthcare Improvement (IHI)’s breakthrough learning collaborative series and allow participating practices to grow through an “all teach, all learn” approach to training.

In addition to our high-touch interaction with our clients, HealthTeamWorks is expanding the reach of our clinical transformation solutions to organizations outside of our current initiatives, HealthTeamWorks is excited to be hosting two events which are open to the public.

May 29-30, 2014: Intensive Training for Care Managers in Primary Care In response to high demand, HealthTeamWorks is pleased to announce its newest training program to improve efficiency in the management of high-risk patients. Our two-day, in-person, Intensive Training for Care Managers in Primary Care is designed for new or licensed (RN, SW, NP, PA) care managers in primary care. This introductory care management training will provide an overview in how to create a care management program in primary care, as well as sample tools and resources needed to launch the program.

For more information, read here.

June 8-10, 2014: 2014 PCPCC Western Regional Conference
In conjunction with our partners the Colorado Academy of Family Physicians (CAFP) and the Patient-Centered Primary Care Collaborative (PCPCC), HealthTeamWorks is pleased to welcome hundreds of health care professionals for the first-ever PCPCC 2014 Western Regional Conference. This 1 1/2 day conference will take place at the Hyatt Regency Denver Tech Center and offer participants the opportunity to participate in panel discussions and workshops that will focus on the critical role of patient-centered primary care in achieving delivery system reform.

For more information, read here.


It was a busy spring! Did we see you at any of these national conferences?


Colorado practices benefit from in-office support to improve patient care and efficiency with funding from the Colorado Health Foundation

by Kristen D. on 12/9/2013 7:29:10 AM

LAKEWOOD, COLO. - HealthTeamWorks is now accepting applications for the 2014 installment of our PCMH Foundations program after receiving a generous grant from the Colorado Health Foundation.

The grant, which will provide practice transformation coaching to more than 100 Colorado practices free of cost, supports a program starting in January of 2014.

In an effort to provide support to those practices early on in their transformation while also providing advanced curriculum to practices across Colorado already on their transformation journey, the program will encompass two parts.

A continuation of the current PCMH Foundations program will continue to lay the groundwork for practice transformation of new practices and those still early on in their journey to practice transformation. A more advanced Innovations program will expand on pre-established concepts and continue support for many practices who are looking to achieve the Triple Aim. 

New practices will master the basics of the Joint Principles of PCMH, a document established in 2007 through the collaboration of four national healthcare organizations, including the AAFP and AAP, while previous and already advanced practices will expand to more complex topics like integration of behavioral health and patient activation.

"HealthTeamWorks is excited to be able to continue serving the practices here in Colorado with which we have built a strong relationship, but we are eager to begin teaching on a larger scale this advanced curriculum we have been developing," said PCMH program manager Amber Carlson.

Applications will be accepted through the end of the year and organizations interested in these free services to enhance value and quality of care should contact Amber Carlson for more information at 303-446-7200 or jkleppe@healthteamworks.org

More information on the program:

To apply for PCMH Foundations, please click here.


HealthTeamWorks Releases Innovative Pregnancy-Related Depression Guideline Supplement

by Kristen D. on 10/15/2013 3:48:47 AM

HealthTeamWorks and the Colorado Department of Public Health and Environment (CDPHE) are pleased to present a new guideline supplement on Pregnancy-Related Depression (PRD), which can be found on our website. This resource supplements the widely-used Depression Guideline.

PRD is a mood disorder that occurs during pregnancy or up to one year postpartum and is the most common complication of pregnancy among women in Colorado. A condition that can adversely affect the health of the woman, developing fetus and baby, PRD is either not detected and/or inadequately treated too often. 

Areas covered in the one-page supplement include

  • Risk and protective factors specific to pregnancy-postpartum;

  • Distinguishing “baby blues” from PRD; 

  • Cross-cultural considerations;

  • Suggested approaches to conversations about depression;

  • Preparing your practice to provide effective PRD care;

  • Screening considerations;

  • Other psychiatric diagnoses and common co-occuring conditions (such as tobacco and alcohol use);

  • Shared decision-making about treatment; and,

  • Options for managing PRD.

Multiple treatment options are outlined in the supplement, including lifestyle (important for all women to prevent and improve depression), mental health services and medication. 

HealthTeamWorks and CDPHE will continue their collaboration in 2013-2014 to implement the PRD supplemental guideline in diverse settings around Colorado. The implementation phase will include efforts to identify and promote mental health and community and resources to improve care for women with PRD.


How Coach University may enhance bilateral integration in health care

by Mindy K. on 2/21/2013 2:36:55 PM

There is growing evidence that integrating behavioral health and primary care improves health outcomes, increases patient satisfaction with the experience of care, and ultimately reduces health care costs. Working with our community partners, Jefferson Center has pursued bilateral integration, i.e. bringing mental health services into the medical setting while also making physical health services available on-site at the mental health center offices. Bilateral integration takes into account patient preferences and helps mitigate transportation, stigma, cost and other barriers to care while improving overall health outcomes.

While the call for integration predates the Affordable Care Act, the health care reform law did call for the creation of models that allow patients to be managed by interdisciplinary teams and supports innovations that help shift payment from quantity to quality of care.

Yet integration continues to face numerous barriers, including different payment methodologies, a health care system that has been built over time to silo the body from the mind, and cultural differences between provider types.  For example, while behavioral health providers traditionally focus 45-60 minutes sessions on building a relationship, discussing emotions, and gathering qualitative information, primary care providers are accustomed to 15 minutes sessions focused on the physical/somatic, and use quantitative data to assess health. Integrated care often requires the extensive collaboration of multiple agencies, so there are organizational differences that may prove challenging as well.

I was introduced to Coach University when approached by HealthTeamWorks to help develop an extension the training program focused on integrated care. I wanted to participate in the week long program to better understand what was in the curriculum currently, and to see what I could bring back of value to Jefferson Center and other community mental health centers across Colorado and the nation.

My experience with Coach University has crystallized for me the importance of supporting behavioral health and primary care providers through the transformative process of creating a truly patient centered health care home. A quality improvement coach can help push the practice to clearly articulate its vision for how far along the integration continuum it wants to go, how it will measure the impact of integrated care, and how to create efficiencies that improve patient care and best utilize provider time.

One “ah-hah” moment for me during my week at Coach University was when we were  “Redesigning Practice Care Delivery,” in an activity that encourages us to think about the various roles in clinics and how they work together, and it occurred to me that when you are working with not only multiple team members, but team members from multiple agencies, you may think you have a good understanding of everyone’s role until you actually sit down and talk through what each person does now, and could do differently, to best utilize their skills.

I look forward to a continued partnership with Health Team Works to apply the knowledge and skills I gained at Coach U to Jefferson Center’s work in integrated care settings, and to assist community mental health centers across the nation in enhancing their own integration work.


Mindy Klowden, MNM, is a Coach University January 2013 graduate and guest blogger. She serves as director of the Office of Healthcare Transformation at Jefferson Center for Mental Health in Denver, Colorado.


Inviting patients to read your notes

by Lisa S. on 10/5/2012 9:17:33 AM

Would you allow patients to read your encounter notes? That’s what 105 primary care physicians did recently in a year-long project involving 13,564 of their patients. Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System (GHS) in Pennsylvania and Harborview Medical Center (HMC) in Seattle participated in this “quasi-experimental” study published in Annals of Internal Medicine. Patients received online access to their doctors’ notes and could review them at their own discretion.

At the project’s end, almost 99 percent of patients in the study wanted continued access to their visit notes, and no physicians elected to end the opportunity.
The authors noted that before the experiment, “both participating and nonparticipating doctors worried about the effect of open notes on their practices.” They expressed anxiety about offending or worrying patients. However, most physicians surveyed after the intervention indicated that their misgivings did not materialize.

Participating doctors observed that open notes:

  • Strengthened their relationships with some patients, including more trust, openness and shared decision-making;

  • Activated or empowered some patients toward their healthcare;

  • May have improved patient satisfaction and patient safety; and

  • Allowed them to reinforce the office visit and patient education.

The majority of responding physicians did not find the open-note process difficult, nor did they see changes in their practice. Some stated that crafting their documentation more carefully was a good thing.

Patients welcomed the opportunity to read their doctors’ notes. In a discussion that follows the article, the authors said, “In striking contrast to the doctors’ predictions, few patients reported being worried, confused, or offended by notes they read. We suspect that fear or uncertainty of what is in the doctor's ‘black box’ may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select not to read them. Nevertheless, we anticipate that some may be disturbed in the short term by reading their notes, and doctors will need to work with patients to prevent such harms, ideally by talking frankly with them or agreeing proactively that some things are, at times, best left unread.”

The paper’s authors concluded that “Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption.”

Perhaps open notes would benefit you and your patients. The opportunity might serve as one more patient-centered strategy to facilitate communication and involve patients in their care.



The PCMH's role in public health

by Lisa S. on 8/3/2012 8:04:11 AM

The patient-centered medical home (PCMH) strives to achieve the goals of the Triple Aim defined by the Institute for Healthcare Improvement1: Enhance the patient’s experience of care, improve the health of populations and reduce the per-capita cost of healthcare.

Does that second dimension — improve the health of populations — intersect or conflict with the role of public health? Public health entities, such as city and county health departments, are charged with promoting and protecting the health of their communities.

Divergent agendas: Health of individuals vs. health of population 

“Primary care practices and public health tend to have different orientations and goals, ” says Martha Johns, MD, MPH, a family medicine physician with a background in public health. Johns is HealthTeamWorks’ medical director for guidelines and evaluation. “Primary care focuses on the benefit to individual patients; public health focuses on doing the greatest good for the greatest number of people. These goals do not necessarily overlap.”

For example, primary care physicians often see patients suffering from sinusitis who ask for antibiotics. Although some sinus infections are caused by bacteria that succumb to these drugs, many are caused by viruses that antibiotics don’t affect. To meet the goals of an individual patient, the physician might give her the medication on the small chance that the infection might be bacterial. However, from a public health standpoint, prescribing antibiotics unnecessarily helps promote drug resistance in infectious organisms — a public health threat.

Divergent agendas for primary care and public health may involve cost, Johns notes. “Say the primary care doctor, acting as the patient’s advocate, wants to order an MRI* to help diagnose a patient’s condition. Evidence-based medicine and healthcare economics both may stand against that choice.” All providers need to decide whether their healthcare spending is appropriate, depending on a number of factors.

More possibilities for collaboration than competition

Despite such issues, the ways primary care and public health can work together far outnumber the ways they might conflict. “We [primary care practitioners] can and should use public health resources to fill gaps in our services. We can refer patients to community programs for things like weight loss, diabetes education, and smoking cessation support” Johns says. “We can also partner with them in supporting immunization efforts, disease identification and control, and education and behavior change for healthier lifestyles.”

Johns recalls a movement in the United States nearly 30 years ago to establish community-oriented primary care. Practices formed community health boards to describe health needs, and the practices would respond. Public health entities were often involved. “[This approach] was very egalitarian, very humble,” she says. “It was person- and community-centered care, and filled gaps between medical practices and public health. We are now seeing some efforts to resurrect this type of approach, with collaboration between among primary care practices, public health and community organizations, which should bring great benefits for the health of individuals and communities.

* Magnetic resonance image

1. Institute for Healthcare Improvement. The IHI Triple Aim. www.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx



HealthTeamWorks' CEO comments on Supreme Court decision

by Lisa S. on 6/26/2012 7:38:19 AM

We watched last week as the national healthcare reform movement teetered on life support. Now that the Supreme Court has upheld the Affordable Care Act, we will need to decide as a nation whether we have the courage to make serious changes to our healthcare system or let “politics as usual” put it off once again.  This is not a Democrat issue ; it is not a Republican issue. It is a human issue!  

The current system is unsustainable. Ultimately, healthcare is local. We all need to work together to change how it is delivered and paid for to improve quality, reduce costs and improve the experience for patients and their healthcare teams — restoring the joy of practicing medicine. This will take comprehensive transformation at all levels. Patients, providers and staff, hospitals, health plans and employers must be willing to think creatively and make the needed changes.

We at HealthTeamWorks believe that THIS IS OUR TIME to make meaningful changes in our practices and communities to improve quality, safety, efficiency, communication and coordination of care to reach Triple Aim goals. By continuing to work from the ground up, while systems also change from the top down, we can meet in the middle to create the kind of health and healthcare system we want for ourselves, our families and generations to come.

Marjie Harbrecht, MD
CEO, HealthTeamWorks


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