Ambulatory Practice of the Future

1. Ambulatory Practice of the Future David Judge, MD – APF Medical Director Nicola Majchrzak, MPH, MSW – APF Project Manager Collaborators: MGPO, CIMIT, MGH Lab of Computer Science Stoeckle Center for Primary Care Innovation, SimsLab Boston, February 2010

2. Agenda • Background and charge • Our Vision • Shifting Paradigms for Care • The APF Care Model • Discussion

3. Background and Charge Multidisciplinary team assembled in 2004, charged with designing a new care model to radically improve the care experience for patients and providers and anticipate the challenges of the future.

4. “We will design the ambulatory care practice that delivers ideal care in the ideal environment to optimize outcomes for all.“ The Ambulatory Practice of the Future

5. Shifting Paradigms for Care Focus on sickness Focus on health & wellness Directive communication Culture of collaboration One size fits all Mass customization Individual experiences Team-based experiences Event-based care Continuous care Patient goes to treatment Treatment goes to patient Obscurity Transparency Static model Evolving care model

6. The APF Care Model • Health & Life Balance Plan • Compact • Orientation & guide • - Customized care plan • Advisory role in ongoing APF development Patient

7. The APF Care Model • Members - MD, RN, NP, MA, Care coordinator, Greeter, Medical Secretary • Acute / chronic care • Proactive pop. mgmt. • Shared responsibility of ongoing practice redesign • ‘Productivity’ redefined (Compensation supports longer visits and non- traditional care activity) Care Team Patient

8. The APF Care Model • Patient-centered design • Critical components: • Check-in Kiosk • Living room/library • Central team area • APF Exam Room • Large meeting space (group visits) • Urgent care + Procedures • Communication tech • Prototyping Lab Physical Practice Care Team Patient

9. The APF Care Model • APF Portal (LCS) • Chart review, visit prep, ongoing care plan work • Synchronous and asynchronous e-visits • Remote physiologic monitoring (CCH, CIMIT) • New services (online scheduling) • Population management • Peer–to–peer care Virtual Practice PhysicalPractice CareTeam Patient

10. Evaluation Patient experience Provider and staff experience Clinical outcomes Utilization of services & cost

11. Discussion