The Pittsburgh-based Jewish Healthcare Foundation (JHF) and our Pittsburgh Regional Health Initiative (PRHI), an operating arm of the foundation, are transforming primary care—equipping practices with the resources necessary to reduce waste and inefficiency, improve workflows, implement and meaningfully use electronic health records, and treat complex patients with both physical and behavioral health conditions. True transformation in primary care, however, requires more than the latest technology and innovative quality improvement—it also requires that every frontline worker have the knowledge and skills required to be an integral member of the patient’s care team.

The PRHI recently wrapped up our involvement in the five-year national Safety Net Medical Home Initiative. This demonstration helped community-based health centers to implement electronic health records and improve workflows as they worked to become high-performing patient-centered medical homes. And since 2009, the PRHI has served as a regional extension center for the Office of the National Coordinator for Health IT at the Department of Health and Human Services. In this role, the PRHI has helped more than 800 health care providers and a number of long-term care facilities to implement and optimize the use of electronic health record technology, including assistance in selection and implementation, workflow redesign, and quality improvement training. We have also helped a number of these primary care practices transition to the patient-centered medical home model.

In these and other projects, the PRHI began to see the increasing need for top-performing health care teams with multidimensional skill sets, in which each team member contributes to the health of the patient by working to the full extent of one’s training. We also call this “working at the top of one’s licensure.” The point is to let people with less training do the things they can do, so those with more training can do the higher-level things that those with less training cannot do!

Medical assistants, the PRHI discovered, possess varying skill levels and are used inconsistently across practices, but if they are properly prepared, the PRHI has demonstrated that they can take on significantly more responsibilities for patient care—thus, reducing the burden on physicians and other members of the care team.

Our JHF board of trustees recently approved a grant to the PRHI to implement a Medical Assistant Champions program designed to prepare medical assistants for a primary care environment in which they take on more tasks typically delegated to providers, such as patient outreach, patient education, self-management support, and tracking of referrals to specialists and other resources outside of the primary care practitioner’s office (such as diagnostic testing, physical therapy, smoking cessation programs, and so forth). The eighteen-month, $360,000 initiative, which kicks off in March 2014, is modeled after other successful Champions programs that the JHF has funded and directed over the past decade in areas such as pharmacy, emergency medical services, and long-term care. The program is based on a curriculum developed by the PRHI Learning Solutions group. Its trainers and coaches have developed a range of services to support quality improvement and workflow redesign, patient-centered medical home implementation, electronic health record implementation and optimization, behavioral health and unhealthy substance use screening intervention in primary care, patient-centered communication skills, and teamwork and team-based care.

Up to twelve medical assistants from primary care practices and health centers in western Pennsylvania will receive training and ongoing coaching and will follow an enhanced curriculum that includes:

* Perfecting Patient CareSM, the PRHI’s flagship process, based on Lean manufacturing principles, to eliminate medical waste, errors, and inefficiencies;

* Tomorrow’s HealthCareTM, the PRHI’s online platform for continuous quality improvement;

* Training on how to use an electronic health record; and

* Training in motivational interviewing, a conversation style in which health care professionals and patients work together to (1) discover patients’ own reasons to make positive behavioral changes and (2) strengthen their commitment to change.

In addition to receiving training and education, Medical Assistant Champions will apply their new skills by improving the workflow in their own primary care offices. Champions will identify an opportunity to impact health care quality, efficiency, clinical best practices, or patient experience; identify key metrics associated with their intervention; measure the outcomes to gauge effectiveness; and present their findings at a wrap-up learning session.

Medical assistants have traditionally been underutilized and undervalued. This eighteen-month initiative is an investment in the careers and professional development of medical assistants in our region that will also help to build primary care capacity at a time when we expect to see a surge in the demand for care (from patients newly insured as one result of the Affordable Care Act). My hope is that this is the beginning of more widespread training of medical assistants, with more physicians and practice managers wanting to elevate their role and more job seekers looking on the medical assistant position as an attractive entry point into patient care.


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