La Clínica De La Raza: Contra Costa Care Team Uplift Initiative

A confluence of factors has dramatically increased the demands on primary care providers, particularly on those at community clinics providing care for the underserved. Among the factors: The Affordable Care Act, with its focus on prevention and the creation of medical homes, increased the demand for primary care services, even as the primary care workforce continues to shrink. In addition, an aging population, growing economic disparities and electronic health records have all increased the amount of time primary care clinics spend managing patients with chronic conditions and co-morbidities across settings.

Too often the result has been overburdened clinical teams and less satisfied patients. To prevent that from occurring at La Clínica de La Raza, in August 2017 the Community Health Fund (CHF) awarded La Clínica a $214,758 grant to implement the first year of its two-year plan aimed at improving workforce engagement and patient satisfaction, increasing patient access and staff productivity, making clinical quality improvements and helping to relieve increased demands on primary care physicians. The program, which builds on the CHF-supported Contra Costa Nursing Care Expansion initiative, will focus on improving communication among clinical teams, streamlining workflows and enabling each team member to work to the top of their training, license and abilities.

In year one, La Clínica will:

  • Hire a nursing manager to help shape and manage the new program.
  • Contract with Coleman Associates to provide advanced training to 30 medical assistants (MAs).
  • Establish standardized protocols and workflows for nurses and MAs.
  • Develop and conduct a communication and culture shift training program for all team members.
  • Develop collaborative partnerships with education and training programs to establish MA and nursing pipelines.

To sustain the program, year two activities will concentrate on preparing for the July 2018 implementation of California’s Alternative Payment Methodology (APM). The APM incentivizes practice transformation at federally qualified health centers (FQHCs) through a capitated model of payment, which moves the clinics away from traditional, volume-based payments. The idea is to give participating FQHCs the flexibility to deliver care in the most effective manner. Success may well depend upon FQHCs using non-physician care team members more effectively to address patient needs that don’t require hands-on physician time.

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