Accountable GME Linking GME to High-Value Health Care,

University of Michigan, Ann Arbor

Macy Regional Conferences on Innovations in GME

May 24, 2016

New Models of Care Require New Models of Learning

Barbara F. Brandt, PhD, Director

Associate Vice President for Education

Significant redesign thinking and realignment of the relationship between

United States health care practice and education around interprofessional

teamwork

Renewed interest in a fifty-year old field: Interprofessional education and

collaborative practice

Need for new models of learning: Implications for GME and post-graduate

education

Themes

We believe high-functioning teams can improve the experience,

outcomes and costs of health care.

National Center for Interprofessional Practice and Education is

studying and advancing the way stakeholders in health work and

learn together.National Center Funders

• Health Resources and Services Administration

• Robert Wood Johnson Foundation

• Josiah Macy Jr. Foundation

• Gordon and Betty Moore Foundation

• John A. Hartford Foundation

National Center Vision3

A coordinating center for interprofessional

education and collaborative practice will provide

leadership, scholarship, evidence,

coordination and national visibility to advance

interprofessional education and collaborative

practice as a viable and efficient health care

delivery model.

“unbiased, neutral convener”

June 2012 HRSA Funding Opportunity Announcement4

What is Interprofessional Education?

Why is IPE important today?

Stop and Think5

Interprofessional education “occurs when two or more professions

learn with, about, and from each other to enable effective

collaboration and improve health outcomes.”

Interprofessional, collaborative practice “occurs when multiple

health workers, students and residents from different professional

backgrounds provide comprehensive health services by working with

patients, their families, carers (caregivers), and communities to

deliver the highest quality of care across settings.”

Interprofessional education and collaborative practice:

The New “IPE” = Interprofessional Practice and Education

Adapted from: The Centre for the Advancement of Interprofessional Education, UK, 1987World Health Organization, Framework for Action on Interprofessional Education and Collaborative Practice, 2010.

• Different professions

• With, about and from

• Enable effective collaboration

• Improve health outcomes

Key Words

Triple Aim of Alignment• Improving quality of experience for patients, families, communities and learners

• Sharing responsibility for achieving health outcomes and improved learning

• Reducing cost and adding value in health care delivery and education

The Big Idea: The Nexus - Our Vision for Health8

Goal:

Provide patients with more comprehensive, accessible, coordinated and high quality care at lower costs

Greater emphasis on primary, preventive and “upstream” care

Care is integrated between:

– primary care, medical sub-specialties, home health agencies and nursing homes

– health care system and community-based social services

– Accountable health communities

Electronic health records used to monitor patient and population health—increased use of data for risk-stratification and hot spotting

Interventions focused at both patient- and population-level

Move toward “risk-based” and “value-based” payment models

What is going on in the United States?

Practice Game Changers – addressing inefficiencies, cost, errors

Interprofessional Education and Collaborative Practice:

Welcome to the Acceleration of the “New” Fifty Year Old Field

1972

1977

1987

1999

2001

2003 Competency Domains1. Values/Ethics 2. Roles/Responsibilities3. Interprofessional

Communication4. Teams and Teamwork

Today

2011

1 1

The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration

Cooperative Agreement Award No. UE5HP25067. © 2013 Regents of the University of Minnesota, All Rights Reserved.

Principles:

Incentives to motivate higher value care

Alternative payment models

Greater teamwork and integration

More effective coordination of providers across settings

Greater attention to population health

Harness the power of information to improve care for patients

What will be the impact on workforce of HHS Secretary Burwell’s

announcement on value-based payment goals?

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Big Picture: Reframing, retooling and retraining

Low status of primary care

Specialization & sub-specialization

Nurse practitioners, Physicians Assistants, Clinical Pharmacists

Little interest in health care processes

Little evidence for teamwork

Redesign around primary care, prevention, population health

Impact of moving from fee-for-service to global payments?

The right worker partnering with patients, families and communities. How not the who

Quality & systems improvement leading to outcomes

Growing evidence for teamwork

1970 Barriers Today

Put patients first

Demonstrate leadership commitment

Create a level playing field

Cultivate team communication

Explore the use of organizational

structure

Train differrent disciplines together

Available at: Nexusipe.org

RWJF: Lesson Learned From the Field

Promising Interprofessional Collaborative Practices

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Re-enter

Interprofessional Practice and Education

New Models of Care Require New Models of Learning14

1 5

The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration

Cooperative Agreement Award No. UE5HP25067. © 2013 Regents of the University of Minnesota, All Rights Reserved.The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration Cooperative Agreement Award No. UE5HP25067.

The National Center is also funded in part by the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation and the University of Minnesota.

© 2015 Regents of the University of Minnesota, All Rights Reserved

How do we improve the

patient experience of care,

improve the health of

populations, and reduce the

per capita cost of health

care simultaneously?

New Models of Care Require New Models of Learning:

Reframing, retooling and retrainingPatients, Families &

Communities

Health Workforce for New

Models of Care

Learner Pipeline

How do we create a health workforce

in the right locations, specialties and

practice settings that has the skills

and competencies needed to meet the

demands of a transformed health care

system while preventing burnout?

Today I owe:

How do we prepare the

next generation of health

professionals for a

transformed health care

system while improving

experience and decreasing

costs?$100K

How do we prepare the

next generation of health

professionals for a

transformed health care

system while improving

experience and decreasing

costs?

$100K

What is the evidence that Interprofessional Education

makes a difference?

An Interprofessional Learning Continuum Model

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FoundationalEducation

Graduate Education

Continuing Professional

Development

Reaction Attitudes/perceptions

Knowledge/skillsCollaborative behavior

Performance in practice

Interprofessional Education Tomorrow

Learning Outcomes

Learning Continuum(Formal and Informal)

Interprofessional Education Today

• The majority of IPE efforts today occur

early in the learning continuum

(Foundational Education) resulting in

lower level learning outcomes (reaction,

attitudes/perceptions and

knowledge/skills).

• The greatest opportunity for

collaborative practice is when

students/trainees are working together

in clinical practice, where relationships

are formed and interdependence is

readily evident.

• If the ultimate goal of IPE is to improve

health and system outcomes, education

& training for interprofessional

collaboration should increase across

the learning continuum.

• At best, there is only a weak connection

between formal classroom-based IPE

and improved health or systems

outcomes. 18

Learning occurs through and is a central part of everyday work in practice.

All members in the practice environment are learners.

Learning is intentional and is guided by the practice needs rather than a university curriculum.

Change in perception and meaning, based upon the practice environment.

Reintroducing the concept of “Workplace Learning”

Different professions and disciplines do not see the world the same way –

and that is good!

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5/24/2016

Who and how to teach IPE

Quality of facilitating IPE: critical to success

– Ensure IP learning environments – conducive and non-threatening

– Maximizing collaborative learning experiences

– Climate of safety and confidence

– Setting realistic goals, motivating learners, managing expectations,

assuring equal participation, minimizing friction

Intentionally develop facilitators

Pragmatic implications: Presage FactorsReeves et. Al. 2005, 2016

Strategies using adult learning theory, focused on how adults learn

Interactive and learning in interprofessional groups

Collaborative learning

Facilitated learning – roles for mentors

Reflective learning

Ideally, problem focused and related to collaborative practice

– Using simulations

– Experiential learning in practice

The IPE Process

Teaching/learning Principles of IPE

DS: Dental Student

Med Student: Medical students. Includes students from 7700, 7701, and 7511

Doctor of Nursing Practice (DNP): Includes those specializing in Psychiatry,

Pediatrics, Family Practice, and Midwifery

Academic Tourism:

Types and Duration of Educational Experiences

• integrate clinical / community practice and education in new ways,

• partner with patients, families, and communities,

• strive to achieve the Triple Aim in both health care and education (cost, quality, and

populations),

• incorporate students and residents into the interprofessional team in meaningful ways,

• create a shared resource model to achieve goals, and

• encourage leadership in all aspect of the partnership.

Elements of the Nexus:

Aligning IPE with Transforming Health Care

• Growing research networks

(NIN, NEPQR)

• Links practice and education

• Comparative effectiveness

research

• National Center Data

Repository

• National Center

implementation support

• Actionable measurement

Nexus Innovations Network, HRSA NEPQR, and

the National Center Data Repository

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Rigorous Interventional Research Approach Example:

University of Kansas Medical Center

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Popular resources: nexusipe.org29

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LEARN MORE ABOUT THE SUMMIT AT:

nexusipe.org/nexussummit/2016

Attend the summit to participate in:

• Conversation Café: an opportunity to share work and describe key

results while exploring key issues surrounding IPE

• Nexus Fair: an interactive and energizing networking and learning

environment

• Skills-based on faculty development, design thinking and assessing team

performance

• Plenary Session: featuring visions of the future from change-making IPE

leaders

• And much more!

Points to Ponder

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nexusipe.org