In this webinar, we explored the expanded role that medical assistants play in improving patient health outcomes. The role of the medical assistant was explored in population management, using electronic dashboards, and health coaching. We discussed how state-by-state variation and regulation may influence medical assistant practice.

1. Welcome
Advancing Team-Based Care
March 3, 2016
WEBINAR 2: Enhancing the Role of the Medical Assistant

2. Community Health Center, Inc.
Foundational Pillars
1. Clinical Excellence- Fully Integrated teams, Fully
integrated EMR, PCMH Level 3
2. Research & Development- The Weitzman Institute is the
home of formal research, quality improvement, and R&D
3. Training the Next Generation: Post Graduate Training
Programs for nurse practitioners, postdoctoral clinical
psychologists, and students of the health professions
CHC Profile:
•Founding Year - 1972
•200+ delivery sites
•130k patients

3. The Community Health Center, Inc. and its Weitzman Institute will provide
education, information, and training to interested health centers in:
Transforming Teams
• National Webinars on the team based care model
• Invited participation in Learning Collaboratives to launch team based care at
your health center
Training the Next Generation
• Two National Webinar series on developing Nurse Practitioner and Clinical
Psychology residency programs and successfully hosting health professions
students within health centers
• Invited participation in Learning Collaboratives to implement these programs at
your health center
Email your contact information to nca@chc1.com and visit www.chc1.com/NCA.

4. Enhancing the Role of the Medical Assistant
Today’s Objectives:
1. Participants will be able to identify at least two new areas for medical assistant roles in the
primary care team.
2. Participants will be able to identify at least one way that state-by-state variation and
regulation can affect medical assistant practice.

5. Get the Most Out of Your Zoom Experience
• Send in your questions using Q&A function in Zoom
• Look out for our polling questions
• Live tweet us at @CHCworkforceNCA and #StartingResidencies and #HRSAnca
• Presentation and slides will be available after on our website
• CME approved activity – please complete survey
• Upcoming webinars: Register at www.chc1.com/nca

6. Expanding the Roles of Medical
Assistants
Learning from Effective Ambulatory Practices
MacColl Center for Health Care Innovation
Group Health Research Institute
March 3, 2016
Ed Wagner, Director Emeritus
Brian Austin, Associate Director

7. Who are MAs?
• “Medical assistants are not licensed but work under the
license of a physician. They cannot make medical
assessments, offer medical advice, or triage patients.
They may, however, provide information to patients
and follow a wide variety of physician-approved
protocols provided that training and supervision are
in place.”
• Formal training – usually 3-6 mos.
• Median salary -- ~$30,000/yr
Willard-Grace et al. JAMA Int Med 2014;174:1025-6.

8. Team Structure:
Major Findings From Site Visits
Medical assistants play key patient care roles
beyond rooming patients.
Roles are expanded. All staff work at the
top of their license and skillsets.
Providers and their panels supported by
Core teams built around PCP—MA dyads.

9. How to Achieve the Quadruple Aim?
Informed, Activated
Patients
Comprehensive
Services
• Engaged Leadership
• Enhanced Access
Essential Practice
Functions or Competencies
• Population Management
• Planned Care
• Medication Management
• Care Management/Follow-
up
• Referral/transition
Management
• Behavioral Integration
• Self-management Support
• Clinic-Community
Linkages
• Communication
Management
• QI strategy/Meaningful Use
• Empanelment/Continuity
• High-functioning Teams
Capacity for Quality Care
• Improved Health • Improved Patient Experience
• Reduced Total Costs
• Improved Staff Experience

10. MA Involvement in Key Functions or Competencies
Track, identify,
and reach out to
patients with
care gaps
Population
Management
Provide patient-
centered,
evidence-based
services
Planned Care
Self-
management
Support
Medication
management
Behavioral
Health
Integration
Provide follow-
up and care
outside the
office
Care
Management
Referral
management
Clinic-
Community
Connections The
Quadruple
AimsCommunication
Management
Enhanced
Access
Meet patient
needs in a timely
manner

11. Deploying MAs
• LEAP practices generally build teams around fixed MA-
PCP partnerships (teamlets).
• Multiple MA to provider models:
– High Plains (CO) - 3 patient facilitators per care team who
rotate front and back office tasks, coordinate referrals
immunizations, bring everything into the patient room
– Family Care Network (WA) – 2 clinical assistants who alternate
between rooming the patient & “scribing” during the patient
visit.

12. What does MA role expansion look like?
Team Guide Assessment item-- MAs in our practice:
D Mostly take vital signs and room patients.
C Perform a few clinical tasks beyond rooming patients, such as reviewing
medication lists or administering a PHQ-2.
B Perform a few clinical tasks and collaborate with the provider in managing
the panel (reviewing exception reports, making outreach calls, managing in-
basket).
A Collaborate with the provider in managing the panel, and play a major role
providing preventive care and services to chronically ill patients, such as self-
management coaching or follow-up phone calls.

13. Newer Roles for MAs
Pre-visit planning
13
Reconciling medications
Scribing for providers
Participating in quality improvement work
Health coaching and motivational interviewing
Delivering or arranging preventive services
Providing telephone or in-person follow-up

14. How do effective practices deliver planned care?
Identify the key
clinical tasks
associated with
evidence-based
care and decide
who does them.
MA reviews
patient data prior
to the encounter
to identify
needed services.
Encounters are
organized so
that relevant
team members
deliver all
needed care.

15. How do effective practices implement self-
management support?
• linkages with self-management programs in the
community.
Forge
• team members to provide basic self-management
support. Can be MA, trained layperson, or nurse.
Organize & train
• self-management support into every interaction.Build
• self-management goals and their attainment in
the patient’s record.
Document

16. How do effective practices manage
medications?
• Medication reconciliation is viewed as a critical intervention
for both patient and practice—often begun by MA at intake.
• Pharmacists and RNs play important roles in complex med.
rec., titrating medications, and addressing non-adherence and
other drug problems.

17. How do effective practices deliver planned follow-
up and Care Management (outside of visits)
• Follow-up between office visits is a core function of the
practice team.
• Care teams regularly monitor patients and promote self-
monitoring.
• Follow-up can range in intensity from periodic status checks
by telephone or e-mail (MA) to active care management (RN).
• Higher risk patients (poor disease control, frailty, etc.) receive
regular follow-up (monitoring) AND active care management.

18. The steps to consistently high team performance
Build trust and
communication
Identify and
assign tasks
Train staff
Develop
standard work
IT supports
work flow
Enable staff to
work
independently

19. Build a Career Ladder
Floor
coordinator
Health
coach
Medical
assistant
Union Health Center MA Career Ladder
http://improvingprimarycare.org/team/medical-assistant-ma#tab-2

22. Resource Spotlight #1

23. Resource Spotlight #2

24. Resource Spotlight #3

25. High Plains Community Health
Center
• Located on the Plains of SE
Colorado
• 120 miles from the closest mall
• 40,000 Medical, Dental and
Behavioral Patient Visits per
Year in a catchment area w/
12,000 people
• Level III PCMH
• Comprehensive Services
including Medical, Dental,
Labs, X-ray, Behavioral Health
& Health Coaching
Jay Brooke, MSW, Former Chief Executive Officer
CeCe Bohl, Medical Assistant and Quality Improvement Coordinator

26. Open Space for Discussion

27. Reminders
Sign up for our next webinar in this series:
The Emerging Role of Nurses in Primary Care
Thurs., Mar 31st, 2016 2:00-3:00 PMEST
Complete our survey!
Sign up at www.chc1.com/NCA

28. Speakers
From Community Health Center, Inc.:
Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director
Deborah Ward, RN, Senior Quality Improvement Manager
Mary Blankson, DNP, APRN, FNP-C, Chief Nursing Officer
Natasha Quinn, Senior Medical Assistant
Dipak Patel, DO, Meriden Onsite Medical Director & Family Medicine Physician
From MacColl Center for Health Care Innovation, Group Health Research Institute:
Ed Wagner, MD, MPH, Director Emeritus
Brian Austin, Deputy Director
Katie Coleman, MSPH, Research Associate
From High Plains Community Health Center
Jay Brooke, MSW, Former Chief Executive Officer
CeCe Bohl, Medical Assistant and Quality Improvement Coordinator