High-functioning clinical care teams routinely use standardized pathways and tools to improve quality. Most of the pathways and tools that have been developed to date are for in-person care. A multi-disciplinary team from Health Management Associates (HMA) developed pathways for four common conditions—asthma, diabetes, hypertension and depression. This presentation will provide an overview of the current and predicted telehealth landscape, discuss the challenges and benefits from developing pathways for care delivered through telehealth, and demonstrate portions of the pathways.
1) Describe the imperative, challenges, and benefits of telehealth services
2) Describe the benefits of clinical pathways and opportunities to modify pathways to support virtual care
3) Describe the potential applications and implementation strategies of virtual care pathways in their own clinical environment
Presenters: Margaret Kirkegaard, MD, MPH
Dr. Margaret Kirkegaard provides client consulting focusing on physician engagement in health care reform, medical education, community health and medical care integration, primary care development and transformation, population-based health care delivery and underserved and vulnerable populations.
Dr. Kirkegaard has particular expertise in the implementation of the patient-centered medical home model (PCMH). For over six years, she served as the Medical Director of Illinois’ state-wide, start-up primary care case management program for 1.8 million Medicaid clients. She was responsible for network development, physician recruitment and practice transformation to the medical home model for 5700 primary care providers and 2300 specialist providers. During her tenure, she was largely responsible for the clinical quality program and developed multiple clinical quality management tools and a pay-for-performance program based on HEDIS and other quality metrics.
Dr. Kirkegaard served as a coach for over 30 primary care practices in Idaho helping them adopt the PCMH model as part of Idaho’s Statewide Healthcare Innovation Plan. She worked with the HMA team to develop the telehealth curriculum for rural practices and coached them to implement telehealth services.
HMA has successfully assisted Hospital Sisters Health System (HSHS), a largely rural healthcare system spread across Illinois and Wisconsin, in the development of the Illinois Telehealth Network. Originally comprised of 16 hospitals, the network membership has now expanded to 21 primarily rural and/or critical access hospitals and some safety-net hospitals located in smaller Illinois cities. Many of the participating member hospitals also operate rural health clinics. HMA has supported the development of the rural health network, provided technical expertise on the adoption of telehealth services and the development of clinical protocols, and led strategic planning efforts. The network now functions to support the members in disseminating best practices, implementing telehealth service lines, sharing clinical protocols, removing barriers, and promoting evaluation.
Dr. Kirkegaard is currently working with the Centering Healthcare Institute in developing an innovative virtual Centering Care model that incorporates the supportive features of group care in a virtual environment.
Dr. Kirkegaard is a board-certified family physician. She received her M.D. from the University of Minnesota and completed her Family Medicine residency at Hinsdale Family Practice Residency. She holds a Masters of Public Health with a concentration in Health Policy and focus on Quality Improvement.
As a third-generation family physician with roots in rural Minnesota, Dr. Kirkegaard has over twenty years of clinical experience and continues to teach and provide clinical care to patients in a Level 3 NCQA Recognized PCMH clinic with integrated behavioral health services.
Nancy Jaeckels Kamp, Managing Principal
Nancy Kamp specializes in the strategic planning and implementation of integrated behavioral healthcare and development of the clinical infrastructure for primary care transformation and accountable care organizations. She has over 25 years of healthcare experience in direct patient care nursing and laboratory medicine, quality and safety, development and implementation of models of best practice, and operational leadership.
As vice president for the Institute for Clinical Systems Improvement for 15 years, Ms. Kamp led multiple, multi-organizational, multi-state projects, including the development and implementation of an integrated model for depression management in primary care called DIAMOND. She designed and led year-long collaboratives to institute this model into more than 85 primary care sites and attain involvement from over 25 behavioral health groups. She then led the expansion of this work to include other co-morbid mental health conditions and chronic medical conditions.
Ms. Kamp is trained in IMPACT and conducted extensive training and implementation of the IMPACT model and the substance abuse model. She facilitated care management skill building, including motivational interviewing, patient self-management, and shared decision making across four states under a grant from the Agency for Healthcare Research and Quality. Ms. Kamp served as a subcontractor to the University of Washington to do IMPACT model trainings and developed learning collaboratives for practices on the IMPACT model. She directed multiple learning collaboratives involving primary care integration with behavioral health groups and ACT teams to integrate preventive care bridging transitions and developing partnerships with primary to specialty care and inpatient to outpatient care. Ms. Kamp oversaw a state-wide implementation collaborative of medical homes, including design, infrastructure development, implementation, development of a new payment methodology, aligning quality regulatory and financial incentives, and evaluation and ongoing improvement of the systems.
Ms. Kamp is a certified professional in healthcare quality, quality and organizational excellence, and change management, and served two terms as president of the Minnesota HealthCare Quality Professionals.
She earned her bachelor’s degree in psychology from Kaplan University.