December 2016 MNRI Work Session Record

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Coordinated By:

Medical Neighborhood Referral Infrastructure Project In-Person Work Session December 16, 2016 Record of Learning Meeting Participants  Jane Acri, Central Ohio Area Agency on Aging  Karen Bishop, CliniSync  Heather Carroll, PrimaryOne Health  Margaret Centofanti, Central Ohio Area Agency on Aging  Matthew Dewit, Central Ohio Primary Care  Maurice Elder, LifeCare Alliance  Linda Gillespie, Central Ohio Area Agency on Aging  Elio Harmon, Alliance Healthcare Partners

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John Leite, HCGC Michelle Missler, HCGC Laura Poling, Charitable Pharmacy Carly Skillington, Mount Carmel Health Partners Krista Stock, HCGC Barbara Sullivan, Franklin County Office on Aging Steve Thompson, Helping Hands Health & Wellness

Welcome and Framing Thank you to the Central Ohio Area Agency on Aging for hosting the session and providing us with refreshments. To view the slides used during the session, please click here. CliniSync Updates (Karen Bishop, CliniSync) Karen shared that CliniSync recently received the next system update from their vendor. Over the next few weeks they will be working to implement the update across the state. Once implemented the referral tool should be able to accommodate non-covered entities by limiting the referral history that they are able to view for patients. CliniSync also is hopefully that this update will include the ability to customize search terms for services, and send email notifications when there is new activity in the tool. The update should also lead to improved performance of the system. CliniSync is hopeful that the update will be completed in early January. If you have any technical questions regarding the referral tool, please contact Karen Bishop (kbishop@ohiponline.org). Sharing Lessons Learned from the MNRI Project in 2016 Small Group Discussion #1  What has been the value of the project for your organization? o All referrals are in one location. o Referrals incoming/info in one place o Responsive of some practices/direct messages. o Streamline referrals—uniform information provided for each referral. o Timely results especially for MCH  What are the challenges of the project for your organization? o Cross education among agencies. o Getting feedback from referring agencies. o Increasing utilization o Low motivation to utilize among staff. o No email notifications o No search functionality to ID resources o System can be slow/time consuming which lowers ease of use. Following the first group discussion participants reviewed activity data from 2016. Participants were first shown overall activity and then activity by organization. The network is on pace to exchange around 500 referrals in its first year.


This is the same number of referrals that was exchanged by the referral network in Michigan during their first year of implementation. After reviewing the data the meeting broke down into small group discussion to work on the following questions. Small Group Discussion #2  What are we learning from the referral activity data? o Most of the referrals are coming from a subset of the network. o Organizations either send or receive not many do both. o Some are more weaved in than others. o Some organizations are more niche/a destination o Some organizations not doing in and out referrals. o Two organizations are responsible for most referrals  What goals can we set for 2017 based on this data? o Champions within organization that can lead the use. o Ease of referral/appropriate info. o Education o Higher referrals o Id others to participate. o One person who is a champion of the program in the organization. o Sending more referrals. o Want to start making referrals. o Want to train more staff. Exploring Approaches for Increasing Referral Activity (Michelle Missler, Healthcare Collaborative of Greater Columbus) Michelle shared information with the group regarding the work HCGC intends to catalyze in 2017 to impact chronic conditions. Based on feedback from partners HCGC plans to bring together organizations across the medical neighborhood to begin screening diabetic patients for depression utilizing the PHQ-9 screening. HCGC will also work to connect participating organizations with behavioral health providers to provide treatment for individuals who screen positive for depression. Project Purpose: Improve chronic condition management by advancing results-based practices with clinical and social service organizations. Objectives:  Adopt and spread utilization of PHQ-9 to screen for depression in patients who self-identify as diabetic.  Strengthen relationships among project participants to raise awareness of resources available in Greater Columbus.  Share learning and best practices to improve care coordination among medical neighborhood participants. Committed Organizations:  Central Ohio Primary Care  CompDrug  Mental Health America of Franklin County  Ohio Department of Health  Syntero If your organization is interested in participating, please contact Michelle Missler (michelle@hcgc.org).


Closing A survey is being sent out to gain feedback from project participants on the preferred meeting schedule in 2017. Once dates are finalized a message will be sent out to the group. Please let us know if you have any questions.

Thank you for participating!


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