Utilizing medical assistants in expanded roles in primary care management

Objective To explore innovative practice models and career paths utilizing front line, entry-level health care workers such as Medical Assistants (MAs). To identify and conduct case studies at sites across the U.S. that illustrate these models and disseminate findings and best practices. Methods Conducted a brief literature review to update information on innovative employers, models, and settings with programs focused on furthering the careers of medical assistants while improving health care outcomes and maintaining or lowering costs. A national environmental scan, review of the literature, and networking identified potential case study participants. From approximately 40 potential case study candidates, we selected 15 sites aiming for variation in region, urban and rural settings, community clinics and large physician group practices, and older and newer models of innovation. Sites were contacted via email and phone for initial screening and willingness to participate. 1-2 day site visits made to 10 sites to date included interviews with 8-10 staff per site (administrator, physician staff, NP, RNs, LVN, MAs, and other support staff). Findings There are many practice settings across the U.S. with expanded roles for MAs. Roles include disease management by protocol, health coaching, EHR management, prevention screening, telephonic chronic care management, and care coordination. Additional training was required to prepare MAs for these roles. At some sites, expanded roles were accompanied by significant career development including increased wages and career steps including new titles such as health coach. These initiatives resulted in organizational and patient benefits e.g.; a community health center in Colorado increased provider productivity from 1.82 patients per hour to 2.7 and realized substantial cost savings; a health center in New York saw the percentage of diabetic patients who met clinical goals rise from 13 to 36%. Most physician and NP partners embraced the expanded MA role, participating in ongoing training and mentoring. Conclusions and Implications Although evaluation of the impact on patient care and outcomes is limited, data indicate improved quality outcomes and cost-effectiveness of the models. Additional training for MAs is needed to focus on chronic care disease management, health coaching, and customer service skills. Expanding and improving the role of medical assistants is an opportunity that partially grew out of necessity to improve care in a team bases and cost effective model. Identifying and disseminating information on successful models may allow duplication in new settings.