Lucky 7: Navigating the Top Approaches to Starting a Medical Home
By Richard Scott
April 24, 2012
Throughout the country, primary care practices are transforming into medical homes. As the shift takes place, early evidence is providing feedback on this collective, health reform-backed upheaval and identifying common barriers facing physician practices – as well as best-practice advice for those seeking to complete the transition to the coordinated world of medical homes.
The Robert Wood Johnson Foundation (RWJF), which has launched the Aligning Forces For Quality (AF4Q) initiative to spearhead practice improvement, recently reported on its program’s initial results, based on data from more than 2,200 providers involved in medical home implementation.
The findings, at least in part, are an attempt to understand whether moving to a medical home is a viable opportunity for practices, particularly during this era of constant flux and shifting roles and responsibilities.
“Primary care doctors have had so much put on them over the last couple years, it’s almost gotten to the point where they don’t have time to do what they went into the medical field to do,” says Kathy Hutcheson, patient partner coordinator with AF4Q of South Central Pennsylvania.
One way the medical home seeks to address that is by creating enhanced patient engagement, which can be achieved through a strong, diverse clinical team.
“The medical home model [aims] to get physicians and their patients to work together as partners,” says Hutcheson. “And in the medical home approach, the doctor makes better use of a clinical staff, like a health educator, dietician or care manager.”
Demolishing Barriers, Creating Success
Researchers from RWJF set out to understand how practices were faring with the medical home and its process changes – and what those changes meant for productivity, outcomes and morale. Through a series of surveys and follow-up interviews with staff, the researchers identified predominant themes that carried across the majority of practices.
First, they identified a quartet of common challenges (or perceived challenges):
- Time demands. One of the biggest obstacles that the research unveiled was a perceived time crunch. Practices that were slow to implement a medical home cited time constraints as a major barrier, saying that the ramp-up time would cut into patient volume and the associated operating revenue.
- Patient obstruction. According to the research, some practices worried that patients would not buy in to the medical home philosophy that centers in a large part around increased patient responsibility.
- Health IT. A huge part of the medical home’s functioning and success, health IT can eat up both time and money, and some practices saw this as an obstacle they could not overcome without sacrificing their livelihood.
- Taming expectations. Practices that viewed medical home implementation as overly burdensome were less likely to move forward with its measures and procedures, while practices that recognized the work involved were much more likely to succeed with systemwide implementation.
Moving past these obstacles, the researchers unearthed a set of common strategies that practices used to prepare for a medical home implementation. The following seven takeaways serve as a blueprint to lasting success in this new paradigm of healthcare delivery.
- Leadership. According to the study, the practices most successful at implementing a medical home had the benefit of two champions: a practice manager and a physician. The practice manager acted as an “implementation leader” who ushered team unity and orientation, while the physician served as a “thought leader” who reminded the team about the benefits of the medical home. Practices without the two leaders had a more difficult time.
- Buying in. Practices that were able to disseminate the value of the medical home to the wider team saw greater success over the long-term. “Consistently holding regular meetings to discuss implementation successes and failures and having physician champions participate in these meetings helped other team members engaged in and develop an appreciation of the overall purpose” of the medical home.
- Understanding details. To help the wider practice understand the nitty-gritty details of the medical home, such as specific domains and tasks, successful practices encouraged a team member to become a “medical home expert” by attending conferences or other educational meetings.
- Small steps. One of the few areas where researchers discovered unanimity among the practices they studied, the concept of “incrementalism” was viewed as a necessary way to begin medical home implementation. Practices recommend reviewing medical home requirements with the entire practice to figure out where to begin implementing change.
- Data use. While all practices saw the benefit of data, the most successful practices proved to be active in obtaining and reviewing data, even from external sources like insurers.
- Clear roles. “Practice teams found that clearly defining roles and responsibilities of team members helped in clarifying duties, engaging all members, and standardizing PCMH work,” say the researchers.
- Curiosity. All practices expressed a desire to learn more from their peers. At the time of publication, however, participation in learning collaboratives was limited.
From practice champions to full staff engagement, the principles outlined above are vetted strategies for a successful medical home transformation. While it may be new (and even scary) for some practices, the medical home “will result in improved patient flow, better teamwork within the practice, more time with patients, higher job satisfaction, and higher patient satisfaction,” according to researchers.