ACO and PCMH model looks for a team-based effort to see that the right care is delivered at the right time. The successful practice transformation, one where all team members are working at the top of their license, requires center-wide commitment.

A nation-wide lecturer on PCMHs and an EngageHealth IQ Advisor, Jenene Washington, MD, MBA, Pediatrician and Medical Director, Baltimore Medical System, shares the multi-tiered approach to medical home transformation with EngageHealth IQ.

Before any gap analysis takes place, the first steps in the transformation include recruiting key people in the conversation who can champion the changes is important to the success of the overall process.

“Different practices have different goals, so bringing in these champions—these leaders and influencers—can help every organization or center on the path to success,” shares Dr. Washington, EngageHealth IQ Advisor.

Here are four initial steps she recommends for organizations to take as they gain momentum in the ability to become PCMH-designated.

1. Determine practice goals and priority of those objectives.

The primary care practice needs to be built so that the physicians, nurses, and the entire care team have enough support for their daily duties, as well as longitudinal responsibilities. “Do we have enough people to get through the day efficiently? Do we have enough people to manage patients as efficiently as we could?” These are the questions that can accelerate the process. Combined with keeping cost effectiveness and revenue gains in mind, “that’s really the first step,” explains Dr. Washington.

The next step is to identify the priority outcomes and goals for the practice. “Since each practice is unique, the focus on practice transformation may differ from practice to practice.” This is where the champions of this better coordinated care can share and cultivate the practice’s unique vision and goals with the rest of the team.

These goals could include any of the following:

·  Access for patients

· Timely communication across care continuum

· Quality of care

· Well-managed transition of care

· Ability of physicians to see more patients

· Team-based, efficient style of care

Or, they could be goals including being better prepared for patients/pre-visit planning; increased care management by nurses; referral tracking; lab tracking—the list goes on.

 “Different practices of course have different goals, and different priorities,” explains Dr. Washington. “Sometimes they really want a true care management program, or maybe it is increasing the ability of patients to access the center. The practice has to prioritize what they want, and the second component of this is really determining the ultimate staffing model desired.”

2. Analyze current workflow to better examine individual roles responsibilities.

By looking at workflows, it’s possible to see where inefficiencies exist in relation to the goals that were set. By looking at the role of all staff members, and adjusting as necessary, a physician’s time can be freed up, removing responsibilities that could be taken on by a different resource on staff.

“Another example is sometimes we can see how RN/nursing role will shift into a role where they are able to have more direct patient care. This would mean they would have more opportunities for patient education and care coordination, so in this situation, the role becomes more hands-on,” she says.

“With a nurse’s role becoming less clerical and having a direct patient care emphasis, the practice as a whole may be able to see the benefits from this in terms of reimbursement, patient compliance with treatment goals, and overall patient satisfaction,” Dr. Washington adds.

“Once you’ve prioritized, and we’ve done an assessment of our workflows—we can evaluate  where we stand with access, or how are we doing now with pre-visit planning. We can begin the process of transforming the practice one step at a time.”

From each of those goals, workflows can be created and shared.

3. Determine gaps in the practice’s framework.

Everyone on the team should be working at the top of his or her license. “Take for example a nurse who might be answering phone calls and scheduling patients; she could be working with a patient and getting reimbursed for that. That’s really what you want them to be doing, and that’s what they really should be doing, says Dr. Washington.

Ultimately, it’s a better outcome for the patient when roles or responsibilities are re-distributed in this way.

Understanding “gaps” in the workflows or processes can be as simple as asking, “Is our current model meeting the needs of our patients? Or our staff?” If not, what else needs to be accomplished, implemented, or even removed to optimize our performance?

The gap analysis includes the “what else” and outlines steps to include the missing pieces, or to remove the redundancies, in the workflow.

4. Implement improved process and procedures. 

After the workflow is determined, process improvement is where the dots are truly connected.

Explains Dr. Washington, “Depending on the size of a center, a question that needs to be answered is: do you have a new policy or procedure in place to ensure that your new workflows and standards are documented to be referenced at a later date? And, in formulating a new policy or procedure, also ask: how will we measure success of the new policy? We would want to know what metrics are required and how often we will evaluate those metrics.

Whether it’s a simple reassignment of roles, or a change in workflow design, we must be prepared for change.

It’s true there are built-in efficiencies with the PCMH model adoption, but real revenue gains and an enhanced workflow are not changes that all happen overnight. 

“We’re talking about implementing change, and what you find is that even though inefficiencies are recognized, the team will have to put in extra effort to implement this change,” explains Dr. Washington. 

“Like with all change, though, it’s well worth it when you see a mediocre practice completely re-energized. It is exciting when patients notice the difference in the management of their health or the efficiency of the team; you know you are making a difference in the new model. It’s great to see people put in the effort to transform the practice, and then you see the rewards as they achieve—and even exceed—the goals they created for themselves."