Navigating the process of becoming a Patient-Centered Medical Home (PCMH) is not simple. The process can take more than a year, according to Jennifer Zreloff, MD, medical director, Emory Healthcare, Atlanta, and Steven Blubaugh, MBA, MHA, CCE, CMPE, MGMA member, senior consultant, DHG Healthcare, Atlanta. The pair outlined important considerations for any practice planning the transition in their MGMA 2016 Annual Conference presentation “Avoiding the Sand Traps on the Path to PCMH Transformation.”
If your practice is considering a move to PCMH recognition and accreditation, here are some of the things that Blubaugh and Zreloff believe are important to know.
Before the commitment
First and foremost, you need to understand who you are working with before you begin PCMH transformation, says Blubaugh. “You need to understand the physicians, staff, the other administrators, and what they would want out of PCMH.” Becoming a PCMH is a long process and can take a toll on your staff. He says that you need to be aware of the benefits of PCMH for each member of your staff to obtain buy-in. “Know your audience and speak to the specifics they care about,” Blubaugh explains.
Communication is also a key factor in the beginning stages. Make sure everyone is in the “knowledge loop,” as Blubaugh calls it. “I think it’s really important that anyone on the transformation team, as well as anyone undergoing transformation, really can say what is a medical home,” says Zreloff. “Because if you can’t say what you are trying to do, then it will be really hard to do the hard work involved in transformation.”
During the transformation
Once you’ve started the transformation, use data to make significant, well-educated changes, says Blubaugh. Data should be used to inform practice improvement activities, both clinical and operational.
Zreloff recommends you start making process changes right away and not waiting to make them until the application is complete. “Make sure, as you are documenting processes, your groups are actually doing those processes the way that they are documented,” she says.
Another step Zreloff recommends is ensuring that your stakeholders participate in meetings about the transition as it’s happening. Failure to get stakeholder feedback leaves good ideas on the table, says Zreloff. Staff understand the inner workings of their job the best and can identify opportunities for improvement. “If you only have the leaders at your meetings, you’re not going to get good group problem-solving,” she explains.
She also advises that practices encourage clinical staff to take on responsibility over time to build the providers’ trust in team-based care and population outreach. Physicians can’t keep shouldering more responsibility without burnout, she says. Gradually shifting the responsibilities can help ease that transition.
After the transformation
Once you’ve completed the PCMH transition, your work is not over. Accountability is essential to maintain improvements realized during transformation, says Blubaugh. “It’s very tough and it takes intentional effort to keep doing what you just spent so much time trying to put in place,” says Blubaugh. “It’s important to assign accountability to your team to help ensure that these new processes continue.”
You should also re-evaluate your onboarding processes so that you don’t lose your progress with staff changes. Onboarding processes should reiterate and reinforce the PCMH mindset. Introduce and train new staff on the concepts of PCMH and how job functions at the practice may be different than what they are used to. “You need to get buy-in from your new staff,” says Blubaugh.
Finally, once you’ve become a PCMH, seek out value-based contracts to fully capitalize on the transformation. Practices risk missing out on very important revenue by not asking commercial payers to increase their reimbursement due to improved care delivery, explains Blubaugh. Use data to show quality improvements and seek out higher contracted rates with commercial payers.
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