Becoming a Patient Centered Medical Home

1. Becoming a Patient Centered Medical Home

2. What is the PCMH? • The PCMH is an approach to providing comprehensive primary care for children, youth, and adults. • The basic premise of the PCMH is that it facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient’s family.

3. Core Features of the PCMH • Centered around continuity relationships with a personal physician • Whole person orientation – comprehensive • Team based approach • Care integrated and coordinated • Patient-centered; self-management support • Ongoing Quality Improvement • Enhanced access • Payment reform

4. Practice Transformation to Medical Homes – Lessons Learned • Becoming a medical home takes time, requires fundamental change in multiple areas • Change is difficult, and this is a lot of change • Have to have a robust change management and quality improvement process • Quality improvement and patient care processes have to become team-based

5. PCMH – Huge Cultural Issues • Three key areas for practice cultural change: • Leadership • Change process requires a shift toward less hierarchical management • Team-based care and improvement process • Clinicians and staff not used to working in teams • Patient-centeredness • Traditional care practice and physician centered; requires a shift for everyone

6. PCMH-Huge Cultural Issues Three key areas for practice cultural change: Leadership Change process requires a shift toward less hierarchical management. Team-based care & improvement process Clinicians and staff not used to working in teams. Patient-centeredness Traditional care practice and physician centered; requires a shift for everyone

7. PCMH is a Team Sport • No way for primary care clinicians to do everything their patients need themselves • Multiple studies showing that delegating responsibilities to the staff has very positive results – Patient, staff, clinician satisfaction, quality and efficiency of care • Goal is everyone working at the top of their license and skills • We physicians are usually the biggest hurdle – have difficulty letting go of things

8. Practice Teams – Who Is Involved? • Within the practice – everyone – front office, MAs, RNs, FNPs, PAs, physicians • Preferably within the practice – mental and behavioral health, care managers, social services, pharmacists, others…. • Generally outside the practice – specialists, community agencies, hospital

9. Defining the Medical Home • Patient Centered Primary Care Collaborative (PCPCC)

10. Today’s Care Medical Home Care Daniel Duffy MD School of Community Medicine, Tulsa, OK

11. Two Parts of Project—Practice and Curriculum Redesign Curricular Redesign PCMH Practice Practice Improvement

12. PCMH Project Goals • Quality Improvement (QI) Teams with staff and resident involvement • Registries and measures for chosen clinically important conditions

13. What this means for the Residents and Staff : • Involvement in practice improvement teams • Learn how to lead quality improvement effort • Population management and use of registries for patient care • Training in becoming a “personal physician” in a medical home • Curriculum designed to integrate the principles of PCMH

14. Resistance to Change: Good or Bad? Resistance is bad when it is covert or driven underground (sabotage, malicious compliance) Everyone needs to recognize the signs of resistance and give personal support.