"The healthcare world is changing in ways that many of us have never seen in our lifetime with the possible exception of Medicare," says Dr. Terry McGeeney, director of BDC Advisors, a veteran of the healthcare system for 30 years.
It has moved away from system fragmentation, patient disenfranchisement, technophobia and fee-for-service (FFS) to system coordination, patient-centeredness, tech savviness and fee-for-value reimbursement, where bundled payments and accountable care are the reality, Dr. McGeeney says.
Ultimately, the patient-centered medical neighborhood (PCMN), or network of physicians collaborating and coordinating care per the patient-centered medical home (PCMH) model, will be a partnership among practitioners, patients and their families that ensures and respect the decisions of the patients, says Dr. McGeeney during Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care, a November 20th webinar now available for replay. Dr. McGeeney examined the trend toward medical neighborhoods and effective strategies for building out the neighborhood.
Bridging the gap between physician and provider-speak and hospital-speak, and identifying and engaging specialists in the medical neighborhood are key, Dr. McGeeney continues. Transitioning a clinically integrated entity to a high functioning medical neighborhood is a real opportunity and challenge.
What are the key attributes of a highly functioning medical neighborhood?
- A clear agreement on a delineation of roles of the neighbors in the system. Many successful neighborhoods are establishing letters of agreement or understanding on who is going to do what.
- Sharing clinical information needed for effective decision making, reducing duplication and waste in the system, as supported by appropriate health information technology (IT).
- Continuity of medical care when patients transition between settings, particularly important in the post-acute space, and the move towards risk and episodic bundled payments. The transition from clinic to the emergency room (ER) is also critical.
- Focusing on patients’ preferences, whether it’s to the primary care clinic or through a dedicated care coordinator, with the PCMH playing a key role. Strong community linkages, including both clinical and non-clinical services, including pharmacy, behavioral health, etc.
The top ways for practices to build capacity, Dr. McGeeney says, is to do a workflow analysis, and add capacity when appropriate, ensuring all are empowered.
As with all new healthcare models, there will be challenges, says Dr. McGeeney, among them PCP buy-in, leadership; communication at multiple levels; unaligned incentives, technology updates, and a difficult transformation.
And perhaps the biggest risk to the PCMH and PCMN model is the lack of patient engagement needed to leverage patient choice, Dr. McGeeney adds.
Choosing the ideal specialists is a good way to start — specialists that possess good communication skills, strong reputations and high value.
But as with any neighborhood, the whole is often greater than the sum of its parts, and assuring specialists that this new model will result in improved quality, cost reductions, the reduction of duplicated, unnecessary work and a better life/work balance is key.
And not everyone will be invited into the neighborhood, Dr. McGeeney cautions: there will be winners and losers. “The reality is there’s a number of hospital beds in this country to contract. Some providers may be left out of networks and thereby left out of the potential to share in savings. Proper positioning in this new environment is critical.”