Lessons Learned from Model Medical Home Tour

Friday, June 5th, 2009
This post was written by Melanie Matthews

Ask early adopters of the medical home for one piece of advice for newbies and responses are varied:

Don’t wait for development of perfect automated reporting system. Start working on process change and gradually incorporate essential reporting pieces into EMR. Barbara Wall, president of Hagen Wall Consulting, which advises healthcare organizations on PCMH development and implementation.

You need one doctor per practice to initiate [the medical home] in a group practice. Dr. Kim Dunn, HealthQuilt Director and Founder and CEO of the Your Doctor Program, L.P.

Redesign of primary care practice is important; performance feedback to providers is critical; case managers must be part of the team, embedded in the practice; team must be accountable for efficiency outcomes, transitions in care a huge opportunity. Janet Tomcavage, RN, MSN, vice president of medical operations for Geisinger Health Plan.

Connect with community resources rather than trying to duplicate them in the practice. Elizabeth (Liz) Reardon, a healthcare consultant, president of Reardon Consulting and a member of the National Integration Consulting Team.

I’ve spent a lot of time recently speaking with these individuals, who were among respondents to HIN’s Medical Homes ’09 online survey. From our conversations, I developed detailed profiles of their medical home experiences. Each either belongs to an organization that is testing the patient-centered medical home model or has advised businesses on specific aspects of this process. They come with expertise in health information technology, behavioral healthcare, health plan management — one even worked as a diabetes clinical care nurse for more than 20 years. Following are key excerpts from our conversations that can guide providers, payors and purchasers in their exploration of the PCMH:

The more formalized the [staff] training — whether outside resources or modules developed by triage nurses within the practice — the better the results in terms of the MAs taking the initiative and following up to make sure patients complied with evidence-based guidelines for the care protocols. Over time, as MAs became better educated and more sophisticated providers of patient education, they found that the relationship with the patient grew for a couple of reasons. They had more contact with the patient, but also had more to offer the patient in terms of information. Barbara Wall, consultant

[HealthQuilt] is going to do two things: First, it’s going to improve the quality of care, because if doctors have good data they’ll improve their care. Secondly, it is reconciling the data, archiving it in a data warehouse and identifying it so that we can start doing community-based comparative effectiveness research. That’s a new paradigm within healthcare reform. Dr. Kim Dunn, HealthQuilt and Your Doctor Program, L.P.

Physician practices can run themselves ragged sometimes trying to be everything for everybody [in the medical home]. Spend some time to find the key people or organizations in your community and develop that relationship with them so you’re not necessarily taking over everything. Liz Reardon, consultant

While many care teams think that they do a good job on medication reconciliation, there are still many opportunities for improvement. For example, patients often go home [from the hospital] on a second beta blocker and end up taking double their beta blocker dosage because the one that was written at home was perhaps a generic brand and the one that the hospital doctor prescribed is a brand name. They end up getting into some difficulties post-discharge. Janet Tomcavage, Geisinger Health Plan.

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