6 Challenges of Medical Home Transformation

Tuesday, February 28th, 2012
This post was written by Cheryl Miller

Providing team-based care, improving patient access and encouraging self-management support were some of the steps taken in transforming to a medical home, explains Dr. Paul Kaye, medical director at Taconic IPA.

The real change is in looking at your practice as a team-based population-oriented practice, and this is where the challenge hit home for many of our individuals. The community health centers had the advantage of thinking that way in the past but the disadvantage was also being large, somewhat bureaucratic and in some ways responding to a regulatory world. Private practices had the disadvantage of not having that experience, but the advantage of being able to nimbly and quickly change direction. When we started to talk about team care, everyone in the group began to realize that changing the way a team was composed and how it functioned was the most profound change for the practice.

The team changes resulted in the largest single change — in A1c’s, for instance. That was an area where we spent some time; everyone thought they were already a medical home until they started to examine what they were doing. We had many interesting confessionals amongst the people in the group saying, “I never realized how things were working in my practice.” Or, “how my relationships with my support staff became relationships with their team.” Formal tasks like communication huddles, meetings and using the tools under the EHR for interoffice communications, became the subjects of a few meetings and of the practice’s works.

Another important issue for individuals was the understanding that in the medical home, the patients that you are responsible for are not only the people who come into your office, but are all of the patients in your panel. That was a light bulb that took about four or five months to go off. We had interesting discussions that were never heated; they were always collegial and the different points of view were helpful, as was getting to hear about each other’s professional lives and understanding what they could learn from each other.

There are also issues of access; how to provide easy access for patients both through the phone and by appointment was a subject that some of the practices struggled with early on.

Other challenges were care management and self-management support; these are not taught to physicians and are not naturally documented, even when they are doing it. Providing structured documentation of controllable conditions, goal-setting and progress were all concerns.

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