"There's no one way to set up a medical home or one way for paying a medical home," said Laura Etchen, partner at healthcare consulting company The Chartis Group in Chicago at the American College of Healthcare Executives' annual congress in Chicago on Monday.
Half of active medical homes receive payment incentives, although payment models can range from pay-for-performance or gain sharing to global primary care payment, among others, Etchen noted.
Even though medical homes can vary, experts shared their lessons learned at a "Pioneering the Patient-Centered Medical Home" conference session.
Consider National Committee for Quality Assurance (NCQA) accreditation.
NCQA accreditation is based on standards, including access and communication; tracking of patients, tests and referrals; case management; electronic prescribing; and performance reporting, among other standards.
Certification isn't required, but some physicians are attracted to and some states favor the NCQA designation, according to Etchen.
Be warned though, that achieving Level III NCQA designation can be difficult, according to John Butterly, executive vice president for medical affairs at Dartmouth-Hitchcock in Lebanon, N.H., though the Physician Group Practice demonstration project participant did achieve Level III accreditation for its 26 medical homes.
Gain provider buy-in, and put it in writing.
To ensure alignment between the physicians and the organization's imperative for clinical transformation, document the workflow and IT plans to make it a real, concrete and smooth transition for the physicians, Etchen suggested. For example, define what a "visit" is and what are the staff competencies on coordination and relationships between caregivers.
Butterly further added that healthcare leaders should engage physicians and nurses by being honest about implementing the new care model. "Everyone needs to be involved and at the table," he said.
As Melissa McCain, partner of The Chartis Group in Boston, said, medical homes aren't just about adding a health coach or care manager and slapping the medical-home label on it.
Patient-centered medical homes require active participation that comes from both sides--provider and patient. The approach looks at not only the medical component, but also the behavioral and psychosocial aspects of patient care, particularly in the racially diverse, disease-burdened population in the Bronx where Montefiore Medical Center is located, Stephen Rosenthal, president and CEO of CMO Care Management Company, said. "It's not just their health but [also] things not seen during the physician visit," he said.
By looking at the individual, the interdisciplinary team led by primary care providers can address the needs for both preventive and chronic care, Rosenthal said. He continued, "We used to always think of the physician as the expert, but we really need to engage the patient and the family too."
E-visits outside of office walls can offer quick, efficient care. For example, HealthPartners in Minneapolis offers virtuwell, a 24/7 online portal that provides easy triage for patients to receive a diagnosis and treatment service with a nurse practitioner, and a prescription, if needed, for $40, according to Chief Information Officer Beth Waterman. Patients must sign up to activate the portal. The patient initiates the "encounter," which sends an email notification to the care team. On the receiving end, a medical office assistant triages the request and directs it to the appropriate caregiver.
Although Waterman said HealthPartners considered other platforms like Skype, the organization decided to use its own portal for HIPAA and other privacy considerations.
Create a flow station.
Although it might require physicians to give up their offices, consider creating a workflow station. HealthPartners carved out hallway space that makes do with the setting and is close to the exam rooms. The switch moves the provider and the rooming staff to work side by side, a change that generally has been well received, Waterman noted.
The flow station eliminates batching of documentation and charting by completing a few items between visits, thereby improving response time to patient communications and test results, she said.
Perhaps, most importantly, the speakers encouraged healthcare organizations to act soon. Butterly said a health system needn't wait for data to start working on achievable goals, such as avoiding ER visits, ambulatory-sensitive hospital admissions and readmissions.
"Don't wait for the stars to align," McCain said. "Move now," she encouraged, to harness the mission of healthcare. She added, "We're giddy about doing things that we only whispered about before."