Still hammering at the patient-centered medical home

In the aftermath of the stunning irony revealed by the first national demonstration of the medical home model in June--that those who received care at these 36 practices that bent over backward to become so-called patient-centered medical homes felt disheveled and somewhat forgotten amid the changes--researchers have been hard at work applying the lessons learned.

"The Achilles heel of all of this is a lack of patient understanding and engagement," Dr. Terry McGeeney, a primary-care physician and chief executive of TransforMED, the nonprofit medical home consultancy that partnered with the American Academy of Family Physicians to publish last month's report, told the New York Times. "Patient-centered medical homes are a massive paradigm shift in how primary-care practices function." As one of the first national studies of patient-centered medical homes, "we were starting at ground zero, and we weren't aware of what we needed to do other than support the physicians' personal motivation."

Now ready for rebuilding, researchers have asked the 36 practices that took part in the two-year national pilot to take the following actions:

  • Create a patient advisory council, made up of patients willing to meet with clinicians regularly to discuss how their needs might be better served.
  • Implement a new 20-question survey that asks patients for their views on patient-provider communication, clinician access and care of the whole person. Whenever they make any changes based on patient feedback, practices can have patients take the five-minute assessment again to measure the results.

According to the newspaper, McGeeney expects this ongoing research to not only build on the success the medical home has had in terms of costs and outcomes, but engage patients to the point where they begin to demand the efficient, higher-quality care promised by the medical home.

Jennie L. Campbell, CMPE, executive vice president and chief operating officer of East Tennessee's Summit Medical Group, the third-largest medical home in the country recognized by the National Committee for Quality Assurance, agrees that this and all pilot projects can be a powerful learning tool for practices learning to implement and optimize the medical home model.

"We have closely followed the medical home demonstration projects and planned the key elements of our medical home accordingly," Campbell says. The top four drivers of success the 220-physician group has gleaned from the demonstration projects include:

1. The use of dedicated care managers
2. Expansion of patient access to healthcare practitioners
3. Data-driven analytical tools
4. Use of physician incentives

"We have focused our investment in infrastructure and our rollout around these four key elements in a number of ways," she says, "including adding care-management coordinators to our care team and investing in analytics technology to slice and dice clinical data, deliver a clinical dashboard to physicians and proactively identify potential gaps in care."

To learn more:
- read this article in the New York Times
- here's the NYT blog post