The path to a better healthcare system starts with primary care. Changing how care is organized and delivered among primary care settings has the potential to transform the entire healthcare system. As physician groups face mounting pressures to produce accessible, high-quality care at lower costs, the patient-centered medical home (PCMH) is emerging as a primary vehicle for care delivery transformation. We are increasingly finding the PCMH model embedded in accountable care organizations (ACOs), clinically integrated networks (CINs), and population health management initiatives. But as critical as the PCMH model has become to redesigning care delivery, not everyone is ready for patient-centered care. With that in mind, we have developed a quantitative and qualitative PCMH Readiness Assessment Methodology that reviews an organization’s ability to successfully operate and sustain a PCMH. This tool is designed to leverage existing strengths, address operational weaknesses, and identify resources to invest in key capabilities.
Readiness Assessment Methodology
Organizations rushing to develop PCMH capabilities often focus on implementing the changes necessary to meet PCMH accreditation requirements. This is a mistake. Their focus should be on understanding performance gaps between current operations and the desired future state of an organization committed to patient-centered care. Thus, transitioning to a PCMH begins with assessing organizational strengths and weaknesses. With a comprehensive understanding of organizational readiness, an organization can then turn to implementing and continuously improving the model, and eventually, integrating the model with payors. While PCMH guidelines are published by national accrediting entities, these are basic requirements and do not address the key operational competencies that are necessary to sustain a high-performing PCMH. Our readiness assessment tool is designed to guide organizations through a targeted, in-depth review of organizational strengths and weaknesses within the five critical components of a PCMH:
- Care Delivery Model – Reviews the extent to which the organization provides patient-centered, team-based care; engages patients and families in their health; follows standard clinical protocols; ensures care coordination as well as access and continuity; focuses on patient flow; and manages a population’s health.
- Organization and Management – Considers the organization and governance of the model, alignment among providers and with the system, integration with specialists and hospitals, breadth of services provided within the delivery network, and the extent to which performance standards are utilized.
- Information Technology (IT) – Assesses the use, optimization, and deployment of IT resources to manage care within the organization and across the integrated care network.
- Financial Management – Analyzes a group’s ability to assume financial risk, distribute funds among providers who deliver care, and restructure existing payor contracts to receive value-based payments.
- Culture – Evaluates the organization- and system-level culture and change management capabilities.
Within each key component, there are specific competencies that are critical to a successful and sustainable PCMH and should be evaluated as a part of the readiness assessment.
With the healthcare industry focused on improved outcomes and lower cost, the PCMH model has emerged as a critical component of a value-based delivery network. As such, providers must consider how they may need to redesign their care delivery around specific chronic conditions and/or patient populations and utilize thoughtful readiness assessments when transitioning to, and operationalizing, a PCMH.
To learn more about PCMH readiness, read the Executive Briefing on our Web site.
Michael Duffy, Manager, contributed to this post.