Health Affairs: Medical home transition can take 3-5 years
Physicians making the transition from conventional practices to patient-centered medical homes will need to master organizational learning and develop an awareness that they may need a three to five year commitment, according to an article in the March edition of Health Affairs.
In addition, transforming primary care requires synchronizing practice redesign with development of a healthcare "neighborhood" in which a broad range of health and healthcare resources are available to patients, stated Paul A. Nutting, professor of family medicine and the director of research at the Center for Research Strategies at the University of Colorado Health Sciences Center in Denver, and colleagues.
“It also requires payment reform that supports practice development and a policy environment that sets reasonable expectations and time frames for the adoption of appropriate innovations,” they wrote.
In June 2006, the American Academy of Family Physicians launched the first large-scale demonstration of the patient-centered medical home. A national recruitment effort and a detailed application process yielded 337 family practices. Of these, 36 mostly small, independent practices were selected to transform themselves into patient-centered medical homes. Practices in this group were randomized to two groups: “facilitated intervention” and “self-directed.” The authors were members of an independent evaluation team for the project.
Transformation is more than a series of incremental changes, the authors found. “Practices that were included in the national demonstration project made efforts and attempted to implement as many model components as possible over the two-year life of the project,” Nutting and colleagues wrote.
The findings suggested that many of the chronic care and health IT components may be implemented by highly motivated practices. However, even with extensive assistance from their facilitator, expert consultation and the incentive of being in a national spotlight, two years was not long enough to implement the entire model and to transform work processes, they wrote.
To become medical homes, practices must see themselves as organizations that apply the four pillars of primary care to the needs and preferences of patients in their communities, rather than as organizations that process patients for the convenience of physicians.
"As collaborative care teams are established and services are better coordinated across the larger healthcare neighborhood, structures and processes within practices need to encompass a broader set of proactive, population-based, integrated activities for patients, groups of patients and eventually entire defined populations," the authors stated. "For most practices, this represents a major paradigm shift.”
New cognitive models are required for innovative care teams, Nutting and colleagues asserted. The transition to team-based care requires primary care physicians and other health professionals to envision new roles for themselves. Practices incorporate new paradigms of how best to care for patients. "Both of these challenges are more difficult than anyone had imagined," they wrote.
Most practices appeared to be functioning well at baseline. However, the unrelenting pressure for constant change led to “change fatigue,” which was manifested as faltering progress, unresolved tension and conflict, burnout and turnover and both passive and active resistance to further change, the authors observed.
Developing patient-centered medical homes from small, independent primary care practices will require "a nurturing policy environment that sets reasonable expectations and timeframes for iterative innovations,” the authors concluded. “Getting there will require synchronizing practice redesign with reimbursement reform. It will require innovation in health systems design and the courage to take collective action to improve the health of the American people."
In addition, transforming primary care requires synchronizing practice redesign with development of a healthcare "neighborhood" in which a broad range of health and healthcare resources are available to patients, stated Paul A. Nutting, professor of family medicine and the director of research at the Center for Research Strategies at the University of Colorado Health Sciences Center in Denver, and colleagues.
“It also requires payment reform that supports practice development and a policy environment that sets reasonable expectations and time frames for the adoption of appropriate innovations,” they wrote.
In June 2006, the American Academy of Family Physicians launched the first large-scale demonstration of the patient-centered medical home. A national recruitment effort and a detailed application process yielded 337 family practices. Of these, 36 mostly small, independent practices were selected to transform themselves into patient-centered medical homes. Practices in this group were randomized to two groups: “facilitated intervention” and “self-directed.” The authors were members of an independent evaluation team for the project.
Transformation is more than a series of incremental changes, the authors found. “Practices that were included in the national demonstration project made efforts and attempted to implement as many model components as possible over the two-year life of the project,” Nutting and colleagues wrote.
The findings suggested that many of the chronic care and health IT components may be implemented by highly motivated practices. However, even with extensive assistance from their facilitator, expert consultation and the incentive of being in a national spotlight, two years was not long enough to implement the entire model and to transform work processes, they wrote.
To become medical homes, practices must see themselves as organizations that apply the four pillars of primary care to the needs and preferences of patients in their communities, rather than as organizations that process patients for the convenience of physicians.
"As collaborative care teams are established and services are better coordinated across the larger healthcare neighborhood, structures and processes within practices need to encompass a broader set of proactive, population-based, integrated activities for patients, groups of patients and eventually entire defined populations," the authors stated. "For most practices, this represents a major paradigm shift.”
New cognitive models are required for innovative care teams, Nutting and colleagues asserted. The transition to team-based care requires primary care physicians and other health professionals to envision new roles for themselves. Practices incorporate new paradigms of how best to care for patients. "Both of these challenges are more difficult than anyone had imagined," they wrote.
Most practices appeared to be functioning well at baseline. However, the unrelenting pressure for constant change led to “change fatigue,” which was manifested as faltering progress, unresolved tension and conflict, burnout and turnover and both passive and active resistance to further change, the authors observed.
Developing patient-centered medical homes from small, independent primary care practices will require "a nurturing policy environment that sets reasonable expectations and timeframes for iterative innovations,” the authors concluded. “Getting there will require synchronizing practice redesign with reimbursement reform. It will require innovation in health systems design and the courage to take collective action to improve the health of the American people."