Safety Net

Medical Home Initiative

Ed Wagner, MD, MPH, MACPMacColl Center for Health Care Innovation

Group Health Research Institute

Safety Net Medical Home Initiative

The Safety Net Medical Home Initiative:Some Lessons Learned

2SNMHI

How does a practice become a PCMH?

“Change is hard enough; transformation to a PCMH requires epic whole-practice reimagination and redesign.”*

*Nutting et al. Ann Fam Med. 2009; 7:254-260

3SNMHI

PCMH transformation is not business as usual

“Change is hard enough; transformation to a PCMH requires epic whole-practice reimagination and redesign.” (Nutting, et al.)

Coach Medical Home: Module 1

3

For most practices, transformation means:

4SNMHI

What helps practice transformation?4

Coach Medical Home: Module 1

5SNMHI

The SNMHI Framework:The Change Concepts for Practice Transformation

Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The Changes Involved in Patient-Centered Medical Home Transformation. Primary Care: Clinics in Office Practice. 2012; 39:241-259.

6SNMHI

Laying the Foundation

It is very difficult for practices to make changes without committed and aligned

leadership.

It is very difficult for practices to make changes without an effective QI

strategy.

Even in practices with strong leaders and QI experience, major impediments

to change are:

The absence of a trusted performance measurement system that enables the practice

to understand and monitor its performance.

Failure to understand and use rapid cycle small tests of change.

Successful practices regularly plan and execute small tests of change (PDSA

cycles) that build toward the full implementation of a key change.

7SNMHI

Why is empanelment so critical?

Linking patients to specific providers:•changes practice culture and accountability, •fosters a population focus and the development of teams, and •facilitates meaningful measurement (at the provider level) and population management.

8SNMHI

Why are continuous, team-based healing relationships so critical?

• Without high-functioning teams, practices find it nearly impossible to implement patient-centered interactions, organized evidence-based care, and care coordination.

9SNMHI

Why learning communities?

• SNMHI fostered national and regional LCs for practices, and national LC for coaches.

• Greatest benefit derived from hearing from people and organizations like us.

• Hearing how other practices implemented a particular change makes concepts come alive.

• Site visiting seemed most impactful.

10SNMHI

Coaching lessons

• Coaches need to ensure that leaders are engaged and the practice has the capacity for quality improvement.

• Many practices, even very good ones, don’t have trusted measurement systems in place; coaches need be able to help.