So, You Want to Become a Medical Home

March 15, 2011

It isn't easy for practices to become accredited as a patient centered medical home. To help you assess your readiness and make the transition, here are a few guidelines to get you started.

You are probably hearing a lot about patient centered medical homes (PCMH) these days. Perhaps an insurance company that you participate with has sent you information about a medical home incentive or you've learned that your state Medicaid program pays additional fees to practices that have PCMH accreditation. Whatever your level of interest, considerable investment in time, resources, and money is required for practices to make the transition to becoming accredited as medical homes. To help you assess your readiness and make the transition, here are a few guidelines to get you started:

Assess your practice

1. Take a look at your practice's current policies and procedures to determine if your practice operations currently meet with the basic tenets of a PCMH. Looking at the NCQA survey standards for PCMH is a good place to start.

2. Determine if adjustments need to be made to foster the creation of a patient-centric culture throughout your organization. Sometimes, making adjustments to the culture of your practice can be the biggest hurdle.

3. Identify gaps in processes and policies and move forward with developing a plan of action that will allow your practice to meet all standards for recognition as a PCMH. Some of the items that may need to be addressed include:

• Staffing needs and education
• Technology - current needs and efficient usage
• Patient outreach, tracking, and follow-up
• Evidence based medicine and decision support
• Care coordination, resource integration, and care management
• Scheduling and access

4. While a practice does not have to obtain NCQA recognition as a medical home (or other certifying bodies), doing so greatly increases the credibility of your practice's model and provides leverage for payment discussions at the payer level.

Create a plan of action

1. Once you've identified the gaps, determine how best to fill them. You'll need to create a solid and implementable plan of action. This will require you to draft protocols and train staff on how to work within them; implement scheduling changes; improve resource utilization through reallocation and job enhancements; and improve patient education.

2. After you’ve begun implementing these changes, monitor your progress regularly to see how you are doing. Re-assess your practice against the standards you are using and make sure that you are able to meet a majority of them, so you have the best chance of achieving the highest level of certification.

Apply for certification

Submitting an application for accreditation can be a daunting process. In addition to providing protocols and policies, there is a lot of supporting documentation that needs to be submitted, along with the application fee. You may also need to gather three months worth of data to prove that criteria for accreditation are being met. But don't be discouraged, the benefits to your practice will more than make up the inconvenience.

Educate your patients

Lastly, educate your patients on the medical home model and their responsibility for participating in their own care. You can advertise your practice's PCMH accreditation in your reception area and exam rooms, and also post this information on the practice website. You should explain what a patient centered medical home is and how it benefits your patients. Two ways to accomplish this are: 1) publishing a short article in your practice newsletter and 2) creating a pamphlet on the PCMH to be distributed to your patients. Also, don't forget to give your patients a "being responsible for your own care" brochure to get them actively involved in playing their part too.

When done right, transforming your practice to a medical home model can reap big dividends in improved patient care, more effective practice operations, and a better bottom line.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.