Medical home implementation: "How do we get started?"
Transitioning to the medical home can be a daunting process. What should a practice do first? How do we get started? To answer these questions, practice leaders will need to take a good hard look at the current state of the practice. One practice may discover that wait times are the bane of the practice.
It would then make sense to begin with open-access scheduling. Another
practice may wonder why its rate of payment on claims is so low. It may
want to start with an investigation into billing and coding.
Surveying staff or, better yet, surveying patients are excellent ways to help shape an agenda. There may be aspects of the practice that have not worked well for a long time and just need some time and attention to fix. Asking your customers can help you prioritize what to do first. For example, one practice developed a survey to assess patients’ readiness for online services.
During our experience in the TransforMed national demonstration project (NDP), we held staff project meetings and discussed at length where we should begin. We did not make any decisions until we had learned what it would mean to implement each component of the medical home. We ultimately decided to create a web site and start virtual office visits. We already had an electronic medical record, which we were very comfortable with, so implementing another IT project was not hard. See “Our implementation of virtual office visits” in this series to see exactly how we did this. We used a patient survey to pick topics and set prices for the virtual office visits.
For any project you are considering taking on, be sure to develop time and cost estimates up front. It is also important to take breaks between big implementation projects. TransforMed facilitators like to describe the transformation process as progressing in “fits and starts.” Breaks are needed to recover, regroup and recharge after a lot of practice time and energy have been put into making innovative changes.
Spreading ownership of change is also a good strategy to help in prioritization. If a staff member is particularly passionate about an element of the medical home, let that person take charge. You may even want to survey staff about their interests and time availability to help with the change process. Understanding and communicating the true amount of resources necessary for a particular project is critical. The AAFP has recently posted an excellent step-by-tiny-step guide to implementing medical home components.
In the end, the decision about which components of the medical home model to implement first, second, third, etc. is very individualized. No two practices in the NDP followed the same path. This is one of the important lessons learned from the NDP.