Medical home pilots: To do or not to do
When TransforMed began in 2006, the NDP was one of the first pilots to test the medical home. Today, more than 100 pilots have been completed or are underway. Many physicians are cautious and confused as to whether they should participate in a pilot. What will the practice gain by participating? Will it require too much work? Will there be any financial gain for the practice?
These are important questions in evaluating potential participation in a pilot. A pressure seems to be building to learn how to practice the “medical home way,” and many practices may be pushed into these pilots simply in an effort to learn, but practices should be very careful before they jump in.
First, make sure you clarify what the pilot will be studying. The NDP studied the “process” of change only with soft endpoints to clarify how the process affected the practices and their patients. Many pilots now are evaluating much more specific endpoints, such as cost savings. Before you join one of these pilots, clarify where the cost savings will come from -- e.g., are the savings out of your practice only, or are the savings out of the total episode of care (involving the hospital and other care facilities)?
Second, make sure you understand what the practice’s responsibilities will be. Some pilots provide consultants or facilitators to help guide the practice in the changes required. Other pilots will expect the practice to use existing staff or hire consultants to make the change. Will there be any financial support from the pilot sponsors for the consulting or for electronic implementation? The NDP either fully paid for or obtained sizable discounts from technology vendors for the products used.
Third, help set and understand a reasonable timeline. As mentioned before in this series, the change process is time and labor consuming. Each change produces a ripple effect in the practice and patients. The usual pace is design, implement, evaluate effects and correct over a three- to six-month time span per item implemented. (Stretch this to years for something BIG like EHR implementation.) As the NDP found, two years was probably just long enough to leave the practices in the middle of the transformation, but not long enough to truly measure the outcomes associated with transforming into medical homes.
Fourth, clearly understand the financial ramifications of participating. Will your practice be paid any money to do the pilot? When will your practice receive the money? Are there any contingencies on your practice receiving the money (e.g., meeting quality benchmarks or receiving only a percentage of savings)? Make sure all details of the financial arrangement are fully defined both to the practice's and the pilot sponsor's satisfaction. Clarifying these financial details can be difficult because of anti-trust laws and a lack of previous pilot examples in which the financing worked well or was beneficial to the participating practices.
Finally, realize you are entering uncharted waters. If there is a pioneer somewhere within you, you will love this aspect of participating in a medical home pilot. If not, you may honestly want to wait and see how more pilots play out for a few years prior to joining in.
–Melissa Gerdes, MD