Considered a vital step in transforming the U.S. healthcare system, the conversion of small, independent primary-care practices to patient-centered medical homes is a daunting task.
An article in the March 2011 issue of Health Affairs analyzes those challenges based on outcomes from a national demonstration project, which ran for two years starting in June 2008 and involved 36 primary-care practices.
Patient-centered medical homes incorporate the four pillars of primary care access to first-contact care, coordinated care, comprehensive care and sustained personal relationships. The homes also incorporate the Chronic Care Model and the latest in medical informatics, and promote the engagement of patients who seek to form partnerships with healthcare practices.
However, based on the study, practices will need more than two years to implement the entire model and transform work processes.
We learned from the national demonstration project how difficult it is for practices to truly innovate with care teams clinicians working together, depending on the patients needs, and not always including a physician-leader, the authors wrote.
Care teams require physicians working in tandem with other clinicians, such as nurses, nurse practitioners and physician assistants.
The authors also wrote that physicians will have to embrace a model that does not necessarily emphasize their autonomy in commanding a staff to support their work of advising and treating individual patients with private, face-to-face encounters.
New ways of thinking about primary care will need to emphasize working within more collaborative teams and using multiple channels of care such as telemedicine, e-visits and group visits. The focus will need to expand from individual patients to encompass populations. A more partnering relationship with patients and much greater transparency will also be required.
Further, the authors wrote, practices must strive to build healthcare neighborhoods by establishing robust and collaborative relationships with hospitals, nursing homes, specialists, other healthcare professionals and community agencies.
This integrated neighborhood must appear seamless to the patient, the authors wrote.
To read the report in its entirety, visit http://content.healthaffairs.org/content/30/3/439.full.