Even as evidence mounts that the patient-centered medical home (PCMH) model improves delivery of care and can result in higher morale and job satisfaction rates among physicians and staff members, the prospect of actually making the PCMH transformation can be financially daunting for many family physician practices. Those financial barriers sent the Kansas Academy of Family Physicians (KAFP) in search of a solution to help its members transform their practices.
According to Jennifer Brull, M.D., of Plainville, Kan., one of the practices chosen for the pilot project, participating in the PCMH Initiative has been a boon for her and her four partners at Post Rock Family Medicine.
"We have all had our eyes on PCMH recognition the last couple of years," she said. "We've looked at how meaningful use has reframed participation and how the idea can help to improve patient care, and frankly, we saw a tremendous upside for our practice."
Brull, who is immediate past president of the KAFP and an original member of the Kansas Primary Care Physicians Coalition that designed the PCMH Initiative, told AAFP News Now the program is particularly advantageous for her group because it resulted in streamlining the practice's operations.
"Post Rock Family Medicine actually encompasses three locations and five separate businesses, with five family physicians and three mid-level providers," said Brull. "It is actually hard to describe because we are not under one set of financial books, but we look like one office from the outside."
Before the pilot launched, each of the locations in Brull's group set its own hours, managed its own resources and interacted with patients in its own way. The opportunity to be part of the pilot compelled the five business owners to come together and figure out how to create a cohesive whole.
Nurse practitioner Leann Zimmerman, A.R.N.P., is part of a Kansas AFP-sponsored pilot project to transform Post Rock Family Medicine in Plainville, Kan., into a patient-centered medical home.
The result is a collaboration between the KAFP, the Kansas Association of Osteopathic Medicine, the Kansas Chapter of the American Academy of Pediatrics, the Kansas Chapter of the American College of Physicians and the Kansas Medical Society. The groups joined forces last year to spearhead the Kansas Patient Centered Medical Home Initiative(www.kafponline.org), which is designed to provide PCMH education and information to Kansas family physicians.
Funding for the initiative comes from the United Methodist Health Ministry Fund, the Sunflower Foundation, Health Care for Kansans and the Kansas Health Foundation. Together, the organizations have contributed more than $513,000. In addition, the initiative received a grant from the Kansas Department of Health and Environment's Systems in Sync program, a state program designed to integrate systems for young people with special health care needs.
The three-phase project initially is focusing on a pilot project that is helping eight physician-led practices in Kansas make the changeover to PCMH practices by midyear 2013. And, in a nod to the many rural practices in Kansas, all of the pilot practices are required to have five or fewer physicians
- In an effort to help its members transform to the patient-centered medical home (PCMH) model, the Kansas Academy of Family Physicians joined with other statewide medical organizations to spearhead the Kansas Patient Centered Medical Home Initiative.
- A key component of the initiative is a 24-month pilot project that is helping eight physician-led practices from around the state make the changeover to the PCMH model.
- As they near the halfway point of the pilot, the physicians involved are finding that transforming to the PCMH model is enhancing their practices and their ability to take care of patients.
"KAFP is ultimately responsible for overseeing all the work for all three phases of the initiative," said KAFP Executive Director Carolyn Gaughan, C.A.E. In fact, the KAFP brought in Leslea Roach last December to act as a coordinator for the PCMH Initiative, said Gaughan. Roach stays in touch with the eight pilot practices by making site visits, providing resources, answering questions and providing anything else they need.
"She also had a major role in planning an event in January that we called 'Catch Up and Education Day,'" said Gaughan. "We brought together the key people from each of the practices in the pilot and went through the assignments to date, providing an opportunity to share questions, successes, ideas and thoughts on how to successfully complete each aspect of each assignment."
"Now that the project is really getting rolling, we (as physicians) are starting to see some nice things happening … the redesign allows us to be more effective and focus more of our time on important things," said Brull. "One example is one of my colleagues deciding he wants to lead the effort, which is wonderful because he transitioned from being the most junior partner to the guy who's championing the PCMH project."
Family physician Rebecca Allard, M.D., of St. Francis, Kan., said her practice, Cheyenne County Clinic-St. Francis, which is one of two clinics operated by Cheyenne County Hospital, applied for the PCMH Initiative pilot to allow the practice to continue to move forward and be innovative in patient care.
"We are in a small community but feel it's important to be in the front-running of health care," said Allard. "Our patients deserve the very best we can give them to make their health care complete and whole."
So far, she added, the implementation has been all about small -- but effective -- steps. "We started by revamping the front desk area for better patient flow and are now working on pre-visit planning," she said. "We felt it was better to take small, well-calculated steps than to take big ones and have to regroup a lot because they did not work."
Gregg Wenger, M.D., a family physician in Sabetha, Kan., who also is a member of the pilot project, said he and his colleagues at Sabetha Community Hospital's Sabetha Family Practice also are seeing positive returns midway through the pilot.
"One of the top goals we have had from the beginning is to make the EHR (electronic health record) system work for us," Wenger said. "We are supposed to be sitting on a computer system that tells us what to do and when to follow up with our patients, and, at this point, it is not doing that. If it is doing that at the end of this program, that would definitely be a step in the right direction," he said.
"Everyone has some example of something they could do better, whether it is following up on (hemoglobin) A1cs or whatever. When you're busy and things are working, it is hard to make your clinic work better." But, Wenger added, there is always room for improvement.
"I'll put it this way: Once upon a time, Michael Jordan was the best basketball player on the planet, and he took the time to rework his shot. Now, I'm not saying we are the 'M.J.' of small-town practice, but I do know that while things are good, we can do better. And this program is helping us do that."
Brull agreed, saying that the services Post Rock Family Medicine gets through Blue Cross and Blue Shield of Kansas, for example, have been a real positive for the practice. Blue Cross and Blue Shield of Kansas pledged payer support for the practices selected to participate in the pilot project, and is helping them transform by offering services, such as nurse-led care coordination via telephone for patients with chronic diseases.
"On one hand, Blue Cross is looking at changing their payment models for PCMH-recognized clinics, which is exciting," Brull said. "But the thing I like most is that they are helping us provide care coordination for our patients with chronic disease by providing one-on-one phone counseling. They have a nurse -- the same nurse every time -- who talks to our patients, and at the same time, we are sending that nurse real data on each patient's hemoglobin A1c, height, weight and so on. In return, the nurse is able to do patient-specific counseling because she -- in our case, our nurse is a woman -- has the data to do that.
"This is also a person who can call and say, 'We can work with the doctor to get you lower-cost medications or find something that will work better for you.' This is someone who can talk to a patient for an hour and find out what is really going on. I can't do that in my office, so this is really an important service for us."
Chapter executive director: Carolyn Gaughan, C.A.E.
Number of chapter members: 1,530
Date chapter was chartered: May 6, 1948
Location of chapter headquarters: Wichita
2012 annual meeting date/location: June 7-9, Overland Park Marriott Hotel, Overland Park
Another key player in the pilot, said Brull, is TransforMED, the AAFP's wholly owned, nonprofit subsidiary.
Specifically, TransforMED facilitators made on-site visits to help the participants in the pilot project with clinical integration and to optimize their use of health information technology. In addition, each practice in the project is using TransforMED's free online assessment tool, Medical Home Implementation Quotient 3(www.transformed.com), to help measure its progress.
For his part, Wegner said TransforMED's participation made applying for the grant a no-brainer. "When we learned that TransforMED was a mover in this deal, that was a big incentive for us," he said. "We had looked at going through that process the year before and had put it on the back burner, which is easy to do in a busy practice. When it became clear (TransforMED) was part of the offering, it just made it look that much more attractive."
Although the practice redesign pilot has been under way since last summer, the KAFP still is rolling out the other two phases of the PCMH Initiative: public information and health professional education.
For example, Gaughan noted that Roach currently is working to beef up the initiative's website, as well as spearheading other information and outreach efforts.
Gaughan herself has been working with the KAFP Professional Development Committee to plan CME around the PCMH Initiative, and she and Roach have been working together on CME for a September PCMH Initiative Summit(www.kafponline.org), which will highlight the project and outline the progress of the eight pilot practices.
Brull said she thinks her practice will be ready for PCMH recognition by the end of the pilot project.
"The grant ends in December 2013, and our part in the pilot will be over in July 2013," she said. "If we follow the path, we will submit for certification then … and we tend to hit our targets, so I am confident."
Wenger agreed, saying that although the process can be frustrating at times, he also is confident his practice will hit the target deadline. However, regardless of the timeline, said Wenger, this process was necessary to optimize the care his practice delivers. "I think that most clinics run at something less than peak efficiency, and I know that we don't run at 100 percent," he said. "To get better, you have to deconstruct a bit -- look at things and make the necessary changes.
"This involves a leap of faith, but if you are willing to do the work, the benefits are real. There is a bit of a labor process, and it does not happen without abandoning a bit of what is working, but things will not work as well as they could if you don't take that shot and embrace change."