A foundational principle of all healthcare providers is to keep the focus on patients and their specific needs. It’s also the philosophy at the heart of the Patient-Centered Medical Home concept.This concept and process can serve as invaluable guidance for transforming your practice, especially in the shift toward value-based reimbursement
“To be a PCMH requires putting the patient at the center of all care, delivered by a multidisciplinary team in which everyone is practicing at the top of their capability,” said URAC Vice President Deborah Smith, MN, RN-BC. “The patient, family and other caregivers must be included in decision-making and enabled to participate actively in self-care where that is safe.”
URAC’s Patient-Centered Medical Home Certification program is designed to guide providers along the route toward PCMH implementation in a sustainable manner. Smith offers these three tips to help physician practices prepare:
1. Have an internal champion. “Change needs a champion and change needs a facilitator,” Smith said. While some providers use the services of an outside facilitator to help achieve PCMH transformation, Smith believes the more effective and sustainable approach is to have internal leadership for the effort.
“When external facilitators are used, and that person’s work is complete, recidivism can occur,” she said. “The stronger way to promote real change is for the champion and the facilitator to be internal.
2. Think of the process in stages. At first glance, the criteria that your practice must meet to transform itself, according to Patient-Centered Medical Home principles, can seem overwhelming. The standards cover areas ranging from patient access and health IT to chronic care management and performance reporting. But Smith encourages providers to think of this transformation as a process, not a destination.
“Rather than depending on the applicant to fill in a checklist of capabilities that they self-report, our process operates by the principle of on-ramping,” she said.
Providers can apply for URAC’s certification at any one of three levels—starting with Qualified, then progressing to Established, and finally achieving Certified. Each level comes with additional standards to which providers must adhere. The process lays out a gradual path to certification that can be easier and more sustainable for providers.
“The difference with our certification is that you can get on the train, so to speak, anywhere you think you are capable of succeeding,” Smith said.
3. Chart a course of progression. When a practice begins the process of PCMH certification—no matter where it starts on the three-stage scale—it commits to making forward and sustainable progress each year.
The levels of Qualified and Established are valid for one year, while the final level of Certified lasts for three years. Tackling the PCMH process in this way positions your practice for a transformation that’s sustainable, while at the same time keeping the focus on creating care that addresses each patient’s unique needs, Smith said.
“Patient-centered care requires looking at the community where care is delivered—where people live—because all healthcare is local,” she said. “There needs to be a bridge between in-the-box healthcare and what goes on in communities to provide services that will promote health and wellness.”
Read more on this topic:
- 3 Tips to Prepare Your Practice for PCMH Certification
- Small Physician Practices: How to Successfully Go It Alone
- URAC's complete, detailed PCMH Certification Standards (PDF format, 101 pages)
- URAC’s Provider Integration and Coordination Programs