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    Chris Harrop
    Chris Harrop

    Lehigh Valley Physician Group in Allentown, Pa., was on the journey to embracing the Patient-Centered Medical Home (PCMH) model in fiscal year 2016. In an employed physician group of about 1,200 providers, 47 of the group’s 171 practice sites would transform in the coming years.

    Jonathan Davidson, MA, CAPM, senior project manager for the group, said the concept was “about making sure that the care for … patients is effectively coordinated, especially through the primary care office, so that they are aware of all the different [types of] care that a patient would be getting.”

    Davidson and Lori M. Hulse, MSW, MBA, CMPE, MGMA member, vice president of operations for the group, shared these 10 lessons from the group’s journey:

    1. Leverage an outside eye

    Hulse said that despite having plenty of resources for the project, internal differences of opinion impeded progress: Some people thought National Committee for Quality Assurance (NCQA) certification was the singular goal, while others thought it was simply about adopting a new philosophy of care. Bringing in a fresh eye “helped us to remove some of the organizational bias that we had” and determine the proper structure after leaving some administrative team members out of the process. “We didn’t necessarily understand our own network,” she said. Recognizing this allowed the group to “corral our own resources that already existed [and] helped us to figure out how to deploy them effectively to be able to work in large groups.”

    2. Utilize both physician and operational leaders

    When the group kicked off its PCMH project in fiscal year 2016, the leadership team was very physician-heavy and lacked input from the operational team. This input was crucial, Hulse said, because of the operational and administrative workflows that would change along with the clinical workflows. As more people came into the project, smaller groups were formed of key decision-makers, “which really allowed us to have significantly more engagement in the work,” Hulse said.

    3. Create a cross-section of practices for a template

    Rather than try to push the PCMH model across 47 practices all at once, Lehigh Valley began with a cross-section of 12 practices, based on factors relating to capability for change. Davidson cautioned against choosing practices based on high or low performance levels. “If you’re only focusing on your star performers or your challenged practices, you will miss the opportunity to effectively test a model,” he said. Especially for low performers, “acknowledge the fact that, through this change process, they may be able to rise to the occasion and be incredibly successful.”

    4.  Engage practices where they are today

    The group’s PCMH project leaders developed 12 individualized work plans, which helped physicians feel autonomous amid the changes. “We were really able to increase buy-in … without it feeling like it was a cookie-cutter approach,” Hulse said. Unique work plans also allowed the group to showcase higher-performing practices’ quick wins in the transformation to offer effective examples of boosted patient satisfaction and quality outcomes to other practices.

    5. Organize the transformation for success

    One of the group’s early exercises produced 32 brainstormed ideas, which became goals. Davidson said that rather than treat those as 32 separate projects, the team sorted them into five projects: a PCMH road map (“the specific, boots-on-the-ground work” with the 12 pilot practices), team-based care, population health, talent management and continuous performance improvement. Each project had a project team, and all project teams worked simultaneously. “I don’t think we would have been able to be as successful as we were if we had just focused solely on developing a road map for our work,” he said.

    6. Too many resources can be a problem

    In fiscal year 2016, the group engaged several third-party individuals to help in the transformation to PCMH: change management consultants, leadership development consultants, Lean transformation coaches and more were spending time with the practices. “We overwhelmed our practices,” Davidson said, to the point that in the next fiscal year, only practice coaches would serve as the focal point for PCMH transformation.

    7. Be prepared to reassess

    Reimbursement challenges in the second year of the PCMH work led to staffing cutbacks. Some practice coaches and project leads — about one-eighth of the PCMH staff — “essentially disappeared overnight,” Hulse said. Losing the ability to reach the same number of practices in the same time frame, the mentor model of using high performers to guide others became more important. Hulse said this helped bring a “collective purpose” to the work across multiple practices.

    8. Build out content for various areas of medicine

    The group’s primary care work toward PCMH included family medicine, internal medicine, pediatrics and health clinics. To customize their work to meet those various patient populations, practice staff had daily huddles and worked to identify their needs and improve communication and throughput. Visual boards helped display metrics and graphs, and different areas of the practice, including physicians, medical assistants and front-office support staff, began to customize their huddles and information exchanges. Hulse said those pieces of content allowed “people to see what’s relevant and what they can build on.”

    9. Leverage project management tools

    Sometimes the PCMH project could feel like “a never-ending process” for practice leaders. Davidson said project-based thinking was important to strategize with discrete beginning and end dates. “I don’t want to hear a future state that’s seven years off. Give me the ingredients for that future state that we can do now, so that in the next iteration and the next project, we can focus on the next few steps that will get us to that future state,” he said.

    10. Set curriculum standards and track performance

    Certification was not the end goal for practices in the PCMH journey. “What we were really trying to accomplish was a patient-centered approach to care that benefited our patients … that really created continuity of care amongst our teams,” Hulse said. Checking off requirements toward certification was not as important as truly making a cultural change. “Our goal is for this to become part of who we are,” she said.

    One piece of advice Davidson added for each of these lessons for practice leaders looking to embrace the shift to PCMH: “Be prepared to show your work.” Lehigh Valley, through its project and team focus, was able to generate a 900-page document to chronicle the extent of work devoted to the transformation. While that level of detail helps show practice leaders how resources, time and effort were used, Davidson added, “I sincerely hope that I never have to create another 900-page binder.”

    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.

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