From The Editor | January 15, 2014

The Cultural Hurdles Of The Patient-Centered Medical Home

ken congdon

By Ken Congdon

Last week, in my column Population Health Management Proves HIT’s Worth, I highlighted how Northeast Georgia Physicians Group (NGPG) and its patients are benefitting from a population analytics toolset that was included as part of a TransforMED grant the provider received from The Center for Medicare and Medicaid Innovation (CMMI). This grant was awarded to fund NGPG’s transition to a Patient-Centered Medical Home (PCMH). A PCMH is a model of care developed by the National Committee for Quality Assurance (NCQA) that emphasizes care coordination and communication. In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams, and coordinating and tracking care over time.

To NGPG, the biggest challenges in its PCMH transition haven’t been technological or procedural in nature — they’ve been cultural. Physicians and patients have both had a tough time adjusting to this new method of delivering care.

“A PCMH requires you to move from a physician-centric practice to one that places the patient at the center,” says Dr. Antonio Rios, chief physician executive at NGPG. “In this model, a clinical team provides care to a patient instead of one specific doctor. This transition has not been easy for many of our physicians. Doctors are autonomous and independent creatures. They aren’t used to consulting a team for patient care.”

While the PCMH model has taken some getting used to by NGPG physicians, Dr. Rios stresses that patient care has been much more effective because of team participation. “We’ve been jumping over PCMH hurdles for a couple of years now and it’s gotten to the point where I can’t remember how I provided care without consulting my staff,” he says. “If there’s a day where a meeting or something interferes with my daily team huddles, I feel incomplete. I’m constantly searching for ways to ensure I consult with my team before researching or treating patients.”

Dr. Rios explains that patients have also had some PCMH-related growing pains. “Patients are comfortable in a world where they have a one-to-one relationship with their doctor,” he says. “Patients have placed all of their trust in a single PCP. This needs to change. A PCP needs to be involved in patient care, but he or she doesn’t necessarily be the one delivering it. For example, if a patient has a cold, a PA or RN may actually be a better option to deliver care because of the time they can dedicate to each individual.”

NGPG believes proper education is essential to making patients comfortable with a PCMH transition. Dr. Rios, for example, has had success introducing his team members (i.e. PAs, RNs, etc.) to patients during office visits and gradually involving them in care delivery. This process has helped patients become comfortable with these new caregivers and gain trust in their clinical abilities.