Factors to Consider in PCMH Practice Transformation

Factors to Consider in PCMH Practice Transformation

April 1, 2014
HIV/AIDS Medical Homes Resource Center (HIV-MHRC)
image of fact sheet

This questionnaire was designed to help your team to assess how to change your practice as you move toward becoming a patient-centered medical home with patient-focused teams. 

The following questions are designed to help your team begin to assess how you want to change your practice as you move toward becoming a patient-centered medical home with patient-focused teams.

  1. What do we want to accomplish?
    • What are our goals?
    • Where do we hope to see the organization next year?
    • What is our vision for the organization in five years?

    Consider the eight change concepts of PCMH in your discussion (engaged leadership, developing a quality improvement strategy, empanelment, continuous and team-based healing relationships, organized, evidence-based care, patient-centered interactions, enhanced access, care coordination). Experts in PCMH note that engaged leadership, quality improvement and empanelment are the foundational concepts that must be in place for the other changes to be successful.

  2. Where do we start?
    • Which of the eight change concepts of PCMH are already being implemented in our are already being implemented in our practice?
    • Which of the eight change concepts should be considered first/prioritized?
  3. Beginning with one area of change, what are our internal resources?
    • Is this concept in place at our site? If yes, how is it implemented or demonstrated?
    • Can we provide documentation that shows that we are meeting the core elements of the concept?
    • Do we need to modify the goals we set?
    • How can we focus on gaps and areas of needed improvement?
      • What is the selected certifying agency requiring for implementation and documentation of this concept? (Note: to be addressed after the certifying agency has been determined)
  4. Who should be on our project leadership team?
    • Do we have clinical, administrative/operational and IT representation?
    • Do we have an innovator? Risk taker? Team player? Communicator/Listener? Problemsolver? Detail-oriented individual?
    • What does this team need to learn to be effective?
  5. How should we communicate with administration, staff and other stakeholders?
    • What do they need to know about PCMH? e.g., What is PCMH? What does the certificationprocess look like?
    • For staff:
      • Why this is PCMH development/certification important and what will it take?
      • What is their role in the process?
      • How will their job be affected (both short and long term)?
      • What can they do to support the initiative?
    • Other stakeholders
      • What are the short and long term benefits of certification (reimbursement,status,facilitating change)?
      • Justify investment of time and resources
      • Describe resources needed to succeed
  6. Do we understand certification options, and are we ready to decide from which certifyingagency to seek certification?
    • Accreditation Association for Ambulatory Health Care (AAAHC)
    • National Committee for Quality Assurance (NCQA)
    • The Joint Commission
    • URAC (formerly the Utilization Review Accreditation Commission)

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