Homing In on the Medical Home

This article appears in the February 2012 issue of HealthLeaders magazine.

The concept of the patient-centered medical home, introduced by the American Academy of Pediatrics way back in 1967, continues to gain steam. But what does it mean to be patient-centered?

Lee Penrose, president and CEO of St. Jude Medical Center, a 384-licensed-bed hospital in Fullerton, CA, part of populous Orange County, recalled the concerns he had after hiring a consultant to interview patients. "We asked them to come in and look with fresh eyes, talk with some of our patients, talk to community members about what they think about healthcare," Penrose said. "The resounding answer we got back was: Healthcare is something you have to navigate your way through.

"We didn't always like a lot of what we heard," Penrose admitted. "But we listened and made changes so that we could develop the essential elements of a patient-centered home—working closely with our communities, inspiring the team and setting common goals for our patients' health."

The interviews were early in the formation of a PCMH within St. Jude's parent organization, St. Joseph Health System, which has annual revenues of $4.5 billion. Penrose and other executives discussed the motivation for PCMH and the path to creating one at the HealthLeaders Media Rounds event, The Business and Clinical Path to Medical Home, hosted by St. Joseph in Orange, CA.

Today, St. Joseph Heritage Medical Group, one of several physician practices under the St. Joseph umbrella, operates as a Level 1 PCMH, as recognized by the National Committee for Quality Assurance. Penrose and his colleagues emphasized that achieving this designation was a slow process, requiring substantial investment and groundwork, even for an already integrated health system.

"This isn't a journey that started 18 months ago, or whenever it was that [PCMH] became a big topic. This started for us in 1994, and we built on it. The long-term perspective is very important," said G. Scott Smith, MD, the medical director at St. Joseph Heritage Medical Group.

The medical home approach is in keeping with St. Joseph's approach to healthcare, Penrose said. "We're all about promoting health … thinking about population health, the health of the communities we serve. It's very important to us that we do more than just acute care, but also reaching out into the community—and what a great way to do it," he said. The organization's working definition is that "The Patient-Centered Medical Home describes how primary care practices should operate to ensure high-quality care and patient safety, as well as work within an integrated healthcare system."

Information technology is important for PCMH. The integration necessary for a medical home requires IT connections. St. Jude invested $15 million in information systems, including an electronic medical record system.

In 2009, the Healthcare Information Management Systems Society named St. Jude Medical Center among the top 1.6% of the nation's hospitals for its use of EMR to benefit patient care. EMR adoption did not come immediately, but has since become a key element of the medical home infrastructure.

C.R. Burke, president and CEO of St. Joseph Heritage Healthcare, the physician practice organization of St. Joseph Health System, lists five elements of the medical home's IT infrastructure: EMR/EHR, patient health records, shared case management, utilization, and risk stratification and predictive modeling. All of these must work in concert within the PCMH.

The medical home is not simply an IT project, however—a point emphasized by Jeff Gartland, senior vice president of connectivity and clinical integration services provider RelayHealth, which sponsored the Rounds event. PCMH "is deployed through technology and supported by technology, but it is a true business model transformation," he said.

Another important step in building a successful medical home is getting the buy-in of physicians, Smith said. "The real big winner for doctors with PCMH is quality of care," he said. Physicians "like to do two things: They like to take care of patients, and they like to provide quality care. If a healthcare system can provide the structure to do that and then give them the reward and feedback … you've got a medical home."

When the IT infrastructure is in place and doctors are on board, physician practices and healthcare systems preparing to launch a medical home should take five steps, "because we are transforming practices into the patient home-centered model," said Ewa Matuszewski, CEO of Medical Network One, a physicians' services organization based in Rochester, MI.

• Appraise your practice's readiness for change: Does the culture frown on innovation or see a need for a
  new approach?
• Evaluate the people who will be part of the medical home team: Are key players resistant, and if so can they be won over?
• Identify a medical home champion from within the practice
• Create a mission and vision for the new medical home
• Create a specific project plan

So what comes after the PCMH? St. Joseph executives envision a patient-centered medical neighborhood on the near horizon. A collection of PCMHs within a single healthcare system would dovetail nicely with accountable care organization requirements. The medical home is a critical step to achieving ACO status, Penrose said. The PCMH is designed to foster collaboration with physicians across the continuum of care and is the most efficient model for adopting clinical IT with both hospitals and physician offices. And so, after 45 years, the PCMH model is finding a home at a time when coordinated and accountable care is becoming increasingly relevant.

This article appears in the February 2012 issue of HealthLeaders magazine.