How to Make a Medical Home Deliver

"For the most part, we here found it to be relatively easy," says Ziring of the transition. "But that may be in part because we had a group of physicians who really felt overburdened and felt they weren't providing the best possible care they could. It's an evolution and nothing succeeds like success, that is, if patients are happy and docs notice over time that their health improves. We're still implementing some of these changes, so it's a very gradual process."

Quick, big changes
Affinity Medical Group—a team of 250 healthcare professions and an insurance plan that is the physician group subsidiary of Affinity Health System, a three-hospital regional integrated delivery system based in Appleton, Wis.—started making the transition to the medical home philosophy about three years ago too. Its changes have been dramatic.

The effort started with two pilot programs. In one, leadership targeted an existing 400-patient practice that had big promise for patient growth. Interestingly, leaders didn't require existing workers to stay for the big experiment. In fact, employees were required to reapply for their jobs at the clinic.

"In that case, we basically started a new practice," says Tim Loch, senior vice president and chief operating officer at Affinity Medical Group.

Affinity took another existing practice that already had a 1,000-plus patient panel and implemented the medical home transitions there as well. There were big changes, which included keeping close track of metrics such as patient satisfaction, access to specialists, and the length of wait to get appointments. But the biggest changes were in work patterns and programs, says Loch.