Is Your Practice a Medical Home?

By Dr. Sue Kressly

Whether or not you plan to apply for NCQA for Patient Centered Medical Home (PCHM) recognition, the future of pediatrics is enhancing the medical home. A growing body of evidence documents the many benefits of medical homes, including better quality, patient experience, continuity, prevention and disease management. Many states and payers have incentives for PCMH transformation. Regardless of whether you have access to recognition incentives, many of the drivers behind PCMH are needed to thrive in the changing healthcare environment.

A key component is understanding your population of patients, and working proactively to care for them. It’s also using data and quality reports to understand how your practice is performing and then work toward continuous improvement. It’s exchanging data with partners who also care for your patients. It’s recognizing that behavioral health has a huge impact on physical health and developing strategies to incorporate appropriate care relationships in your community. It’s improving access to your patients so they don’t head to the Emergency Department or a Retail-based Clinic instead of your office.

If you aren’t already doing so, you should be using your EHR tools to manage your patient population, identify gaps in care and recall for services due/overdue. Do you have someone running your report to identify children due/overdue for well visits at least monthly? Do you have an office procedure for how to contact them and get them to come into your office for care?

Are you tracking and following up on referrals to close the referral loop? Do you know if your patients are going to a referred specialist or if you are getting a timely report back from them? Are you rescheduling missed appointments for immunizations?

Regardless of whether you are planning to apply for NCQA or another external entity recognition for PCMH, you should be transforming your practice to the PCMH model. Start today by reviewing your active patient list, make sure it is up to date and you know as much about those patients as possible. Then run your recall for well visits. Do you have enough availability to accommodate those patients over the summer? If not, what’s your plan to make sure they have appropriate access to good care?


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