1. Safety Net Medical Home Initiative Ed Wagner, MD, MPH, MACP MacColl Center for Health Care Innovation Group Health Research Institute Safety Net Medical Home Initiative The Safety Net Medical Home Initiative: Some Lessons Learned

2. 2 SNMHI How does a practice become a PCMH? Change is hard enough; transformation to a PCMH requires epic whole-practice reimagination and redesign.* *Nutting et al. Ann Fam Med. 2009; 7:254-260

3. 3 SNMHI PCMH transformation is not business as usual Change is hard enough; transformation to a PCMH requires epic whole-practice reimagination and redesign. (Nutting, et al.) Coach Medical Home: Module 1 3 Asking physicians & staff to change their roles Investing time & money Changing how care is provided For most practices, transformation means:

4. 4 SNMHI What helps practice transformation? 4 Coach Medical Home: Module 1 Practice will, ideas, and execution Trusted measurement system Change Concepts Learning communities Practice facilitation

5. 5 SNMHI The SNMHI Framework: The Change Concepts for Practice Transformation Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The Changes Involved in Patient-Centered Medical Home Transformation. Primary Care: Clinics in Office Practice. 2012; 39:241-259.

6. 6 SNMHI Laying the Foundation It is very difficult for practices to make changes without committed and aligned leadership. It is very difficult for practices to make changes without an effective QI strategy. Even in practices with strong leaders and QI experience, major impediments to change are: The absence of a trusted performance measurement system that enables the practice to understand and monitor its performance. Failure to understand and use rapid cycle small tests of change. Successful practices regularly plan and execute small tests of change (PDSA cycles) that build toward the full implementation of a key change.

7. 7 SNMHI Why is empanelment so critical? Linking patients to specific providers: changes practice culture and accountability, fosters a population focus and the development of teams, and facilitates meaningful measurement (at the provider level) and population management.

8. 8 SNMHI Why are continuous, team-based healing relationships so critical? Without high-functioning teams, practices find it nearly impossible to implement patient-centered interactions, organized evidence-based care, and care coordination.

9. 9 SNMHI Why learning communities? SNMHI fostered national and regional LCs for practices, and national LC for coaches. Greatest benefit derived from hearing from people and organizations like us. Hearing how other practices implemented a particular change makes concepts come alive. Site visiting seemed most impactful.

10. 10 SNMHI Coaching lessons Coaches need to ensure that leaders are engaged and the practice has the capacity for quality improvement. Many practices, even very good ones, dont have trusted measurement systems in place; coaches need be able to help.