The PCMH & Team-Based Care Summit

While the specific definition of a Patient Centered Medical Home (PCMH) may vary from place to place, the main functions and attributes making up the foundation of this model of care are the same across the country. In this in-depth workshop, explore what separates a PCMH from a typical primary care practice, how each attribute of a PCMH influences protocols and processes, how to engage practices to encourage PCMH activities, as well as how team-based care is a vital activity in the model.

• Define what makes a PCMH different from other models of care to understand how using it can result in providers better achieving the goals of the Triple Aim
• Identify vital staff members and each of their responsibilities to improve quality and clinical outcomes
• Learn how to engage primary care practices to join the PCMH initiative through changes in the community
• Discover how the PCMH model can address unknown patient needs, chronic registries
• Delve into the five functions and attributes of a PCMH designed to achieve success:
• Comprehensive Care
• Patient Centered
• Coordinated Care
• Accessible Services
• Quality and Safety
• Explore how behavioral health integration can impact clinical outcomes and attain population health goals
• Outline methods to gain administration and IT buy-in on behavioral health integration to improve clinical outcomes and reduce costs
• Partner with organizations within the community to engage PCMH members and reduce overall hospital admissions

As the Patient Centered Medical Home model of care continues to grow throughout the nation, there are varying definitions and terms in each PCMH. In this session, discuss what the components of a PCMH are, what makes it different, and the inner-workings of the model.

• Review specific PCMH terminology and explore ways to communicate to staff and patients in layman’s terms
• Investigate the roles and boundaries of team members to understand each person’s responsibilities and their contribution to the model of care
• Compare the team-based model of care versus traditional primary care to recognize the differences in clinical outcomes

Discover innovative strategies and methods to overcome common challenges faced when implementing team-based care in different settings.

• Recognize the key personnel necessary to manage the database, care coordination efforts, communications with referring providers, and other important tasks to ensure efficiency
• Explore how to delegate responsibilities in different settings to improve patient and provider satisfaction
• Hear how to navigate staff turnover and shifting responsibilities as the team rebuilds throughout the PCMH accreditation process

Use lean methodology and communication to improve productivity and efficiency in a team-based approach to care.

• Identify communication gaps within staff protocols, the chain of command, and team responsibilities to improve collaboration and decrease misunderstandings
• Discover methods to implement in procedures to anticipate the needs of patients, the team, and the model to be proactive instead of reactive
• Explore how to create efficient workflows that differ between staff members to incorporate their needs and responsibilities

What works in one setting may not in another — Or may not be feasible to try all together. During these roundtable discussions, attendees split into groups to meet their ‘birds of a feather’ peers who share similar experiences, challenges, and opportunities based on the type of organization they represent. The facilitator poses questions and topics of discussion to the room that each group individually discusses to come up with solutions that can be directly applied in their type of setting.