Drivers of Innovation
In response to market pressures that are compelling organizations to demonstrate the value of healthcare, innovative care delivery models – such as the patient-centered medical home (PCMH) – have emerged. Concurrently, graduate medical education (GME) programs are rethinking traditional curricula and developing methods to train the next generation of physicians to work within these new models of care delivery.
While this journey may begin in response to changes in the Accreditation Council for Graduate Medical Education’s (ACGME’s) requirements, forward-thinking organizations are integrating PCMH concepts into the clinical training environment to enable evolving medical practice and contemporary curricula by teaching the following concepts:
- Working in interprofessional care teams.
- Use of information technology.
- Patient- and family-centered care.
- Leadership and communication skills.
- Coordination of care and clinical integration.
- Population health management.
- Continuous quality improvement.
- Innovative visit types (e.g., telephone visits, e-visits, group visits).
Therefore, it is an opportune time for healthcare delivery systems to consider how to best take advantage of strategic synergies between GME programs and PCMH concepts. Integrating evolved practice models into residency programs will support overall clinical delivery system and medical staff strategies while simultaneously enhancing the competitiveness and reputation of the training program.
From Implementation to Integration
Successful and sustainable integration of PCMH concepts into GME programs involves a three-phased approach that extends well beyond implementation, requiring continuous evolution and transformation and, ultimately, full integration of the model within the clinical and academic components of the health system.
Value-Add of Alignment
There is some evidence that supports the effectiveness of the PCMH model at improving clinical and financial outcomes.1 Fully aligning PCMH and GME further creates substantial benefits for patients and the community, health systems, GME programs, and current and future physicians, as illustrated in the following table:
For any health system that is engaged in PCMH implementation and GME programs and is adapting to new educational models related to patient-centered care, it is mutually beneficial to collaborate, align incentives, and engage in coordinated planning efforts. Doing so may support broader efforts related to accountable care, clinical integration, and the improvement of health outcomes for the community. Furthermore, and perhaps more importantly, failing to consider potential alignment opportunities between PCMH concepts and GME may place an organization at risk of having, at best, divergent and, at worst, conflicting strategies; duplication of effort; and increased resource consumption in a time when the focus is on providing high-quality, cost-effective care.
Coordinated planning efforts may also help mitigate implementation challenges by leveraging the GME programs as learning laboratories in an environment that offers flexibility to test, perfect, and facilitate change through teaching. The disruption to physicians and patients often caused by any sizable change – particularly in practices adopting the PCMH model – indicates that the transformation must be thoughtfully planned and implemented. One solution to mitigate this disruption is a proactive approach of change management that occurs during medical education, ensuring that future physicians have the proper skills and the requisite level of engagement needed to sustain and improve upon the model in the future.
J. Arend, M.D., J. Tsang-Quinn, M.D., C. Levine, M.D., and D. Thomas, M.D., “The Patient-Centered Medical Home: History, Components, and Review of the Evidence,” Mount Sinai Journal of Medicine, 79; 2012; pp. 433–450.