Care Transformation Center Blog

Top-of-license practice can't be limited to the MD

by Megan Clark

In the first round of medical home transformation, much of the focus was on PCPs working at top-of-license, shifting tasks from the PCP to an RN. However, as organizations continue to advance the medical home model, we need to revisit the care team and reallocate who does what.

Reprioritize the role of the RN

RNs are great "utility players" for the PCP team, capable of taking on a lot of patient management responsibilities and acting as both an advocate for patients and a partner for physicians.

But RNs are a limited practice resource. So the question becomes, are you keeping your RNs at top-of-license too? All too often, we find the answer is "no." It’s fair to say, when we were getting PCPs used to care teams, we probably needed to over-rely on RNs to make the transition as easy as possible. But now that PCPs are on board, its time to review the task list again.

Revisit care pathways and task allocations

Standards make team-based care work. Because we assign specific owners to each step, there are no gaps, no duplications, and no assumptions. If something gets skipped, we know exactly who is responsible.

If you and your team have been working on medical home deployment for a while, now is the time to go back and revisit the care standards and the staff members assigned. An interdisciplinary team of primary care providers and care continuum partners should work together to identify which tasks really belong to the RN and which tasks might be handled by other members of the care team.

With a little extra training, medical assistants in particular can help the practice achieve larger care management goals.

More Tips for Elevating Care Team Members

Making a few tweaks to the traditional medical home model could increase your panel size by 43%.

Advisory Board Consulting and Management CMO Dennis Weaver, MD—a seasoned expert who led the Adirondack Medical Home Pilot—offers steps for advancing practice workflow and improving the patient experience in your medical home.


We also recommend you to check out the Nursing Executive Center's infographic on addressing three common causes of care team inefficiency.

Five Steps to Build the Advanced Medical Home

The advanced medical home is what's next in primary care innovation. Get five strategies for evolving the current model to scale care management across the health system. Read the briefing »


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Meet the Author

Megan Clark
Practice Manager
Health Care Advisory Board