The Blueprint

PCMH sites adding staff to meet goals

Optimizing the care team staff model is critical to the success of the medical home model. A high-functioning PCMH team should be able to support care coordination and quality improvement activities, provide more hands-on care for higher-risk patients, and expand the practice’s reach to a larger per-physician patient panel—while still protecting and even improving provider workload sustainability.

Recent Medical Home Project research identified three key trends in PCMH staff model innovation today.

  • Sites are adding staff support
  • Centralized care management platforms are emerging
  • Sites are increasingly applying the “top-of-license” principle in making all staff roles more robust

Over the coming weeks we will explore each of these topics through a series of blog posts, including updated data from the benchmarking initiative, beginning with the increase in PCMH staff.

Medical Homes Adding Staff Support

Given that medical home sites are systematically investing in taking on more population management-related work streams, the first staff model question is always, “Do we need more staff to accomplish these goals?” Qualitative research says yes.

Medical home leaders tend to agree that adding FTEs will not only improve a practice’s quality performance and meet population management goals but also improve its near-term productivity and profitability under a wide variety of contracting scenarios, including both fee-for-service (FFS) and risk.

The case for increased PCMH staffing under FFS and risk

Under a FFS contracting paradigm, industry research about physician practices shows that additional staff members, when well utilized, tend to improve the practice’s total margin performance because productivity is critical to physician practice economics.

Research into the PCMH staff model takes this theory a step further, finding that practices can achieve a positive ROI by adding medical home-focused staff even when that person’s job does not appear to directly boost productivity in conventional ways. Through behind-the-scenes work on tasks, like pre-visit chart reviews or reaching out to patients who need evidence-based services, a staff member, such as a health coach, will increase practice productivity.

Other downstream wins, such as improving capture of pay-for-performance incentives and raising average complexity per case, also contribute to this effect.

  • Health Care Advisory Board members may access the Health Coach ROI Calculator to assess the business case for adding health coach FTEs to physician practices.

As contracting portfolios shift to include more risk, the business case for adding PCMH staff should become even stronger. The core activities of PCMH staff members should directly advance goals such as avoiding unnecessary ED and hospital utilization. Also, productivity and panel size growth will become even more critical to the practice and affiliated health systems that will need to offset per-patient utilization losses by serving more patients overall.

How many staff members are medical homes adding?

Looking at uptake today, the Medical Home Project’s 2011 Benchmarking Initiative suggests that many practices have room to grow. In our sample of 49 medical home sites, about half (49%) reported adding FTEs to the practice to support transformation to date.

Qualitative research revealed that some sites not adding staff were receiving significant operational support from systems and organizations outside the practice—e.g., care management services from a central platform housed at the health system level.

However, to support substantive medical home activities, we believe that sites that have not already added staff or external support services should strongly consider doing so. A larger team will help to bring PCMH site goals within reach without burning out existing members of the team.

  • Medical homes average 2.5 total clinical support FTEs (NP, PA, RN, LPN/LVN, MA) per physician, slightly more than non-medical homes in the survey sample. (n=49)
  • Among medical homes that have added staff, sites added an average of .6 per FTE physician. (n=22)
  • Source:  2011 Medical Home/Primary Care Benchmarking Initiative, Health Care Advisory Board Medical Home Project

Upcoming Analysis

Next in the staff model series, we will explore other PCMH staffing trends, including:

  • The incorporation of centralized care management platforms into staff models
  • An update on the use of the "top of licence" principle to make all staff roles more robust--including data on which clinical team members are primarily owning which population management tasks today

We are also in the midst of releasing more updates on PCMH operations, including:

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