BTC is a primary care physicians’ office
BTC has a team of four physicians and two nurse practitioners
BTC provides care to individuals of all ages
Primary care practices incur considerable costs when adopting and implementing comprehensive primary care abilities
BTC is not an exception
A care delivery model change can help BTC mitigate this challenging issue
Background of issue
The cost of operating a primary care office can run primary care physicians out of business
Research reveals that by 2032, the USA would face a shortage of up to 55,200 primary care doctors, compared to about 480,000 primary care physicians in the USA in 2019 (The Lancet, 2019)
Physicians are needed in a health care sector where their skills and expertise are mostly needed to enhance effectiveness of care and promote quality care across the continuum
The main goals for a department that aligns costs, quality are cost containment and sustainability promoting efficiency of care care coordination with other specialties for best patient outcomes
High health care cost necessitates finding strategies to manage healthcare resources appropriately and effectively for the patient, providers, the health care system, and the population
SWOT Analysis of the issue
- Accessibility due to office location, the ability of patients to visit, and prominent health promotion for proactive health care methods
- A strong and trusted image as a result of customer satisfaction, supplier reliability, and positive performance in new markets
- Highly skilled workforce with specialized and general capabilities to address patient needs (Stanborough, 2020).
- Cohesive referral system in relation to secondary or tertiary care in the case of more specialized intervention
- The limited profitability of the office, which can inhibit growth or cause a decline in the business
- Inability to be successful outside the central offered service of primary care
- Often lacking the necessary technology, equipment, or resources to provide complete care and intervention for patients
- Possibility to be too reliant on the sale of products for financial success and expansion of care procedures and models
- Inability to service large populations and a higher quantity of patients (Blumenthal, 2022).
- Primary health care providers are less affected by inflation variations and can begin or continue business in a more stable manner
- Advancements in technology provide better opportunities as they become more available and more accessible to patients
- Consumer trends are also more positive toward primary care physician and provider models
- Changes in government policies also benefit primary care physicians through agreements that target technology, free trade, and taxation
- Due to the size of a primary care physician’s office, changes in consumer preference or the economy can cause detriment that is severe
- Competition is diverse, stemming from other primary care providers, secondary and tertiary care firms, and from hospitals, clinics, and other healthcare facilities
- The external impact such as price changes or the inability to purchase certain equipment can cause inadequate care for patients
- Due to the heavy reliance on suppliers, changes in the supply chain may cause harm
Adopting a comprehensive primary care model can potentially improve:
- Quality of care
- Effectiveness of care
- Improved care coordination (Martsolf et al., 2019)
- A care model that can assist in mitigating challenges faced in primary care practices such as BTC is
- The primary care medical home (PCMH) care model
- PCMH provides coordinated care for patients based on their personal preferences and needs
- Attributes PMCH includes
- Comprehensive care
- Patient-centered care
- Lowers costs
- Coordinated care
Accessible services Image retrieved from Web.
Commitment to quality and safety (National Committee for Quality Assurance, [NCQA], 2020)
Benefits to physicians
According to the National Committee for Quality Assurance ([NCQA], 2020)
Many payers acknowledge PCMH recognition as a hallmark of high-quality care
Many payers offer benefits ranging from enhanced reimbursement, to preferred provider status, to complimentary coaching/practice support
Many payers provide incentives to NCQA-recognized practices
A study found PCMH practices rapidly increase office visits relative to non-patient-centered clinics, with 163 more office visits per 1,000 members per year (Chu, Tu, Lee, Sayles, & Sood, 2016)
To be credentialed as a PCHM provider, the provider must meet some criteria
Team-based care and practice organization
Knowing and managing your patients
Patient-centered access and continuity
Care management and support
Care coordination and care transitions
Performance measurement and quality improvement
These criteria are evidence-based guidelines and best practices categorized as competencies (NCQA, 2020)
Ways Proposed Solution Meets Needs of the Population
To the patient and the health care system
The PCMH model is coordinated through the primary care physician
It ensures that the patient’s care is at the forefront
It serves as a means to enhance several chronic disease outcomes and reduce healthcare costs (American College of Physicians [ACP, 2019]; NCQA, 2020; Almalki, et al., 2018)
It promotes better-coordinated care among the different healthcare disciplines
Promotes interprofessional collaboration
Ways Proposed Solution Meets Needs of the Population
Ensures that care is specific to each individual patient
Improves patient experience
Improve patient-centered access
Improve staff satisfaction
Reduce fragmentation and improve quality
Proposal for a Change Process
Kurt Lewin’s change theory is the prosed implementation strategy for the proposed care delivery model
It has three stages of change (Unfreezing, Changing, and Refreezing)
In this change management process
Change initiatives need to weaken the status quo, implement the alternative, and improve the improve (Batras, Duff & Smith, 2016)
This change management model is acknowledged throughout the nursing literature as a framework to transform care
Experts affirm that Lewin’s theory offers the vital principles for change (Wojciechowski, Murphy, Pearsall, & French, 2016)
Creates problem awareness
Demonstrate issues or problems
Increase the group behaviors for change
Challenge status quo
Leadership intensifies pressure for change to a higher level
Involves a shift from the old method of doing things to the new method that is introduced
Key stage of implementation which requires support from all levels of leadership
Leadership is expected to help in providing structure and encouragement
Team members are expected to actively participate
Involves instituting stability and permanence once change has occurred
The change initiative is acknowledged as the new norm, and part of the organization’s culture
Every staff member works in collaboration to
Continue to implement, continue to evaluate, make necessary adjustments, and create permanence for the new process to thrive
Reasons for using this change model for implementation
Can be used to effectively implement a change vison with minimal complexity
It is used by clinicians in different specialty areas for diverse quality improvement strategies to transform care
It can be used in health care organizations with different degrees of difficulty such as the high cost of running a primary care provider setting
Adopting this change management model can increase productivity, effectiveness, and sustainability can be expanded by integrating organizational change as a key element of health promotion practice and research
Improved value for all stakeholders
The PCMH model provides value to patients, payers and practice to physicians
Improved quality of care, and reduced costs of care
Enhanced physician experience
Provide primary care physicians with delight in their practices by placing them in a better financial position than most other practices (O’Dell, 2016)
Patient-centered care has an excellent connection to increased patient satisfaction and improved patient outcomes
Since it is patient-centered, it empowers patients
Patients who are treated as a unique entity feel that they are truly cared for
Enhanced population health
The PCMH is a robust primary care model believed to be vital to transforming and enhancing population health
Enhanced patient-provider relationship
Focuses on the patient-provider relationship, enabling providers to partner with patients to better meet patient goals
Patients’ needs and preferences are fore-front
Helps providers integrate patient preferences, needs, desires, and experiences into every phase of medical treatment, and care
The PCMH model typically integrates increased virtual visits, patient education, and links to social determinants of health (Bokhour et al., 2018)
Improves patient experience
It is recognized as a critical aspect of quality that leads to improved patient experience, trust, and care quality (Bokhour et al., 2018)
Implications that aligns with current and future health care financing
The PCMH model saves costs ….. by reducing hospital and emergency department visits mitigating health disparities improving patient outcomes
Inspires quality in care
Cultivates more engaging patient relationships
Encourages effective care coordination
Captures savings through expanded access and delivery options that align patient preferences with payer and provider capabilities (NCQA, 2020)
As evidence reveals….. the PCMH model has been demonstrated to improve outcomes in terms of quality, cost and utilization
A major implication is the model’s potential to enhance practice and proven best outcomes that is a win-win for all stakeholders
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