The Implementation Plan

In order to ensure the success of the medical home model,

implementation will take place in four gradual steps. By beginning in
one month, the timeline for implementation sets up the Medical Home
Model for full integration by mid-2013, giving the City of Philadelphia
ample time to make adjustments before the Affordable Care Act fully
takes effect in 2014.
Planning Period:
From May through July 2012, the Medical Home Model will solidify
its plans for implementation.
Additional funding sources will be identified. As identified above, there
are three major funding sources: the 90% federal match through
Medicaid for patients with multiple chronic conditions, higher
reimbursement rates, and the funding for meaningful use of EHRs.
However, implementation will require upfront costs when employing
care coordinators although these costs can be low since Americorp
volunteers have been used for this position in the past. Further,
implementation of EHRs will require an initial investment of time,
which could require additional work hours.
In addition to solidifying the various components of the medical home
model to create a cohesive approach to primary care, the summer
months will commence the Health Information Exchange process.
Health Center #6, the pilot location for the Medical Home Model, will
begin a more formal relationship with Thomas Jefferson University
Hospital.
Early Implementation
From August through October 2012, the Medical Home Model will
begin formalizing the relationship between Thomas Jefferson
University Hospital and Health Center #6. This will be complemented
with the hiring and training of staff members and full implementation
of EHRs.
Formalizing the relaionship between Jefferson and Helaht Center #6

during the early fall months will reveal the many advantages and
limitations of developing formal relationships with local hospitals. The
Health Information Exchange between hospitals and health centers will
undoubtedly reduce costs and wait time in the long run, but will face
some obstacles when first implemented. Identifying them with the pilot
location will allow the City of Philadelphia to correct these problems
before growing to further health centers.
Hiring and training staff members from August through October will
allow the Medical Home Model to have the appropriate staff support
necessary for care coordinators. The staff to be hired can range from
Americorps volunteers to registered nurses depending on the severity
and complexity of the patients case. Figuring out the number of cases
each care coordinator can undertake will be one of the largest
challenges.
Later Implementation November-March, 2013
From November 2012 to March 2013, the Medical Home Model will
finish implementation at Health Center #6 and will begin to grow to
other health centers. The care team at Health Center #6 will begin
seeing patients associated with two of their care providers. As care
coordinators begin to aid patients navigate the health care system to
reduce costs and improve quality, this third stage will hopefully identify
how best to deal with high risk and complicated patients. As the process
gets worked out and streamlined, the number of providers will be
scaled upwards to account for the other Philadelphia health centers
(explored in more detail below). Creating ways to cheaply and
efficiently train new staff members for other health centers will need to
rely upon the lessons learned from Health Center #6.
Early Evaluation
From April to May 2013, stage four will begin to evaluate the successes
and failures of the Medical Home Models. This will include using data
from EHRs at the various health centers. Further, we will analyze key
health outcome variables associated with chronic disease to determine
what kind of impact of the program has on reducing 30-day hospital
readmission rates. If the model is successful and mirrors other cities

Medical Home Models, we should see significant reductions in

readmission rates and improvements in chronic illness prevention and
management.