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Healthcare Design In Support of the Military Health System’s Transformation to a Patient Centered Medical Home (PCMH) Model of Care

The Military Health System (MHS) includes over 300 Medical Centers, Hospitals and Clinics located worldwide on Army, Navy, Air Force and Marine Corps installations.  These 300 Military Treatment Facilities (MTFs) serve over 3.3M active duty service members, retirees and their families. In 2011, the MHS began transforming its over 440 primary care practices within MTFs into the PCMH model of care and adopted NCQA PCMH standards to establish consistent Tri-Service operating principles, which the Uniformed Services used to develop MTF operating guidance.  As a result, the MHS has been able to standardize business and clinical operational workflow, appointing/scheduling templates, staffing models, performance measures, goals and a capitated revised financing model.  The MHS has also implemented enhanced access tools such nurse-run/physician-led walk-in clinics for common acute problems, the Nurse Advice Line, secure messaging and embedded behavioral health, physical therapy and pharmacy specialists within the PCMHs based on the health needs of its population. 
This session will discuss how existing primary care practices had to be redesigned to be more patient-centered and to support efficient team-based workflow, embedded specialists and enhanced access clinics.  Redesign engaged multiple business, medical and architecture areas subject matter experts, who developed, piloted, tested and revised a standard primary care clinic model.  We will discuss what worked and what did not and how this information has been codified in Tri-Service guidance for any future MTF undergoing renovation.  In addition, we will discuss the new agreed-upon standard “footprint” for a primary care clinic.  Finally, we will discuss the new community-based medical home (CBMH) innovation and how these clinics are supporting the larger MHS mission.  CBMHs are stand-alone primary care clinics with ancillary services located around a larger military community hospital or medical center; the goal is to provide primary care near where beneficiaries, especially family members and retirees, reside.  CBMHs have standard footprints and staffing models, which have been proven to allow effective, patient-centered team-based workflow.