Change Concepts Overview

"Change concepts" are general ideas used to stimulate specific, actionable steps that lead to improvement. The Safety Net Medical Home Initiative established a framework for PCMH transformation that includes eight change concepts in four groups:

• Laying the Foundation: Engaged Leadership and Quality Improvement Strategies
• Building Relationships: Empanelment and Continuous and Team-Based Healing Relationships
• Change Care Delivery: Patient-centered Interactions and Organized, Evidence-Based Care
• Reducing Barriers to Care: Enhanced Access and Care Coordination

Download the Change Concepts for Practice Transformation Overview

The Change Concepts for Practice Transformation were developed by the Project Team with guidance from a Technical Expert Panel that included providers, patients, researchers and safety net site leaders. A brief overview of the Safety Net Medical Home Initiative's framework is provided in the following video.

Introduction to the Change Concepts (August 2009)
Speaker: Ed Wagner, MD MPH, Director, MacColl Center for Health Care Innovation at the Group Health Research Institute
Video for Windows | Video for Mac

The sequencing of the Change Concepts for Practice Transformation was revised in May 2012. To learn more about the eight change concepts and where to begin, read below.

The Change Concepts for Practice Transformation: Where to Begin?

Becoming a patient-centered medical home (PCMH) means wholesale transformation of practice systems for most primary care organizations. But wholesale transformation ultimately entails a broad assortment of small changes in different aspects of the practice. Eight change concepts comprise the Change Concepts for Practice Transformation, the Safety Net Medical Home Initiative's PCMH transformation framework. These eight change concepts represent the critical dimensions of PCMH transformation. Each change concept includes multiple "key changes" that describe the general directions for the changes. Two questions frequently asked by practices implementing the eight change concepts and 33 key changes are: "How do all these fit together?" and "Where do we begin?"

"How do the change concepts fit together?"

Payer and policymaker enthusiasm for the PCMH Model of Care stems from their belief that a practice that provides high-quality primary care will improve outcomes and reduce healthcare costs by meeting patient needs for accessible, continuous, comprehensive, coordinated services and evidence-based, patient-centered, planned care. The eight change concepts collectively enable the delivery of care consistent with these expectations.

"Where do we begin?"

We think that the change concepts naturally divide into four groups: laying the foundation, building relationships, changing care delivery and reducing barriers.

Change concepts in laying the foundation—"Engaged Leadership" and "Quality Improvement Strategy"—reflect the fundamental base required to enable the practice to learn and implement change. If these foundational changes are not addressed first, meaningful transformation cannot occur.

The change concepts directed at building relationships among teams, and between patients and providers—"Empanelment" and "Continuous, Team-based Healing Relationships"—prepare the practice to deliver care efficiently, and increase the likelihood of productive interactions between patients and care teams.

The next change concepts—"Patient-centered Interactions" and "Organized, Evidence-based Care"—focus on changing care delivery. These changes encompass the practice system modifications associated with improvements in clinical performance.

The final two change concepts—"Enhancing Access" and "Care Coordination"—focus on reducing barriers to the seamless delivery of care. These changes are no less important than the change concepts addressed earlier, but they are more difficult to implement in systems that are not already routinely providing well-organized, patient-centered care.