Population health and PCMH

PCMH roll out stalled

Formal statewide patient centered medical home (PCMH) alliance in place for six months. Significant on-the-ground diagnostic and planning work not translating into action. Expectations of leading local providers not being met. Diffuse accountability leading to silos and finger-pointing across payer, provider and population health vendor. CEO level questions about ability to execute and possibility of terminating arrangement.


Analyzed population health and PCMH functions performed by vendor, payer and provider in the context of primary care clinical and administrative workflow. Convened a full day workshop with key stakeholders and facilitated a structured discussion to identify root causes of issues. Developed a clear action plan to reset PCMH initiative.

Successful turnaround of initiative

Tactical roadmap of action items, deadlines and accountability in place. Changes seen on the ground by providers within 3 weeks. Coordinating group established to oversee implementation. Turnaround of relationship between population health vendor and payer. PCMH initiative continues and is considered a model.


Population Health
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