Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home

This study was published in the Annals of Family Medicine back in June 2009.  Some people think that we can increase primary care capacity through pay for performance programs.  There are examples of pay for performance programs where the targeted clinical metrics improved, however, it seems likely that primary care practices in P4P programs shifted attention from non-incentive areas to those with a reward.  There isn't much progress in a zero sum game.  As the baby boomers age and require more care, and if health care "reform" leads to more insured Americans, we must find a way to increase primary care capacity.  This article http://www.annfammed.org/cgi/reprint/7/3/254 discusses the early lessons from attempts to transform primary care practices into Patient-Centered Medical Homes.The Commonwealth Fund summarized the key points well here http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/May/Initial-Lessons-from-the-First-National-Demonstration-Project.aspx. 

From the Commonwealth Fund:

Key Findings

• Transforming a primary care practice into a patient-centered medical home requires wholesale practice redesign and continuous commitment to enhancing the patient experience. Transformation will likely include a host of interdependent components, such as new scheduling arrangements, better coordination with other parts of the health care system, more point-of-care services, and development of team-based care, among others. "Change is hard enough; transformation to a patient-centered medical home requires epic whole-practice reimagination and redesign."
• Developing and implementing an information technology infrastructure to support this transformation is more difficult and time-consuming than may be anticipated. Information technology is currently underdeveloped to meet the needs of the patient-centered medical home.
• Transformation involves a shift from physician-centered care to a team approach, in which patient care is shared among office staff.
• Rapid transformation can result in staff burnout, turnover, and financial distress.
• Moving toward the patient-centered medical home model is a developmental process that can take up to five years to achieve; successful transformation is highly dependent on local conditions that affect health care practices and their surrounding health care system.

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Addressing the Problem

Based on their evaluation, the authors make several recommendations to support practices in their efforts to adopt the patient-centered medical home model:

• Pilot programs should include up-front capital to help purchase and implement new information technologies, and ongoing funding to support personnel changes needed to implement better care management.
• Practices must determine the specifications and path toward achieving their own transformation, but facilitation through consultation and other services can play an important role.
• Professional organizations should help doctors acquire the patient and practice management skills needed to make this transformation.
• The National Committee for Quality Assurance may need to revise its process for recognizing patient-centered medical homes to encourage a more developmental approach at the practice level.

 Enjoy!