A High Performing Patient Centered Practice

The Patient Centered Medical Home (PCMH) continues to be a very hot topic at multiple levels across the country.  The federal government is aware of the need for every patient to have a medical home as part of the health care reform efforts.  Most states have incorporated the attributes of Patient Centered Medical Home into Medicaid legislation.  Multiple insurance companies nationally are doing pilots that evaluate and reward patient centered medical homes.  Many large multi-specialty groups view PCMH as providing a framework for meaningful system redesign. Most recently hospital systems are focusing on the PCMH concepts within the concept of Accountable Care Organizations. 

What remains absent is the engagement of individual primary care practices, the ones taking care of patients and best positioned to make a meaningful impact on the US health care system.  The reason for this is that while government, payers, large groups and hospitals understand the potential "up-side" of the attributes of PCMH at the system level, individual practices have difficulty appreciating why they should start the difficult journey of transforming their practices without payment and possibly tort reform.  Practices continue to question the "win" at the practice level.  The issue becomes more complicated with the blurring and confusion around the concepts of a Patient Centered Medical Home.  Even practices that want to become medical homes get confusing, mixed message on what a medical home actually is.  Practices are often not clear on what they are to transform to.  Meaningful, substantial practice transformation to a PCMH is more than doing a better job of disease management or implementing an electronic health record.  Primary care practices need to focus not so much on the PCMH, but the attributes of the TransforMED patient centered model which will not only enable practices to become real medical homes, but most importantly—high performing, patient centered practices.

The TransforMED model provides a framework and common language for meaningful change.  This change is true system change and not just minor adjustments to a inefficient and sometimes ineffective system.  Everyone understands that a practice needs to be "patient centered".   Everyone does not understand that the practice needs to be "high performing". 

Primary care practices will not survive even with health care reform without the transformation to high performing practices.  Practices need to be "high performing" not only in their ability to leverage technology, provide and capture meaningful outcomes and expand access.  Practices need to perform as efficient and effective teams and function as the complex, high volume, low margin businesses that they are.  This is the only way practices will thrive in today's environment while positioning themselves to capitalize on health care reform.

The transformation to high performing patient centered practices needs to start now.  The concept of a patient centered medical home has been slow to get traction at the practice level. There are many reasons for this that are not likely to change.  The concept of a high performing, patient centered practice is one that practices can embrace and can deliver immediate value.  Primary care practices need to drive change and not simply position themselves to react to change.