From a Patient-Centered, High-Performing Practice to a Patient-Centered High-Performing System

The concept of a patient-centered, high-performing practice discussed in the last CEO report really resonated with physicians and practices across the country. It is clear that many have had difficulty embracing the concept of Patient Centered Medical Home for their practices. Everyone agrees with the PCMH concepts, but describing their practice as such is another issue.  As outlined in the last report, the important issue is that practices embrace the concepts of the TransforMED model of care to become patient centered, high performing practices.  The TransforMED model of care will enable practices to become medical homes if that is the goal, but for many it is not.  On the other hand, what practice does not want to be "patient-centered" and "high performing"?

While becoming a patient-centered, high performing practice is good for the practice it will not by itself solve what ails the U.S. Healthcare system.  As I travel around the country I often speak of patient-centered medical villages or neighborhoods made up of medical homes all inter-connected and working together for the betterment of the patient.  The real strength of the PCMH model is that practices not only redesign themselves but focus on collaboration, coordination and movement of information to maximize patient care.  What we really need to focus on is patient centered, high performing SYSTEMS made up of patient-centered, high performing practices. 

Taking this concept one step further, a primary care based, patient-centered, high performing health care system is exactly what this country needs.  We often read that the United States has low quality and high cost in health care.  The truth is that patients with unlimited access to the health care system via good insurance coverage get very good, high-tech care.  The problem is that many of the patients in the United States do not have such access because they are underinsured or have no insurance at all.  There are many reasons for that, but the point is that the issue exists and must be addressed.  An undeniable truth is that the United States spends more on health care than any developed country in the world.  Those of us who have been at this for a while fully recognize that there is a lot of slack and waste in the system that could fund high quality health care for all and support a modified physician payment system that will put primary care back on a track to survive and even thrive. 

The amount of money and energy that should be spent taking care of patients is instead spent on unnecessary and duplicative paper work, unnecessary or duplicative testing, unnecessary consults and procedures, defensive medicine, on and on.  What we need is a patient-centered, high performing health care system with patient-centered, high performing, primary care practices at the helm.  Quality would go up, costs would go down.  Certainly government and payers need to address the paperwork, Health Information Technology (HIT) interoperability, tort reform and payment reform issues with aligned incentives as well.  A laser-sharp focus on government, payers and providers all transforming to a patient-centered, high performing health care system will create the opportunity for a high quality and improved efficiency that is required.  Such transformation is possible, but only with primary care practices leading and not just responding to these important issues and opportunities.