Then and Now

As the Patient Centered Medical Home (PCMH) and practice transformation world continues to evolve so quickly, it is worth the time to step back and reflect on how much things have changed since the days of the National Demonstration Project (NDP). I recently came across the origial "bubble document" describing the NDP's "new model of care" and was struck by how much it has evolved over the years.

The NDP was based on a model of care described in the Future of Family Medicine report. That model evolved and was eventually renamed the Patient Centered Medical Home model of care while the NDP (National Demonstration Project) was still in progress. Thanks to the learnings and experiences from the NDP, the model was changed and expanded over seven times during the original project and continues to evolve to this day. That is why the project was described then and now as a "learning lab" and not a true research project. In the beginning of the NDP, our goal was to find what worked and what didn't work and to change primary care for the better. When we learned something, we applied it. We knew that if primary care was going to survive and the health care system was to change, what we learned had to be implemented immediately. Our ultimate goal was to develop a viable and sustainable model of care with the tools and resources to support it.

Over the past several years of the Patient Centered Medical Home journey, practice transformation has evolved from being very process focused early on to today's focus on outcomes, the patient and aligned incentives. It is truly about how the health care system and all of the stakeholders are impacted rather than how the practice is impacted. Payment reform, performance incentives, practice and provider support and the need to focus on systems are all now "givens". We now need to maximize opportunities around all of these issues to generate outcomes that will have a meaningful impact on the US health care system. These outcomes focus on overall satisfaction, quality and efficiency at the patient, practice and system level.

The fact that these outcome issues were not even on the radar screen during the early days of the "new model of care" demonstration project, is a testament to how much has been learned and how much has changed. We now know that transformation is very difficult -- practices need to be supported, workflow processes and efficiencies need to be leveraged for practices to have the time and financial flexibility to transform, and of course, incentives must be aligned. In 2005 we suspected many of these things but now they are known and we are tasked with delivering improved outcomes based on what we learned from the NDP "learning lab".

Things could not have evolved better. I often talk of "magic wand" scenarios. The American Academy of Family Physicians (AAFP) had the vision and foresight to fund the NDP which provided foundational, real-time learning that allowed the Patient Centered Medical Home concept to evolve and flourish at the exact time that the US health care system desperately needed a resurgence of a transformed primary care in a transformed health care system. This is exactly what the Future of Family Medicine report clearly stated needed to happen and it is happening. We now have a TransforMED Model of Care that provides a clear vision for a Medical Home for all. We now have pilot projects providing aligned incentives and improved compensation for primary care and we have a health care system that is focused on the need for a primary care based system of care. We now have data that demonstrates in as little as a year quality can improve, incentives can be aligned, patients can be more satisfied and engaged, and primary care compensation can improve significantly.

President Obama once said "If you're walking down the right path and you're willing to keep walking, eventually you'll make progress". The vision of the Future of Family Medicine Report pointed us to the "right path". Primary care physicians, patients, payers, and health care systems are demonstrating an unwavering willingness to "keep walking" down the path, and we indeed are making progress. Eventually not only will we have made progress -- we will have transformed primary care and the US health care system, and most importantly, improved the lives and health of millions of Americans.

Find out more about TransforMED's Patient-Centered Model.