The Era of the "Comprehensivist"

Over the years I have heard Paul Grundy talk more than a few times about "comprehensivists" and "partialists."  The "comprehensivist" is the consummate primary care physician who focuses on the whole person while engaging in and coordinating all aspects of a patient’s care.  A "comprehensivist" is not a triage specialist, but one who delivers whole-person, comprehensive care.  The partialist is just that, what Dr Grundy often calls the "left kidney specialist."  The healthcare system needs both, but the "comprehensivist" must be the foundation.

Barbara Starfield, one of the most respected champions of primary care, often spoke about the importance of comprehensive care in any successful patient centered medical home model.   She knew very well that the key to an effective healthcare system was comprehensive and coordinated, not fragmented care.

National discussions continue to reference primary care physicians and specialists.  New discussions may very well be around "comprehensivists" and specialists.  The recently announced Comprehensive Primary Care Initiative (CPCI) will drive that discussion.  The Initiative clearly lays out what is expected of primary care going forward and how primary care will be paid. 

"Comprehensivists" will focus on the whole person while providing access to care and information.  Patients will be risk stratified with the appropriate resources deployed including aggressive, structured care management.  Care will be coordinated at multiple levels throughout the patient healthcare continuum.  Practices will be high-functioning teams and the capabilities of Health Information Technology (HIT) will be maximized.  All of this will be accomplished with the goal of maximizing patient engagement and outcomes.  Comprehensive practices will provide as many services as reasonable, not just triage services:  comprehensive care, not partial care.

This will be a defining year for primary care.  Providing partial care will no longer be acceptable for Family Physicians, General Internists and Pediatricians.  New payment mechanisms will reward the value of comprehensive care and move away from rewarding volume or partial, fragmented care.  We have seen this trend evolve in insurance pilots around the country.  We are seeing it play out in expectations of primary care by hospital systems and large groups in ACO projects.  Now we are seeing it evolve with CMS.  Primary Care physicians who want to be recognized and rewarded as "comprehensivists" must move in that direction with haste.

The question we frequently hear is "Now I get it, but how do I get started?" 

The answer is simple: the Medical Home Implementation Quotient Assessment (MHIQ®).  The MHIQ is a free TransforMED tool, recently updated to include a crosswalk for the 2011 NCQA standards.  It will allow your practice to determine where it is along the PCMH continuum and provide self-help resources for motivated practices. 

You should also sign up for Delta-Exchange (DX) which is free to all AAFP members and available at a nominal cost to everyone else.  DX is a vibrant PCMH learning community with a maximum focus on comprehensive primary care.  I would like nothing better than the Delta-Exchange being the official home of Comprehensive Primary Care.  Of course as practices start their journey and discover they need more help, TransforMED is positioned to assist with a myriad of tools and resources.