Back in 2004, after the release of the landmark Future of Family Medicine Report(www.annfammed.org), which called for a new model of care that became the patient-centered medical home (PCMH), the AAFP reached deep into its cash reserves for $8.5 million to fund a new entity called TransforMED(www.transformed.com).
TransforMED President/CEO Terry McGeeney, M.D., M.B.A., gives a tour of new office space nearing completion at the AAFP's headquarters building in Leawood, Kan., that will provide more room for TransforMED's rapidly growing staff.
Fast forward to the close of 2012, and it's clear that TransforMED has grown, stretched and taken on many new responsibilities. However, the organization has never wavered from its mission: the transformation of health care delivery to achieve optimal patient care, professional satisfaction, and the success of primary care practices large and small.
AAFP News Now recently sat down with TransforMED President and CEO Terry McGeeney, M.D., M.B.A., to reflect on the organization's remarkable journey and take a peek into what the future holds.
Q. What is your role at TransforMED?
A. I was hired in 2005 after the Academy took that huge leap of faith to fund the original TransforMED. The organization's first task was to create a demonstration project around the PCMH model of care. That two-year project involved 34 family medicine practices and was completed in 2008.
In the early days, my role was very hands on, and I was involved in day-to-day operations. Today, I serve primarily as a leader and visionary of the company, and as such, I spend a lot more time interacting with stakeholders and policymakers on the national stage. Last year I was on the road about 100 days.
- TransforMED, a wholly-owned subsidiary of the AAFP, was founded as a vehicle to test the patient-centered medical home model of care.
- Circumstances in the health care environment -- along with passage of the Patient Protection and Affordable Care Act -- pushed the organization into new roles.
- TransforMED is recognized as an expert in the field of practice transformation and also has played a major role in demonstrating the value of primary care and testing new payment models.
Q. What is the link between TransforMED and the AAFP?
A. TransforMED is a wholly owned subsidiary of the AAFP but now is financially independent. The AAFP appoints the board of directors but is not directly involved in decision making. TransforMED's 13-member board has full operational authority and includes two members of the AAFP's Board of Directors and one AAFP senior staff member.
Q. How has TransforMED's work been received by physicians, public and private payers, the corporate world, and other outside entities?
A. I have to talk a little about the journey. In the 2006 demonstration project, we began working with individual physician practices. When health care reform hit (passage of the 2010 Patient Protection and Affordable Care Act), TransforMED began conducting a series of payer pilots around the country aimed at demonstrating the value of primary care and testing new payment models for primary care physicians.
Those payer pilots created a lot of national visibility for TransforMED and led to requests for assistance from hospital systems, large physician groups and state Medicaid programs. We were involved in a now-completed residency demonstration project called P4 (Preparing the Personal Physician for Practice) and more recently have been working with CMS, state governments and the U.S. military.
I'd say we've been well received by all.
Q. Do you have any idea how many physician practices TransforMED has worked with since its inception?
A. Since 2005, TransforMED has provided resources, training and solutions to hundreds of practices and thousands of physicians. In our 2011 year-end report to our board of directors, we estimated that as many as 40,000 physicians had experienced an encounter of some sort -- virtual or face-to-face -- with a TransforMED staff member. Our work has touched more than 20 million patients.
Q. How does the support you offer small primary care practices differ from the work you do with larger entities?
A. Small practices have fewer resources but more autonomy, so they retain the flexibility to make their own decisions. Practices that are part of a large health system often have lots of resources but need corporate permission when it comes to making business decisions. The concepts of practice transformation don't change, but the scale and presentation vary with the size of the organization with which we are working.
Q. What is TranforMED's greatest accomplishment to date?
A. 2012 has been a milestone year. In June, TransforMED received a (nearly) $21 million grant from CMS' innovation center (Center for Medicare and Medicaid Innovation) to help build medical neighborhoods around primary care practices.
More recently, CMS asked TransforMED to serve as the national convener/supporter of the Comprehensive Primary Care (CPC) initiative; as such, we will help develop content for a program charged with creating new payment mechanisms for primary care across a multi-payer environment. We'll also have boots-on-the ground personnel working in three CPC initiative regions in Oklahoma, Arkansas and New Jersey.
Lastly, the U.S. military engaged TransforMED to train staff members in 15 outpatient clinics in the U.S. Army Medical Department's Northern Regional Medical Command as those clinics become patient-centered medical homes.
Q. What is the organization's greatest strength?
A. It's our people and their levels of expertise, professionalism and dedication. Staff members who work with practices spend 30 percent of their time on the road. It's a hard job. More than 90 percent of TransforMED employees have advanced degrees and multiple years of experience in primary care. We know that primary care practices are extremely busy, and the people we present to them as trainers need to be incredible from day one.
TransforMED's greatest asset is its association with the AAFP. The Academy name gets us in the door and creates a lot of credibility. It tells physicians that TransforMED is not a typical consulting company. That, coupled with my background as a practicing family doctor, tells physicians that we understand their issues and their challenges and that we know what drives them -- better care for their patients.
Q. What steps is TransforMED taking to ensure that it has the capacity to handle its increased responsibilities?
A. From the beginning, we've tried to keep a 20 percent capacity; that is, we always have capacity in excess of demand so that when someone calls, we have staff on hand to handle the request. We've doubled our staff size in the past three months and anticipate doubling again by next summer.
We've also changed our business model from one where our practice facilitators were "generalists" and knew a little bit about everything to a system where we have eight centers of excellence created around subject matter, such as health information technology and care coordination. Our project managers are like conductors of an orchestra; they go into a project, assess the needs and pull in whoever they need when they need them.
We've also developed additional internal capability; for instance, we produce several webinars a week and archive them for easy access on our Delta-Exchange network(www.delta-exchange.net).
Q. How would you describe the success of this organization?
A. TransforMED's success has exceeded everyone's expectations, including my own.
The biggest marker of our success is the large number of premier health care systems in this country that now understand the value of their primary care practices and are engaging TransforMED to maximize that value by hiring us to work with those practices. That's important because currently more than 50 percent of family physicians are employed, and in three years, that number is estimated to be as high as 75 percent.
TransforMED also has helped big hospitals and health systems change their physician compensation models to match what is necessary for health care provided in the patient-centered medical home model. We've done a lot of coaching on how to change payment methodologies, and as a result, (we) have achieved a big national footprint around compensation.
Q. You are a self-described visionary. What is TransforMED's future?
A. TransforMED will experience an almost 300 percent growth in revenue this fiscal year. I see us continuing to play a major role in the transformation of health care delivery systems around the country. We're spending a lot more time in training-the-trainer kind of programs instead of doing all the ground work ourselves. We're just now beginning to talk to health IT vendors about the creation of data repositories to store cost and quality data that would help physicians make better-informed decisions about their practices.
Regardless of the project, we always will support primary care. The AAFP advocates for good ideas -- such as the blended payment model -- and TransforMED operationalizes.
We make things happen.