TransforMED: Building a Gateway to Care

"Defining patient-centered care is really up to primary care specialties. If we don't define it, somebody else will, and it likely won't be in the patients' best interests," said Terry McGeeney, M.D., M.B.A., during a session at the AAFP Scientific Assembly on Oct. 4.

"Many groups are talking about patient-centered care. Yet nobody knows what patient-centered care really is or what they want from it," said McGeeney, who is president and CEO of TransforMED, the AAFP's practice redesign initiative, which is overseeing a national demonstration project on the patient-centered medical home.

McGeeney shared early findings from the demonstration project during the session "Transforming Your Practice to a Patient-centered Medical Home." The U.S. health care system is demanding that primary care change, and initial data from the project indicate that change can produce positive results for patients, practices and communities, said McGeeney. However, preliminary findings also demonstrate that change is difficult to implement.

The new mentality must be about what's best for the patient, said McGeeney. And primary care providers must be positioned as the gateway to care, not as the gatekeepers. "We must focus on disease prevention and wellness promotion," McGeeney said. "That's where our wheelhouse is. No one else is positioned as well as family physicians to manage populations of patients and promote wellness."

The demonstration project has shown that the new model of care works. Doctors are happier. Patients are happier. The economics are better. The quality is better.

However, "to succeed in primary care, family physicians must perform meaningful outcome analyses to prove that we actually do provide a higher quality of care," said McGeeney. "We all say we do it, but in reality very few doctors actually do." And that, unfortunately, could be FPs' undoing. Payers need data to validate reimbursements. Family physicians must have systems in place through which outcome analysis can be seamlessly measured.

In addition, for the new model of care to work, everyone in the office needs to be part of the team -- from the front desk, to the nurses, to the lab techs. The medical home is defined as a practice -- not as an individual physician within the practice, said McGeeney. When physicians use their time to do what somebody else can do, they are wasting one of their practice's most valuable resources -- themselves, he noted. Delegating is imperative.

"We have seen practices where the doctors made a low of about $110,000 a year. Then others made more than $300,000 a year. Guess who's working the hardest? The $110,000 doctors. They can't figure out how to see 15 patients a day because they're running around doing things they shouldn't be doing," said McGeeney.

TransforMED has found that the biggest challenge for practices in the demonstration project is getting in a position to change. At a practice level, everybody needs to be on board to make it work, said McGeeney.

Change creates a tremendous amount of chaos, but "it's important to understand that chaos is part of the process, said McGeeney. "Then the transforming idea catches hold, and all of a sudden, you have a new status quo, and the bar is raised. You just have to hang on to the bar for the ride."