AAFP's TransforMED Launches Project to Prove Innovative Model of Care

As others decry the impending collapse of primary care in the United States, AAFP's TransforMED initiative stepped into the future April 3 by announcing the launch of a national demonstration project designed to test an innovative practice model that could ensure the rebirth of primary care.

TransforMED, an AAFP division that focuses on transformative practice redesign, made the announcement at the National Press Club. The news conference was the Academy's first live video webcast, and it had received more than 600 visits as of press time.

Representatives from CMS and the Agency for Healthcare Research and Quality participated in the event, praising AAFP for investing in TransforMED and anticipating the usefulness of the project's results.

"I have waited for two years for the opportunity to stand before you with this announcement" of the demonstration project, James Martin, M.D., of San Antonio, TransforMED's board chair, said at the news conference. The TransforMED initiative grew out of the 2004 Future of Family Medicine report, which envisioned a model of health care with both a patient and a system focus. Martin, an AAFP past president, was chair of the Future of Family Medicine Project Leadership Committee.

Thirty-six family medicine practices (PDF file: 10 pages / 1.5 MB. More about PDFs.) have been selected for the two-year demonstration project. Each of the 36 will transform itself "from a 20th century, physician-focused practice into a 21st century, very patient-centered type of health care delivery system" using the TransforMED Model of Care, said Martin.

The TransforMED Model of Care calls for

The demonstration project is intended to test the model of care to evaluate if it truly is workable in a variety of everyday family medicine settings. "The goal of this project is to provide an objective view into exactly how the components of the TransforMED Model of Care will impact patient satisfaction, quality of care, and practice efficiency and economics. It also will help determine the most efficient and effective way to implement this kind of transformative change in physician practices," according to TransforMED materials distributed at the news conference.

"The proof is in the pudding, and what you have before you in this demonstration project will be that pudding. It is the research laboratory that will be used to determine the success of the TransforMED model," Martin told reporters.

"It's the kind of broad-scale improvement our health care system really needs," said Helen Burstin, M.D., M.P.H., director of AHRQ's Center for Primary Care, Prevention and Clinical Partnerships, who also spoke at the news conference. "Without a primary care system that’s functional and that can really be the backbone of what our health care system needs, we're not going to get to a high-quality health care system that can appropriately provide what patients need and want."

The TransforMED project "gives us a chance to learn from practicing physicians how quality improvement can be most effective for them," Burstin added. "Oftentimes, things are tossed at clinicians, as opposed to having a sense of what works for them. We'll learn much about the kinds of hands-on technical support that clinicians want and need to transform the health care system."

The 36 practices in the national demonstration project were chosen from among more than 300 applicants. The pilot practices are both geographically and demographically diverse. They range in size from practices with seven or more physicians to solo practices. Although some have TransforMED Model of Care concepts (e.g., electronic health records) in place already, others are starting from scratch.

One of the selected solo practices is a new one being opened by Theresa Shupe, M.D., in Haymarket, Va. Shupe participated in the April 3 news conference. "I was really thrilled, when I read the Future of Family Medicine report, to find out that I wasn't the only one thinking that way ... that the Academy was thinking the same way I was," said Shupe about the tenets of the TransforMED Model of Care. "I look forward to having a medical home for patients, better quality care, and being able to improve the lives and health of my patients."

The demonstration project "has a vision, a plan and a purpose which is nothing short of changing the health care system in this country," AAFP President Larry Fields, M.D., of Ashland, Ky., said at the news conference. "Far from accepting the collapse of primary care that's been recently predicted, we're announcing the rebirth of that care -- the kind of care Americans want and the kind that they deserve."

Fields noted that the TransforMED Model of Care holds so much promise for moving health care into the future that the AAFP decided to infuse $8 million into the initiative. "This change in health care delivery is so important to our country … that we're not asking others to pay for this," he said. "We -- family physicians -- are going to pay for this project ourselves."

Trent Haywood, M.D., J.D., deputy chief medical officer for the CMS Office of Clinical Standards and Quality, said he appreciated the sentiment. He noted that many organizations present ideas on the future of health care to CMS, but few have the commitment shown by the AAFP to invest up front in their ideas.

"Over the course of this next two years, CMS will be eagerly looking at (TransforMED's) results and, hopefully, at the end of two years, shamelessly stealing from you guys and looking for ways in which we can incorporate (the results) into the Medicare program," said Haywood.

A final report on the national demonstration project is expected in early 2009, but key lessons learned from the project will be shared on an ongoing basis. "The research that comes from the demonstration project will be available to everyone in this country," said Martin.