Family Medicine Launches Project to Transform Primary Care

36 Family Medicine Practices Prepare to Undergo Transformative Change

Monday, April 03, 2006

Janelle Davis
American Academy of Family Physicians
(800) 274-2237 Ext. 5222

Washington, D.C. – In a bold step, family medicine today took the lead in the effort to transform the way primary care is delivered in our country.

TransforMED, an $8 million practice redesign initiative of the American Academy of Family Physicians, today announced the launch of a demonstration project that will test a new and enhanced model of patient care in 36 medical practices across the nation.

The 36 family medicine practices, selected from an applicant pool of more than 300, will undergo transformative change as participants in a first-of-its-kind “proof-of-concept” project. The project aims to determine empirically whether this model of care – the TransforMED Model of Care – can deliver on its promise to improve patient care, patient satisfaction, physician satisfaction and practice performance.

“Family Physicians are moving forward with a vision, a purpose and a plan to make a patient-centered personal medical home a reality for all Americans,” said Larry S. Fields, M.D., president of the AAFP and a practicing family physician in Ashland, Ky.

“Everyone is talking about reforming the health care industry – but the AAFP is doing it. Our TransforMED Model of Care will ensure quality, save people money, provide better health outcomes, and be the lynchpin for a revolution in the way health care is delivered. This is an American solution to an American problem that will truly benefit our patients,” Fields continued.

“Far from accepting the recently predicted collapse in primary care, today we are launching a rebirth of that care. The kind of care Americans want and deserve: patient-centered; convenient; and electronically linked to hospitals, labs, other doctors, emergency departments, pharmacies, quality measures, and up-to-the-minute medical and patient education data,” Fields said.

“We are not asking government or insurers to pay for this project. We consider it so important to our patients and America’s family doctors that we are going to pay for it and proceed with all possible speed,” Fields concluded.

Based on the concept of a relationship-centered personal medical home, the TransforMED Model of Care is family medicine’s answer to the Institute of Medicine’s call to cross the quality chasm. The model, proposed two years ago as part of the Future of Family Medicine Project report, has both a patient focus and a systems focus, and features eight core elements:

  • Patient-centered care
  • Whole-person orientation
  • Team approach to care
  • Elimination of barriers to access; open access by patients
  • Advanced information systems, including electronic health records
  • Redesigned, more functional offices
  • Focus on quality and safety
  • Sustainable reimbursement

These elements are achieved through practice innovations including: open access scheduling, online appointments, electronic health records, group visits, electronic visits, chronic disease management, Web-based information, leveraging and engaging clinical staff, clinical practice guideline software, outcomes analysis and alternative reimbursement models.

The 36 practices selected to participate in the two-year National Demonstration Project reflect the variety in family medicine practices across the country. Practices were chosen to maximize diversity in a number of areas including practice size, location, age, ownership, arrangement, revenue and degree to which each has already implemented the TransforMED Model components.

With a kick-off meeting in early June, the practices will begin to implement fully the elements of the TransforMED Model and will undergo thorough, real-time evaluation by a group of independent researchers to determine the model’s impact.

“The National Demonstration Project will provide an objective view into what the TransforMED Model looks like in real-world practices, and it will measure the Model’s effect on practice and patient outcomes,” said Terry McGeeney, president and chief executive officer of TransforMED. “Perhaps most importantly, the knowledge gained from this project will be used to further more widespread efforts to transform practices with the goal of improving the quality of care for patients.”

Additionally, to help determine the most efficient and effective way to implement transformative practice redesign of this scale, the National Demonstration Project practices will be randomized into two groups – a facilitated and a self-directed group. Practices in the facilitated group will receive support for the duration of the project from practice redesign experts, and they will participate in on-going collaborative learning opportunities with other facilitated practices to encourage the sharing of best practices. In contrast, practices in the self-directed group will only be provided access to practice improvement tools and services. They will receive no additional intervention. Both groups will be evaluated by the same team and according to the same guidelines.

“I am excited to be part of this effort and for the promise it holds for my patients, their families and our health system,” said Theresa Shupe, M.D., a practicing family physician in Haymarket, Va., whose practice has been selected to participate in the National Demonstration Project. “I know transition to the TransforMED Model of Care won’t be easy, but I am ready to embrace the challenge because I believe this model embodies the enduring values of family medicine and will allow me to better serve my patients.”

The need for fundamental reform is palpable. Research reveals a fragmented health care system fraught with waste and inefficiency. Among industrialized nations, the United States spends well over twice the per capita average, yet this higher spending has not resulted in commensurate health outcomes. Inefficiencies, such as duplication and use of unnecessary services, have increased health care costs and have been shown to compromise the quality of care. The number of Americans without health insurance has continued to rise, from 40 million in 2000 to 46 million in 2004. Problems with health care safety and quality continue to make headlines, as do problems with health care delivery and administrative costs. America’s primary care physicians – the backbone of our health care system – are beset with financial stressors as a result of increasing practice costs and declining revenues due to antiquated coding practices and payment formulas. And, they are faced with a maelstrom of competing interests, making it increasingly difficult to provide the kind of care they were trained to deliver.

“Piecemeal approaches to improving health care are unlikely to improve quality or enhance value over the long term,” said James C. Martin, M.D., board chair of TransforMED and past chair of the Future of Family Medicine Project Leadership Committee. “Rather, the key lies in profoundly transforming health care delivery and financing to promote more effective and efficient care for all. With this effort, TransforMED is moving our country toward a high-performance health system.”

“With the launch of this project, family medicine is taking meaningful steps toward making that ideal a reality,” Fields said. “And, we invite all physicians, payers, employers, and state and national government to join us in moving the United States toward a health care system that provides better access, improved quality and greater efficiency.”

Key findings and insights gleaned from the National Demonstration Project will be synthesized and disseminated on an on-going basis among the demonstration sites and within the larger practice community. The evaluation team will independently publish a final report in early 2009.

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Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website,


The Leawood, Kan.-based TransforMED is a practice redesign initiative of the American Academy of Family Physicians (AAFP). Established in 2005, TransforMED provides ongoing consultation and support to physicians looking to transform their practices to a new model of care that is based on the concept of a relationship-centered personal medical home. In an effort to make the transformation process as turn-key as possible, TransforMED offers practices fully integrated and prepackaged products and services, including consultation and advice on implementing the new model. To learn more about TransforMED, visit