Report: Healthcare Reform Goals Achievable; Process is Difficult, Time Consuming

An unprecedented research project into how to transform primary care practices into patient-centered medical homes has concluded with the release of a new eight-paper supplement to the May/June issue of Annals of Family Medicine.

After working for two years with 36 practices nationwide, a team of researchers issued their findings and recommendations on the National Demonstration Project (NDP), which looked at ways to test how practices would have to change to achieve a new model of care. The new care model focuses on integrating technological and team-based care advances into the patients’ ongoing relationship with their personal physician while employing efficient and cost-effective processes.

The NDP sought to transform primary care and family medicine practices into patient-centered medical homes, a popular model of care touted for its fit into the current overhaul and redesign of the United States health care system. Patient-centered medical homes emphasize patients as partners in managing their health, while clinicians utilize a team-based approach that takes advantage of the larger medical neighborhood to ensure comprehensive delivery of care.

In the two-year study, the evaluation team sought to answer four specific questions:

• Can the NDP model be built so that primary care practices become patient-centered medical homes;
• What does it take to build it;
• Does the NDP model make a difference; and
• Can the NDP model be widely disseminated to meet the needs of diverse practices, in size, geography and demographics of patients?

“The NDP patient-centered medical home model is largely attainable and can improve the delivery of care to benefit patients while addressing practice management concerns of the physicians,” said Dr. Crabtree, who was the lead author on the summary manuscript and a co-author on the other manuscripts and a member of the evaluation team. “However, after working with more than 70 family physicians nationwide, the evaluation team has determined that transforming the traditional primary care practice is a difficult and time-consuming process. It is an evolving process that requires effort and self-motivation on behalf of practitioners.”

Transforming a practice requires physicians and their staff to focus on the needs of the practice itself, to continually learn, to regularly communicate and to adapt to improve healthcare delivery. According to the summary, providers must be willing to forgo traditional delivery systems and adapt team approaches to care, within the practice and within a medical neighborhood, in which different types of healthcare professionals work together as a team to improve patients’ health. This requires major shifts in how practice members see their roles and work together.

“In addition to a personal relationship with a primary care physician, the health of a patient improves when other providers are easily accessible, such as a mental health practitioner or a nutritionist,” added Dr. Crabtree.

The evaluation team also reports in its findings that delivery system reform incurs a substantial cost that requires funding for infrastructure support in order to successfully redesign a practice. Achieving a patient-centered medical home requires utilization of modern technology and technical components, which many smaller practices are unable to afford, to manage disease knowledge, patient records and financial controls.

The study found that too often the new technology is not well implemented because components are unable to work together and practice members do not adjust their roles to take advantage of new features. In addition, according to the findings, the current formula for compensation is a key obstacle to primary care practice development, as it supports the existing model in which finances often take precedence over clinical process.

Moving forward, the evaluation team recommends the patient-centered medical home as a preliminary model for future primary care practices, but cautions that practitioners must be prepared to break with tradition in their approach to healthcare delivery. To that end, professional organizations, policy makers and medical educators must take lead roles in facilitating change system-wide to ensure improved healthcare delivery and practice management.

Source: Robert Wood Johnson Medical School