Medical home model improves efficiency, docs say

August 15, 2008

Medical Economics spoke with physicians from five of the 32 practices that participated in an AAFP demonstration project that focused on a new model of patient-centered care.

Key Points

The same could be said of managing change at your practice. Too much sudden change, and you could lose control; too little, and you risk falling behind competitors.

The 32 U.S. practices that completed the American Academy of Family Physicians' TransforMED project endured a lot of change, some of which drove associates and employees away. But the physicians involved in the two-year, $8 million demonstration of a new model of patient-centered care learned that evolution is paramount to a successful practice.

Here's what a sampling of the demonstration practices learned during the project, and how these five diverse practices (in terms of size and geography) managed the changes within their staff and patients - as well as their own attitudes.

A NEW MODEL

The American Academy of Family Physicians introduced TransforMED after the leadership of seven national family medicine organizations, including AAFP, launched the Future of Family Medicine project in 2002. It was a response to frustration among family physicians and patients over the growing costs and inefficiencies of care. It was the group's belief that the old approach of a traditional doctor-focused practice, in which the practitioner single-handedly dictates care to patients and staff alike, was no longer an effective business model and unrealistic in an age in which patients are more informed than ever.

Out of that project, six task forces studied such issues as practice leadership, patient needs, training, communication, services, and financial models. Their findings were combined into a March 2004 report published in the Annals of Family Medicine titled "The Future of Family Medicine: A Collaborative Project of the Family Medicine Community," which outlined a new patient-consultative model for primary care focusing on a team approach, improved communication, efficiency, and preventive care.

To roll out the new model, in June 2006, AAFP selected 36 practices out of 337 eligible applications nationwide to serve as test subjects to overhaul their operations. Half of the selected practices were assigned expert facilitators from AAFP to implement the TransforMED changes, while the other half were self-directed - a split that drew contrasting reactions from the physician leaders.

"I don't think you can do it on your own," admits Stephen Veit, a solo practice FP in Cherokee, Iowa, who had a facilitator. "You need outside help. It's like trying to get over depression on your own. It might happen, but it's probably not the best way to do it."

Kim Leatham, an FP in Bainbridge Island, Washington, was initially disappointed that her seven-physician clinic, part of an eight-office group practice and hospital, didn't receive a TransforMED adviser. But after an adjustment period, she realized she didn't need one.

"For my group, it worked out way better," says Leatham, whose practice had already been implementing organizational changes based on Toyota Motor Corp.'s Lean Manufacturing principles. She and the other self-directed groups attended a pre-program retreat at Dartmouth College in New Hampshire last spring. "That was very helpful at propelling everyone forward and sharing ideas and getting the courage to go on," she says.