Transforming Primary Care Practice and Payment

The MPCC "Primary Care is in Crisis" white paper series, released in 2009, defines the crisis facing the health care system as the primary care foundation erodes. Resolution of the crisis requires efforts in three arenas: 1) transformation of the way primary care is delivered and compensated, 2) activation of healthcare consumers and 3) rebuilding the primary care workforce.  Part 2 of the MPCC White Paper Series defines the patient centered medical home, identifies essential components, and describes methods used to redesign primary care practices for greater efficiency.  The importance of payment reform is affirmed.

Front page of Primary Care is in Crisis

White Paper Series: Primary Care is in Crisis

Part 2: Transform Primary Care Practice and Payment


Transforming Primary Care

The traditional primary healthcare system is primarily designed to provide acute, episodic care.   In its 2001 publication Crossing the Quality Chasm, the Institute of Medicine called for a  transformation of the way healthcare is provided in the US.  The goal of the redesigned healthcare system is to “continually reduce the burden of illness, injury and disability, and to improve the health and functioning of the people of the United States.”

The redesigned system would ensure that health care services are safe, effective, patient-centered, timely, efficient and equitable. Ten principles were identified for moving toward patient-centered health care processes. In addition, four arenas for environmental change were identified:
     1) evidence-based care
     2) information technology
     3) payment policies
     4) preparing the healthcare workforce.

In response to the IOM call to action, organizations throughout the United States began developing and testing frameworks and models to create healthcare processes and systems meeting the specifications outlined in "Crossing the Quality Chasm". Among those are models that will strengthen primary care through the creation of:

  • Redesigned primary care practices staffed by prepared, proactive health care teams that assure the provision of evidence-based care for all patients, including those with chronic illnesses.
  • Payment systems that align financial incentives with value, to encourage provision of care that will improve health outcomes at reasonable cost.
  • Venues for engaging consumers in healthy behaviors to prevent illness and to manage chronic disease, thereby reducing further progression of disease and development of complications.

Medical Homes = Redesigned Care

The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth, and adults. The PCMH is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. In becoming a patient centered medical home, the primary care practice is redesigned around the needs of the patient.  Processes are put into place and electronic tools are used to assure patients receive the right care at the right time and to coordinate the care provided by different specialists in different settings.  A healthcare team partners with the patient to create an individualized plan of care. Patients are provided with all the support needed to follow their treatment plans and to adopt healthy habits. The medical home model is expected to lower healthcare costs by preventing costly complications and hospitalizations.  Click here for more information on patient centered medical homes.

Funds to Build and Sustain Medical Homes are Essential

The model requires payment reform so the practice teams will get paid for coordinating care, self management support, and reaching out to patients to encourage them to obtain recommended screenings and follow up.  There are costs to becoming a medical home.  Practices must invest in electronic tools, staff and training. Sufficient financial resources and other incentives must be identified both to build and to sustain the Patient-Centered Medical Home, or primary health care will not survive in Michigan or in any other state.  For more information on payment reform click here

"Medical Neighborhoods"

Patient Centered Medical Homes do not exist in isolation, they exist within communities.  Although medical homes exist within a geographical community, the community of care for an individual has no geographic boundries. It is defined by all the services received from healthcare professionals and other organizations that contribute to the individual's health and well being.  The medical home is the communication hub for all the healthcare services received by individuals, and is therefore well situated to coordinate and integrate healthcare services.  New models of care are also exploring means for integrating primary care, specialists, hospitals and other care settings to facilitate communication, improve health outcomes, and improve efficiency. 

Accountable Care Organizations/ Organized Systems of Care

Several large healthcare systems are improving health outcomes while simultaneously reducing the cost of care.  Click here for more information on integrated healthcare systems.  

MPCC Activities

For information about MPCC patient centered medical home practice transformation activities click here

PCMH Toolkit click here