Practice Tactic Team
The Practice Team has been charged with preparing for a future in which primary care teams are ready and able to provide comprehensive practice for comprehensive payment. Comprehensive practice, at times called advanced primary care, or high-performing primary care, builds on the definition of the role of family physicians and their teams described by Robert Phillips, MD MSPH et al in The Future Role of the Family Physician in the United States: A Rigorous Exercise in Definition, published in the Annals of Family Medicine in 2014:
“Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health.”
The Practice Team has identified three tasks that contribute to strengthening the ability of primary care practices to build on their strengths, take advantage of local opportunities and meet challenges as they transform their practices. These three tasks are to:
- Build on the success of the Patient Centered Medical Home in order to chart a course for the evolution of advanced, high performing primary care that helps practices achieve the Quadruple Aim: Delivering better health, better quality, and better value while strengthening joy in practice for all members of the team.
- Champion a metrics framework that recognizes and supports the value of patient-centered primary care, advances health and reduces health disparities. To do this, the team is focusing on a limited set of measures that will help practices be accountable for increasing the value of primary care for the patients they serve. These measures:
- Lower the total cost of care for the patients we serve.
- Continuously improve the health and quality of care of the patients we serve.
- Continuously improve each patient’s experience of, and access to, care, emphasizing the patient’s definition of both
- Ensure that every person in the United States understands the value of, and has the opportunity to have a personal relationship with, a trusted family physician, or other primary care professional, in the context of a medical home.
Jason Marker, MD, FAAFP; Team Leader; Associate Director, Memorial Hospital Family Residency Program
Rebecca Etz, PhD; Associate Professor, Virginia Commonwealth University
Samuel Jones, MD, FAAFP; Program Director, Fairfax Family Medicine Residency Program
Mike LeFevre, MD, MSPH; Future of Family Medicine Professor, University of Missouri
Jay Lee, MD, MPH, FAAFP; Chief Medical Officer, Venice Family Clinic
Robert L. Phillips, MD, MSPH, FAAFP; (FMAHealth Board Liaison); Family Physician, Fairfax Family Practice
Additional Project Team Members/Advisors
Melissa Arthur, PhD
Margaret Day, MD
Aaron George, DO
Kathryn Harmes, MD
Farhad Modarai, MD
Bradley Neaderhiser, PhD
Johnathan O’Neal, BS
Cecil Robinson, PhD
Raymond Tsai, MD
Primary Care Measures That Matter Project Team
Rebecca S. Etz, PhD (team leader)
E. Marshall Brooks, PhD
Martha M. Gonzalez, BA
Sam Jones, MD
Michael LeFevre, MD MSPH
Jay Lee, MD, MPH, FAAFP
Jason Marker, MD
W. Harris Middleton, BA
Jonathan P. O’Neal, BS
Sarah R. Reves, FNP-C, MBA
Kurt Stange, MD PhD
Executive Steering Committee for Starfield III
Andrew Bazemore, MD, MPH – Robert Graham Center
Theodore Ganiats, MD – Agency for Healthcare Research and Quality
Larry Green, MD – University of Colorado, Denver (Chair)
Rita Mangione Smith, MD MPH – Seattle Children’s Hospital
CJ Peek, PhD – University of Minnesota
Robert Phillips, MD, MSPH – American Board of Family Medicine
Eileen Reynolds, MD – Society for General Internal Medicine
Kurt Stange, MD PhD – Case Western Reserve University
Primary Care Measures Initiative
The United States is in desperate need of measures appropriate to the function of primary care. The pervasive and growing use of financial incentives in health care is one of the great natural experiments of our time, yet the development of primary care quality measures able to support value-based payments and advanced practice models lags. Rapid transformation efforts, side by side with an equally rapid increase in the burdens of documentation and reporting, place the primary care platform at risk. Physicians and practices are both buried by measures and at risk of not being able to measure or report adequately.
The Primary Care Measures Initiative (PCMI) is a collection of activities designed to interrupt this dynamic, identify gaps in primary care specific needs, and provide both insights and direction for potential solutions. Some of the activities comprising the PCMI include:
- Primary Care Measures That Matter. PCMTM was a two-year project during which we surveyed national cohorts of clinicians (500+), patients (350+), and employers (80+). This effort allowed us to identify quality indicators of greatest importance to these stakeholders, to determine how well those indicators overlap with current assessments and across stakeholder groups, and to identify areas of critical gaps.
- Starfield III Summit, October 4th-6th, 2017. Starfield III is a hands-on summit where more than 70 stakeholders from diverse backgrounds will be working together to change the way we measure high performing primary care. It builds on the work of PCMTM, the Vital Signs report, the Shared Principles of Primary Care, and others. (Results of the Summit will be added to this website later in 2017 and in early 2018.)
- A research program that includes work with the national PRIME Registry to field measures based on the implications of our survey findings and to evaluate the experience of patients and clinicians as these new measures are used.
- As an extension of this work a Center will be created that will be able to integrate these Primary Care Measures Initiative activities through a common conceptual framework and a growing network of partners.
More information on Primary Care Measures Initiative.
Bright Spots in Practice Transformation
Throughout the country there are Bright Spots in Practice Transformation, sites where practices are already starting to experience the benefits of working in a comprehensive practice structure for achieving the quadruple aim. Building on the work of Tom Bodenheimer, MD and others, the Practice Team is currently interviewing practices around the country to learn how they are able to transform their practices, often in spite of the constraints of working within a fee-for-service payment framework.
Through the interviews, the project team is learning how practices of different types, working in different kinds of markets, have been able to overcome obstacles that stood in the way of transforming their practices.
If you know of a practice where the team has transformed the practice that you would like to recommend for inclusion in this project, please send the name of the practice and its location to firstname.lastname@example.org
Practice Readiness Project
There is no “one size fits all” solution to practice transformation. Different types of practices, in different markets, face different challenges. Through a series of focus groups the team is working to discover what practices need to move toward practice transformation at all stages of change from Pre-contemplation to Maintenance.
Sharing the Story of Practice Transformation
Check back soon for vignettes on how to briefly (1 minute or less) share the story of the benefits of practice transformation with a variety of audiences to help turn them from skeptics to believers.