Focus on Practice Redesign, Quality Improvement

As CEO and President of TransforMED, I applaud the letter from Drs. Schroeder and Arenberg discussing the FFM project and specifically TransforMED. I believe this type of candid discussion is what has been traditionally missing within the specialty of Family Medicine.

It is true that the FFM project announced a “new” model of care for family medicine in its 2004 recommendations, but none of the components of the model on their own were new or earth shattering. In fact, groups like the IHI and others had discussed the components of the model for several years.

It is also true that this model was basically “opinion-based.” For that reason, TransforMED is working to take the “opinion-based” model of care, study it in real family medicine practices, and produce evidence- based data about the model. We have launched a National Demonstration Project (NDP) where 36 medical practices were selected to participate and be studied based on the model of care. Although it may have been optimal to have medical practices all on the same EHR system, we wanted to replicate what's really happening out in family medicine across the country so we could best understand how to work with all practices once the NDP is done in July 2008. It also would have been simpler to select practices from limited geographic regions to keep the study more tidy. We instead selected practices from across the country to provide a glimpse at regional variances. TransforMED has the difficult task of translating what we’re learning through the NDP and finding ways to work with the all the remaining family medicine practices to help them transform to the proposed model of care.

The TransforMED NDP is an extensive, independent external evaluation process utilizing a rigorous multi-method assessment. Our project has two evaluation goals. One to provide evidence based, quantitative outcomes measurement and analysis around standard AQA and other accepted quality metrics; and an aggressive qualitative analysis to study the critical success factors in practices. These qualitative metrics include but are not limited to change management, leadership, communication and provider/patient satisfaction. For that reason we like to describe our National Demonstration Project as a “learning lab.”

Because we are working with practices in a variety of settings we are not able to access payer records which would provide a greater level of outcome analysis of the cost of care including hospitalizations, ER visits and pharmaceutical costs. TransforMED is, however, developing a new corporate level demonstration project which will include payer data.

Quality outcome measures and improvements within a practice are important to TransforMED, but so is the financial viability of the practice. If we are not able to achieve BOTH high quality AND financial viability, the specialty will be not survive. Financial viability will be dependent not only on identifying and managing economic drivers, but developing efficiencies within a practice.

We refer to our process as total organizational transformation because it is so much more than just practice redesign or adding technology. It is about total transformational change of a practice. It is about implementing all of the components of the TransforMED model of care to provide higher quality in an economically viable practice environment.

Yes, it is true that none of the components of the model are necessarily "new." This is why we refer to it as family medicine’s model of care or the TransforMED model of care vs. the “new” model of care. At the same time, it is rare to find a practice that encompasses all of the elements of the model. What we are working on with TransforMED is to find ways to help practices implement ALL of the components that make sense in their practice environment. It is evident that the components of the model of care are dependent on each other for maximal success. What makes the model “new” is not the individual components, but incorporating all of the components into a practice.

One thing we learned from FFM is that Family Physicians are important to patients because they value family medicine and what it can offer. What we must do is deliver what patients are so desperately in need of – a relationship with their personal physician providing high quality care over time.

Terry McGeeney, MD, MBA CEO/President TransforMED Competing interests: None declared

Competing interests:   None declared