Table 2.

Summary of Recommendations

ACO = Accountable Care Organization; EMR = electronic medical record; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home; wRVUs = work-related value units.
The PCMH model must continue to evolve
Emphasize the 4 core attributes of primary care
Consider moving beyond the physician-led PCMH to more collaborative care models
Encourage disruptive innovations, given that incremental changes may not be enough
Promote local variations in PCMH model development and implementation
Discourage limited pilot projects that are underfunded, focus on disease, or last less than 2 years
Delivery system reform and resources must be in place for implementing PCMH development
Change how primary care is paid:
    Separate documentation of care from billing and eliminate wRVUs
    Encourage capitation, bundling, direct care, or some mix thereof
Promote business models that encourage integration across the health care system
Promote pilot projects that test the PCMH and ACO linkage, and that last more than 2 years
Develop a nationally shared online platform for communication and coordination of care
Develop EMRs prioritizing clinical care as opposed to billing documentation
Implement the extension agent model nationally for training in the areas of leadership, management of change, and practice operations, and for leveraging health information technology resources
In the meantime, much can be done
At the practice level:
    Help primary care practices strengthen their core, develop their adaptive reserve, and enhance their attentiveness to the local environment
    Promote and assist continued evolution of the NCQA PCMH recognition process not only to emphasize the core attributes of primary care and patient-centeredness, but also to include lengthening the time span and addition of categories that help practices prioritize their efforts to develop their internal capability
In the area of medical education:
    Prepare current clinicians for less episodic care and more population-based care
    Prepare current clinicians for partnering with collaborators in their practice
    Increase experimentation and flexibility in primary care residency training
    Support changes in medical school admissions and premedical requirements to encourage more generalists
In the area of health care research:
    Promote research that seeks better understanding of the practice development process
    Encourage all pilot projects of PCMH to include mixed-method evaluation with a strong qualitative component and then ensure adequate funding of the evaluation
    Accelerate work to develop better measures of the 4 core attributes of primary care, whole- person health within a community context, and healing relationships