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 |