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 |