Table 1

A Few Parsimonious Enablers and Tenets of Primary Care Transformation

System-level enablers
Payment reform
Practice facilitation
Data use and aggregation
More usable EHRs
Practice-level tenets
Build whole change together
 Focus on large-scale, long-term change to become the practice that you want to be for your patients and your staff
 Enlist everyone in the practice in the effort, including patients, families, and communities
 Use facilitators and facilitation strategies
 Change as a community, region, or system when possible
 Find the right financial payment model and structural support for long-lasting change
Pace yourself
 Do not work too fast on too many things, but also do not work only on marginal changes that do not matter
 Sequence the change, starting with leadership, practice culture, and empanelment. Then move to other features of team-based care and coordination
 Build adaptive reserve and work on maintaining joy of practice
 Allow enough time to pass before passing judgment
Focus on what matters most
 Explicitly target the most beneficial primary care outcomes or functions to for patients and communities, such as:
  Building long-term relationships
  Risk-stratified care management for high-need patients
  Key chronic diseases such as cardiovascular disease and diabetes mellitus
  Beneficial preventive measures (ie, immunizations, smoking cessation, colorectal cancer screening)
  Integrated behavioral health
  Social needs identification and resource connections
 Save the rest for another day—work on what matters most now
Practice regular “quality improvement hygiene”
 Meet regularly as an entire team to review change
 Set targets and review progress toward those targets
 Use registries of electronic clinical quality measures (do not wait for old and often inaccurate claims quality data)
 Use an established quality improvement method—try changes and learn from them
 Involve patients and your community in the change upfront and throughout
  • EHR = electronic health record.