April 01, 2014 03:29 pm News Staff – Family physicians interested in elevating their practices to new heights when it comes to patient care will be interested in reviewing a new conceptual model for getting there put together by researchers from the University of California, San Francisco, Center for Excellence in Primary Care, Department of Family and Community Medicine.
The model, which is featured in the article “The 10 Building Blocks of High-Performing Primary Care”(annfammed.org) in the March/April Annals of Family Medicine, is based on 10 basic building blocks that, as the research authors pointed out, could help physicians looking for a “roadmap to help navigate the journey from old to new.” Two of the four researchers, Thomas Bodenheimer, M.D., and Kevin Grumbach, M.D., are family physicians.
The building blocks are “both a description of existing high-performing practices and a model for improvement,” said the authors.
They noted that although practices may vary the implementation order, “first-tier blocks often support achievement” of other functions near the top of the building blocks hierarchy.
Defining the Building Blocks
Researchers relied on their personal experience as practice facilitators, along with site visits and a review of existing research, to build their model. In total, authors and their colleagues visited 23 practices; of those, eight were hospital-based clinics, seven integrated delivery system sites, six federally qualified health centers and two independent private practices. Seven of the 23 had five or fewer physicians.
“Full implementation of this future template requires payment reform that does not reward primary care simply for in-person clinical visits,” noted the authors. They suggested that fee-for-service payments for primary care be eliminated entirely and be replaced with a risk-adjusted comprehensive fee-per-patient payment model with adjustments for quality and patient experience.
Digging Into Discussion Points
Authors called the 10 building blocks “a practical conceptual model that can help practices in the journey toward becoming high-performing, patient-centered medical homes.”
The model relies heavily on design elements controlled by the practice; however, as noted previously, implementation of payment reforms would greatly support the building blocks.
Small independent practices with five or fewer physicians were underrepresented in the study and in the practice coaching portfolios of the researchers. The authors pointed out that the 10-block-model likely would need refinement to be useful to small private practices.
Finally, regarding the ordering of the blocks, researchers acknowledged that although their shared observations and experience suggested “a degree of hierarchy in the building blocks, with some blocks being enablers of others … there is no single right way of moving forward on practice improvement.”
They concluded that although the model should not be construed as a “universal road map,” the 10 building blocks could provide an “overview” to assist practices eager to move forward with transformation efforts.
Source: http://www.aafp.org/news/practice-professional-issues/20140401tenbldgblocks.html
