Findings From FMAHealth's Bright Spots in Practice Transformation Project.

BACKGROUND AND OBJECTIVES: Family physicians are increasingly making or contemplating various methods of practice transformation, but most report significant barriers to making that transition. Given strong interest in practice transformation, and perceived barriers to doing so, it is important to examine how some practices are implementing changes and overcoming barriers. In this project, Family Medicine for America's Health Practice Team learned from practices across the United States that are transforming and experiencing the benefits of working in a comprehensive, value-based practice. The objectives of the project were to identify drivers of transformation to value-based care and ways of working with drivers to mitigate potential barriers, and to determine relationships between practice transformation and joy of practice. METHODS: Fifteen practices of varying size and type from 11 states participated in this project. Practices were sent a short-answer survey about their practice, transformation, and payment structure. Next, practices participated in a 45-60-minute deep-dive interview. All surveys and interviews were iteratively coded to identify themes using Thomas Bodenheimer, MD, et al's building blocks of high performing primary care framework. RESULTS: Engaged leadership, data-driven improvement, team-based care, and comprehensiveness and care coordination were primary drivers of transformation, with payment as a needed foundation. Practice transformation helped meet the triple aim and was correlated to joy of practice. CONCLUSIONS: Practices are transforming to comprehensive value-based care delivery and experiencing greater joy in practice; but payment reform is required to spread and sustain practice transformation.

A Systematic Approach to Understanding and Implementing Patient-Centered Care.

In 2014, Family Medicine for America's Health (FMAHealth) began implementing a specialty-wide strategic plan. The FMAHealth Board of Directors created an Engagement Tactic Team and charged the team with two major objectives: (1) to engage patients as partners in transforming primary care, and (2) to strengthen working alliances with other primary care professions and key stakeholders to speak with a unified voice for primary care. The team's first objective sought to engage patients as partners to achieve the triple aim. The second objective required the team to explore how best to collaborate with others to align on core values of high-functioning primary care.When it comes to realizing the promise of patient-centered care, aspirational strategic objectives are often easier to declare than to implement. As the team grappled with its charge, it discovered that the approach to achieving each objective became as important as the actions required to accomplish them. The team recognized the value of taking ample time to build an approach to delivering patient-centered care that could be sustained and scaled over time to achieve the two objectives.The team ultimately settled on three projects that leveraged collaborative partnerships with organizations inside and outside the specialty to better understand and advance patient-centered care at three levels: practice transformation, organizational governance, and policy making.

The Shared Principles of Primary Care: A Multistakeholder Initiative to Find a Common Voice.

As America's health care system continues to transform, the foundational importance of primary care becomes more clear. The Joint Principles of the Patient Centered Medical Home are now more than a decade old. As delivery reform continues, the importance of seven essential shared principles have emerged from a dynamic, collaborative, and iterative process of consensus building across multiple stakeholders. These seven principles will help the public, policy makers, payers, physicians, and other clinical providers speak with a unified voice about these core principles that define the enduring essence and value of primary care. The seven shared principles of primary care consist of: (1) person and family centered, (2) continuous, (3) comprehensive and equitable, (4) team based and collaborative, (5) coordinated and integrated, (6) accessible, and (7) high value. When used together, these shared principles provide a solid platform on which to build all further health care reform.

Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine Report From Family Medicine for America's Health Payment Tactic Team.

BACKGROUND AND OBJECTIVES: Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America's Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value. METHODS: In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements. RESULTS: The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization. CONCLUSIONS: The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.