I’ve complained before about the uselessness of traditional industrial QI/Metrics in primary care. There is now more proof in the literature. The National Health and Nutrition Examination Survey (NHANES) is the annual comprehensive assessment of American health. They enroll about 10,000 people each study year and ask them a thousand questions,...
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Two more state-level experiments to support primary care have failed. Before I go over the findings, let me first say that I appreciate that some states are willing to think big and take risks by trying new approaches. Change is hard. One of the real strengths of America has been its...
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First, a history lesson. Back in the mid 2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the “new model of care” from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical...
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First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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In the AAFP’s Advanced Primary Care Alternative Payment Model document, the concept of population health management is a little more muddled, but it keeps rearing its head in different places in the document with different descriptors. From the definition of the primary care medical home, the phrase Planned Care and Population...
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Two recent reports extoll the virtues of the Patient-Centered Medical Home (PCMH) and direct primary/concierge care. One is the annual report of the Patient-Centered Primary Care Collaborative. The other is a study of a network called MD-Value in Prevention (MDVIP). Before I continue, let me be clear that there are positives...
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Let me translate the title. The Center for Medicare and Medicaid Services was directed by the Patient Protection and Affordable Care Act (Obamacare) to implement the Patient Centered Medical Home model in 500 Federally Qualified Health Centers. It didn’t work. The rationale was the usual mixture of “care coordination,” primary care...
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We continue to examine the results of our recently published study on the ways family physicians deliver better care at a lower cost than a multi-ologist approach. The next concept is complexity. Family physicians are more comfortable with complexity than any other physicians, especially in their ability to negotiate the diagnostic...
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A normally very respectable and reliable source of healthcare observations, the Center for Studying Health System Change (CSHSC), had a bad day recently. A report by one of its fellows for the Commonwealth Fund modeled “real-world” parameters found that if primary care physicians were paid more, Medicare could save 2%. Two...
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The PCMH pushers love to talk about care coordination. They believe the key to more cost-effective care is to have primary care practices hire care coordinators to keep track of patients. I asked the leader of a large integrated network what his care coordinators actually do. He said they mostly track...
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