Medical home missionary sees encouraging cost and quality trends

Dr. Bruce Bagley is president and CEO of TransforMED, a wholly owned subsidiary of the American Academy of Family Physicians, which provides guidance and support to physicians implementing patient-centered medical homes. Bagley, a family physician who spent nearly three decades practicing in Albany, N.Y., also served as AAFP's president and board chair, and most recently as its medical director for quality improvement. Maureen McKinney, Modern Healthcare's editorial programs manager, spoke with Bagley in April at the annual meeting of the American College of Physician Executives. They discussed the growth of the medical-home model, emerging outcomes data and how primary-care physicians are doing when it comes to implementing health information technology. This is an edited transcript.

Modern Healthcare: What kinds of services does TransforMED provide?

Dr. Bruce Bagley: TransforMED helps primary-care practices become more capable. We're really about establishing medical homes in many communities. The medical home is nothing less than an extreme makeover for how we do primary care. It's more service-oriented for patients, more effective for outcomes, more efficient for the bottom line, better for the health system, and makes going to work more fun for doctors and their staff. We also are helping develop medical neighborhoods, so primary care doesn't operate as an island. Hospital systems and accountable care organizations must have robust primary care as their foundation.

MH: You received a federal grant to evaluate medical-home outcomes. What are you seeing so far?

Bagley: Two years ago, we got a $21 million, three-year grant from the CMS Innovation Center. With this grant, we're building medical neighborhoods in 15 communities around the country. One partner is VHA, which is the convener. Cobalt Talon is helping us analyze the Medicare data to determine costs. Phytel helps take quality data out of the electronic health records for our quality reporting, registry functions and outreach to manage chronic illness. We're just beginning to get some data back. We now can tell an individual practice what its quality data look like and what its total cost of care is, down to the individual physician.

Even though that might not be statistically significant in some cases, it doesn't matter. We're about quality improvement. So if we find that there's a particularly high ER-visit rate or high bed-day rate per thousand, we help the practices understand what's causing that and what to do about it.

We are seeing trends that are in the right direction. The medical homes we're studying are about 5% better than the trends would predict. This is very preliminary data, but it's also very consistent with what we've seen in many other pilots.

MH: Are more large hospitals and health systems looking at the medical home model?

Bagley: I think enlightened leaders recognize they have to have robust primary care to do anything else. If you're trying to build an ACO, robust primary care is a critical component. Each component has to demonstrate its effectiveness and efficiency.

MH: How are primary-care physicians doing when it comes to implementing health IT systems?

Bagley: Primary-care practices should be IT-enabled. That contrasts with the thinking that, “If I open the box and I install it, everything will be wonderful.” It really is a platform for redesign for everything—knowledge management, registries for chronic illness, communication, education, connectedness and decision support, secure messaging with patients and patient education. More than 80% of our active members at the American Academy of Family Physicians have EHRs of some kind. At least they're engaged at that level, so we're very proud of that. We're probably the largest single physician group with that high of a participation level.