The American Academy of Family Physicians consulting service, TransforMED, helped nearly 700 primary-care practices adopt the patient-centered medical home model and now appears to be winding down its operations.
TransforMED, a wholly owned subsidiary with an independent board, is not taking any new business but will continue to fulfill its grant-related work and contractual obligations with six large commercial clients as it evaluates what course to take next.
“While we decide the best way to maximize resources, it didn't make sense to take on any more projects,” Dr. Reid Blackwelder, AAFP board chair, said in an interview. Blackwelder added that it's been a good run and the AAFP can be proud of its role in promoting the medical home model. “When no one else was doing anything, we were leading the way for others to get on the bandwagon with us.”
But even if AAFP and TransforMED played a crucial role in getting the model off the ground, their efforts to commercialize their expertise may have been overwhelmed by a flood of competitors similarly selling their expertise to help physicians transform their practices, including Geisinger Health System's xG Health Solutions, the National Committee for Quality Assurance, the Joint Commission and even a new consulting business started by TransforMED's original CEO.
AAFP signaled in a little-noticed blog post late last year that TransforMED was losing momentum.
“TransforMED's efforts have been instrumental in shaping the PCMH model into what it is today—a healthcare standard that is widely accepted by physicians and payers alike,” Blackwelder wrote in a Dec. 19 post. “However, with the proliferation of the PCMH model, the market niche in which TransforMED thrived has changed, and future growth opportunities have become limited. In the new year, the AAFP will work to redefine the focus of TransforMED with an eye toward how the Academy can best meet its members' continuing needs for practice transformation support.”
TransforMED was spun out of the AAFP's pioneering 2006-2008 medical home national demonstration project in which 36 practices tested the then new concept. Eighteen practices implemented it on their own and the other half did so with help from the newly formed TransforMED consulting service.
TransforMED split into its own for-profit company in 2008, though it later switched to not-for-profit status.
Beyond advancing its core PCMH model, TransforMED helped incorporate medical-home elements into 46 federally qualified health centers and “supported organizational change” at 34 medical residency physician-training programs. And it is involved with the CMS Innovation Center's $20.75 million “patient-centered medical neighborhood” project that was launched in 2013 and aims to reduce Medicare and Medicaid expenditures by $49.5 million. It's also participating in the CMS Innovation Center's Comprehensive Primary Care Initiative, which involves nearly 500 practices located in seven geographic markets.
Blackwelder declined to comment on possible layoffs but noted that at least some of TransforMED's staff are working under time-limited arrangements on grant-funded projects. TransforMED CEO Dr. Bruce Bagley said in a 2013 interview that the company had 59 employees.
Blackwelder said he had not spoken to Bagley about TransforMED's new direction and that he didn't have any information on how long Bagley would remain at his post. “He's done an amazing job helping to keep TransforMED moving forward,” Blackwelder said.
Many of TransforMED's original clients were insurance companies engaging in medical home pilot projects, said Dr. Terry McGeeney, TransforMED's founding CEO. The company policy was to only participate in pilots that involved some payment reform component such as providing a care-coordination fee or offering an opportunity for shared savings. Larger health systems or medical practices that had recently acquired smaller primary-care groups were also frequent clients.
“Our early focus was on practice redesign and quality improvement,” McGeeney said. “There wasn't a lot of focus on cost of care.”
Some military contracts came later and train-the-trainer programs were also launched, he said.
McGeeney acknowledged that medical home transformation didn't make financial sense back then for small practices and solo practitioners because financial incentives weren't in place to cover the cost of needed investments in information technology and additional staff. This changed when insurance companies began offering rewards to practices that received third-party recognition as a medical home by the NCQA or other certifying organizations such as the Joint Commission. The CMS this year began paying a monthly $40 care-coordination fee to practices managing treatment for patients with two or more chronic conditions and McGeeney expected this will lead to more small practices operating as medical homes.
“It's potentially a game changer for small practices particularly those in rural areas with a high number of Medicare patients but few opportunities to participate in an accountable care organization,” he said.
McGeeney left TransforMED in February 2013 and was replaced by Bagley. He has just launched his own company, Care Accountability, which will offer consulting in such areas as population health, primary care-ACO transformation and earning NCQA recognition.
But even as TransforMED winds down, others are ramping up. Geisinger Health System's company, xG Health Solutions, is helping systems adopt Geisinger's ProvenHealth Navigator medical home model, and the NCQA's new program certifying individuals as patient-centered medical home content experts has had early success.
The program requires participants to attend two NCQA medical home seminars and pass an exam. The NCQA reports that, in the first two years of the program, 803 individuals from 48 states have been certified. Of these, 59% have a master's, medical or doctoral degree.
“Demand for the program continues to grow as well as we see an increase in applicants for each exam-window period,” said NCQA spokeswoman Apoorva Stull. “Right now, we have 71 candidates scheduled to take their test in March.”
Last August, the NCQA recognized Family Medicine Clinics in Le Mars, Iowa as its 8,000th medical home. Its 9,000th will be recognized any day now, as the organization's website lists the latest total at 8,988.
The Joint Commission has designated 138 organizations as primary-care medical homes. While the total number is much smaller than the NCQA's, the operations those numbers represent are typically much larger than the individuals included in the NCQA numbers.
The 138 in the Joint Commission tally represent 1,301 sites of care where 4.2 million patients visit some 12.6 million time a year and where more than 3,000 licensed professional practice, said Michael Kulczycki, Joint Commission ambulatory care accreditation program executive director.
“It's still going strong,” Kulczycki said of the program. “Our growth is on track with where we thought it would be.”
The medical home is the foundation of coordinated-care efforts, but the term “medical neighborhood” may be the more appropriate term to use in the emerging team-based care landscape, Blackwelder said.
“As we talk about the PCMH, it's important for people to see a broader definition,” he added.
This is the direction the NCQA has taken. It's added a medical-home certification program for specialists and is seeking early adopters for its patient-centered connected care recognition program. The new initiative will include such care sites as retail clinics, urgent care centers, and onsite employee healthcare facilities.
“I think the observation or take-away here is that, in today's rapidly evolving healthcare landscape not only do healthcare providers and health systems need to evolve at an ever-escalating pace, but those that provide products and services to those providers and systems need to evolve as well,” McGeeney said.
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