Findings From FMAHealth’s Bright Spots in Practice Transformation Project

Abstract

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.

Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review

“…Analysis revealed 10 specific behaviors that professionals pursued in VBHC, next to acting upon their professional standards ( 68 ). These interconnected and mutually reinforcing behaviors, as visualized in Figure 4 , are to (1) focus on what matters to patients and adopt other VBHC mindsets ( 24 , 31 – 33 , 47 , 50 , 52 , 53 , 61 , 62 ), (2) measure outcomes ( 14 , 24 , 31 – 35 , 44 , 56 , 68 ), (3) learn and improve care ( 14 , 24 , 31 – 34 , 47 , 53 , 62 , 66 , 68 – 70 ), (4) organize care around the full cycle of disease ( 24 , 32 , 44 , 45 , 54 , 60 , 61 , 64 , 66 , 70 – 73 ), (5) participate in population health and prevention ( 24 , 62 , 66 , 70 , 72 ), (6) discuss value in the clinical encounter ( 31 , 47 , 50 , 55 , 56 , 58 , 63 , 64 , 74 , 75 ), (7) involve patient representatives ( 24 , 31 – 33 , 50 ), (8) take accountability for patients and resources ( …”

“…Related to professionals' roles and behaviors, studies described VBHC as a bottom-up initiative (14,24,31,32,34,47,53,54) that expanded roles and established new roles such as the "contact nurse" function (14,24,32,56,(60)(61)(62)(63)(64)(65)(66). Engaged leadership was studied in terms of necessity, leadership approaches, competence, personal characteristics, as well as professions that were suggested to take up leadership roles (33,34,54,66,67). Analysis revealed 10 specific behaviors that professionals pursued in VBHC, next to acting upon their professional standards (68).…”

“…This observation underlines the need for organizations to better support their employees by providing the necessary resources and designing appropriate organizational structures and interventions to "The focus on value for the patient, emphasized by the hospital management team, contributed to their feelings of 'enthusiasm for the concept and strong engagement in implementation work" (24) Engagement being moderated by demands ( 24) "These hindrances contributed to decreasing engagement in carrying the process forward. […] Engagement for VBHC also decreased when participants did not see any actual activity or result of their implementation work" (24) Being energized (24, 66) "I think even greater sense of meaning that we're all working towards the greater good of patient health and well-being, and I think that genuinely energized people" (66) Having joy in practice ( 66) "All but one of the practices indicated that their transformation efforts led to increased joy of practice" (66) Joy in practice being moderated by demands (66) "The one outlier practice indicated increased sense of purpose and mission and did not indicate decrease in joy or well-being, but did acknowledge that increased work necessary for practice transformation moderated increased joy of practice" (66) Increased Job Satisfaction (24,32,44,60,66) "All participants in the structured interviews noted improved job satisfaction after the transition period, given the new sense of employee engagement and accountability" (44)…”

FMAHealth: A Work in Progress

“…Their work addresses research capacity, [12][13][14][15] workforce goals, [16][17][18][19][20] and new models of clinical care. [21][22][23][24][25][26] These articles are a sample of the work that has taken place over the course of FMAHealth. There is much to be proud of here.…”

Progress Report From Family Medicine for America’s Health

“…The FMAHealth Practice Team devoted efforts toward better understanding and facilitating that transformation and identified bright spot examples to guide others. 16,17 Central to this effort is changing the payment system for primary care. The FMAHealth Payment Team focused on developing an improved Comprehensive Primary Care Payment (CPCP) model and a calculator tool to facilitate the transition from traditional fee-for-service payment to CPCP.…”