Table 2.

Summary of Recommendations

The PCMH model must continue to evolve

Emphasize the 4 core attributes of primary care

Consider moving beyond the physician-led PCMH to more collaborative care models

Encourage disruptive innovations, given that incremental changes may not be enough

Promote local variations in PCMH model development and implementation

Discourage limited pilot projects that are underfunded, focus on disease, or last less than 2 years

Delivery system reform and resources must be in place for implementing PCMH development

Change how primary care is paid:

Separate documentation of care from billing and eliminate wRVUs

Encourage capitation, bundling, direct care, or some mix thereof

Promote business models that encourage integration across the health care system

Promote pilot projects that test the PCMH and ACO linkage, and that last more than 2 years

Develop a nationally shared online platform for communication and coordination of care

Develop EMRs prioritizing clinical care as opposed to billing documentation

Implement the extension agent model nationally for training in the areas of leadership, management of change, and practice operations, and for leveraging health information technology resources

In the meantime, much can be done

At the practice level:

Help primary care practices strengthen their core, develop their adaptive reserve, and enhance their attentiveness to the local environment

Promote and assist continued evolution of the NCQA PCMH recognition process not only to emphasize the core attributes of primary care and patient-centeredness, but also to include lengthening the time span and addition of categories that help practices prioritize their efforts to develop their internal capability

In the area of medical education:

Prepare current clinicians for less episodic care and more population-based care

Prepare current clinicians for partnering with collaborators in their practice

Increase experimentation and flexibility in primary care residency training

Support changes in medical school admissions and premedical requirements to encourage more generalists

In the area of health care research:

Promote research that seeks better understanding of the practice development process

Encourage all pilot projects of PCMH to include mixed-method evaluation with a strong qualitative component and then ensure adequate funding of the evaluation

Accelerate work to develop better measures of the 4 core attributes of primary care, whole- person health within a community context, and healing relationships

ACO = Accountable Care Organization; EMR = electronic medical record; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home; wRVUs = work-related value units.