The Ideal Medical Practices project used Dartmouth Professor John Wasson's HowsYourHealth.org tool to measure key attributes of primary care. This broad denominator approach gave us meaningful data down to the level of individual clinician - a problem considered insurmountable by many of the current medical home projects.
The individual practices could compare their results against a large (200K+) database and even sort by burden of illness, indicators of socio-economic status, etc. Practice participants were able to use an online curriculum to close any gaps they might find and collaborate in group learning through conference calls and listserv.
Contrary to those who think that solo and small practices are incapable of delivering high quality care, we found that:
- Solo and small practices would volunteer if engagement were made simple and the cost of engagement reduced to acceptable thresholds
- Meaningful outcome improvement was tied to active participation
- Individual clinician data were meaningful and actionable
- Data could be aggregated so that we could look at low-incidence issues of interest at the population level
We were in essence a practice-based research network with pooled data. We could expand on this approach to understand the impact of our work on congestive heart failure or any other condition whose incidence can only be tracked for populations aggregated across many practices.
We could become an Accountable Care Organization able to demonstrate meaningful outcomes.
The necessary ingredients are:
- A large enough group of practices willing to work together on a common quality platform
- A payer willing to be flexible in the MEANS to the end.
Our path to high quality primary care is different and we believe more compelling than the approaches gathering most of the press. We are willing to be held to high standards but are not willing to pursue endless trivia that is tangential to high quality primary care.
To be specific: NCQA recognition is not the goal. Meaningful use criteria are not the goal. The goal is to improve population health, improve the experience of care, and in so doing achieve a lower cost per capita or a meaningful reduction in health care cost trends.
A group of practices serving a large enough population could be held accountable to the rate of 'preventables' (ED use, hospitalization, re-hospitalization), to total cost trends, etc. A payer can use claims data as the overall assessment tool. The group could use the HowsYourHealth tool as engine for individual practice accountability and improvement.
The outcomes are important. Be flexible in the approach. Allow inventive means.
P.S. I'll be talking with Gregg Masters of ACO Watch today on blogtalk radio. 11A PST.