He wrote: "We rarely observed mid-level clinicians' being engaged by the practice to perform activities that provided a value-added service, such as care coordination, behavioral health, mental health, family life, or dietary counseling, as they often do in large integrated systems.
Nutting recognizes that in some ways there are elements beyond the physicians' control, such as reimbursement problems. Indeed, payment reform should be considered as part of maintaining the medical home model, he adds.
Bundled payments for episodes of ambulatory care comprise one model that could "incentivize" teams for population-based care, he says.
While reimbursement changes are in order, Nutting says that professional physician organizations should do more to assist small practices for a population-based approach to care, and overcome physician characteristics that are "deeply ingrained."
A "transformation will require new strategies, workshops, and other learning and personal development formats to help physicians," Nutting writes.
Physician groups must help lead the way toward helping small practices change behaviors if they are to become involved in medical homes, Nutting tells me. "I point to the American Academy of Family Physicians, and the American College of Physicians and the American Academy of Pediatrics " among others, Nutting says. "They have to step up and help change the culture. I'll probably get a nasty letter from them for saying this. I just hope we have a reasonable conversation."