The first step was to concentrate on six primary care pilot sites in a patient-centered medical home pilot project with TransforMED, a subsidiary of the American Academy of Family Physicians.
"It was a way to get started," Kaufman says. "It was a bit messy. In retrospect it wasn't data-driven enough, but a couple of really good things came out of that."
The pilot sites—which included 30 physicians at five Dean Clinic locations and one that is part of Dean's joint venture with St. Mary's Hospital—reached Level 3 PCMH certification for the National Committee for Quality Assurance program, which includes such foundations as access and communication, use of paper or electronic charting tools to organize clinical information, and adoption and implementation of evidence-based guidelines for three chronic conditions.
The other real benefit was a new physician compensation formula meant to align physician performance with the goals of value-based care, and not by volume. Five years ago, Dean's PCPs were compensated on the industry standard relative value unit (RVU) formula, in which a standardized dollar amount is given for each encounter or procedure. Dean initially had introduced a 2% incentive for patient satisfaction, but as part of the PCMH pilot, leaders radically redesigned the formula, Kaufman says.
Under the new compensation formula, 60% of primary care compensation was still RVU-based; another 20% was based on age/gender-adjusted panel size; and 35% was built around incentives for service, financial performance, clinical quality, and growth goals. The formula intentionally totals 115%, Kaufman says. "We purposely made it possible for our physicians to earn above market compensation, but the way our physicians did that was by performing well on the incentives that were really all about the goals of primary care redesign."