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The TransforMED Medical Home Model

In much the same way that primary care treats the whole person, the TransforMED Medical Home Model recognizes that all the elements of a successful Medical Home practice are interrelated, thus the TransforMED approach "treats the whole practice."

The benefits of this TransforMED Medical Home Model continue to emerge from the National Demonstration Project's continuing evaluation, as well as the pilot projects and practice transformation projects currently facilitated by TransforMED.

Click the link below to download
a full-color PDF of the
The TMED Medical Home Model


The TransforMED Patient Centered Medical Home Model

A continuous relationship with a personal physician
coordinating care for both wellness and illness

  1. Mindful clinician-patient communication:
    trust, respect, shared decision-making
  2. Patient engagement
  3. Provider/patient partnership
  4. Culturally sensitive care
  5. Continuous relationship
  6. Whole person care
 
Access to Care & Information
• Same-day appointments
• After-hours access coverage
• Lab results highly accessible
• Online patient services
• e-Visits
• Group visits
• Culturally sensitive care		   Practice Management
• Disciplined financial management
• Cost-Benefit decision-making
• Revenue enhancement
• Cost-Benefit decision-making
• Optimized coding & billing
• Personnel/HR management
• Facilities management
• Optimized office design/redesign
• Change management
Practice Services
• Comprehensive care
  for both acute & chronic conditions
• Prevention screening and services
• Surgical procedures
• Ancillary therapeutic and support services
• Ancillary diagnostic services		   Health Information Technology
• Electronic medical record
• Electronic orders and reporting
• Electronic prescribing
• Evidence-based decision support
• Population management registry
• Practice Web site
• Patient portal
Care Management
• Population management
• Wellness promotion
• Disease prevention
• Chronic disease management
• Care coordination
• Patient engagement and education
• Leverages automated technologies		   Quality and Safety
• Evidence-based best practices
• Medication management
• Patient satisfaction feedback
• Clinical outcomes analysis
• Quality improvement
• Risk management
• Regulatory compliance
Continuity of Care Services
• Community-based services
• Collaborative relationships
• Hospital care
• Behavioral health care
• Maternity care
• Specialist care
• Pharmacy
• Physical therapy
• Case management 		  Practice-Based Team Care
• Provider leadership
• Shared mission and vision
• Effective communication
• Task designation by skill set
• Nurse Practitioner / Physician Assistant
• Patient participation
• Family involvement options

Version 2.3. Updated September 2008

Copyright 2008 TransforMED, LLC. All rights reserved.

 
IN THIS SECTION
About the Nat'l Demonstration Project
The TransforMED Medical Home Model
Participating Practices
Selection Process
Evaluation Team
Methods & Measures
Data Collection

 

“Piecemeal approaches to improving health care are unlikely to improve quality or enhance value over the long term. Rather, the key lies in profoundly transforming health care delivery and financing to promote more effective and efficient care for all. With this effort, TransforMED is moving our country toward a high-performance health system.”

James C. Martin, MD, board chair of TransforMED and past chair of the Future of Family Medicine Project Leadership Committee.


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© 2008 TransforMED, LLC. All rights reserved.