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By Monica E. Oss

Greetings from D.C. and the opening day of the 2015 OPEN MINDS Technology & Informatics Institute. Paul Grundy, M.D., founding President of the Patient-Centered Primary Care Collaborative and IBM’s Director of Global Healthcare Transformation, opened the day with his keynote presentation, Making The Transition To Value-Based Payment: Transforming Your Organization For The New Normal. Often referred to as the “godfather” of the medical home, Dr. Grundy took us through the history of the evolution of medical homes and the early data on their impact.

Paul Grundy, M.D.

In this presentation, he discussed the confluence of the need for better population health management and individual care coordination – along with the shift to value-based payment. On the payment front, he reviewed the move to pay-for-value – even in Medicare reimbursement. And he emphasized that by 2018 almost 90% of Medicare payments would be moved away from traditional fee-for-service.




At the same time, the consumer delivery system model is shifting to medical homes as the preferred vehicle for coordinated consumer care management. What does this evolution look like? Care is proactive, standardized, and coordinated; And providers track and measure all care, and follow-up and improve care based on the metrics.


His discussion of the emerging dominance of the medical home model – and its effectiveness in reducing the use of specialty care – brought me to my question at the end of the session: What is the role of a specialist organization in a health care market dominated by medical homes? His answer was straightforward. “Specialists need to choose – are they a comprehensivist or a partialist? In other words, do they want to role of managing all of an individual’s health and well-being? Or do they want to specialize in the conditions that effect a specific part of the body? The medical home model decreases the utilization of specialists – but we need great specialists. And, the specialist organizations need to choose.”

To me, this is the crux of the strategic crossroad for most specialist organizations that have revenue from the health care system. The boards and executive teams of these organizations are at a crossroads – and need to choose. And, they need to realize that not choosing is a choice – and one with consequences. Later in his presentation, Dr. Grundy described the fate of the “non-choosing” and “non-changing” health care organizations in a market where the medical home model became the dominant consumer care management model. After a few years, those organizations ceased to exist.

So the strategy question for specialist organizations – market positioning as comprehensivist or as a partialist? This is the proverbial  strategic “fork in the road’ for many organizations – the deciding moment in life or history when a major choice of options is required. There is great opportunity in either choice. But the implications of the choice on an organization’s future business model are significant.

If your organization is facing this decision point in your market, perhaps you can take comfort in the words of Peter Drucker: “Whenever you see a successful business, someone once made a courageous decision.” But making this fundamental decision in a timely manner is critical. And to quote the less cerebral but always interesting Yogi Berra: “When you come to the fork in the road, take it.”

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