Last Thursday, something unusual happened – I had time to think.  Actually, I scheduled it in.  I was preparing to travel and speak in several venues:  Virginia Commonwealth University hosted by Alan Dow, a VCU assistant vice president, and then off to the University of Pittsburgh Medical Center to work with the Nexus Innovations Incubator Network team implementing practice models.  While there, I had a scheduled Institute of Medicine webinar requested by Marilyn Chow, a Kaiser Permanente vice president and member of our National Advisory Council.

It has been well past time that I stand back to reflect on what we are seeing and learning. The National Center team has been doing incredibly heavy lifting lately.  We’ve launched the measurement instrument resource, conducted webinars, met with our funders, worked on the National Center Data Repository with the Nexus Innovations Incubator Network, finished a literature review on linking interprofessional practice and education, prepared a curated collection of publications to be launched for use soon, so on and so forth. 

I realize that a surprise for me is the growing number of requests we are receiving about the practice side.  “What new models of care are out there?”  “What is working?”  “What should we be doing?”  The questions are coming from the people who are practicing – not the education side, or the people who are educating the next generation of health professions for the evolving health system. I talk to many people and there is great work going on in practice. There are many organizations working on transforming practice.  How to meaningfully shed light on the exemplary work in practice will be a major topic of our April National Advisory Council meeting.  I welcome your ideas.

An ah-ha for me is that the National Center grew out of a recognized need to connect and engage many in interprofessional practice and education (IPE). Today’s environment is chaotic and confusing across practice, education and the Nexus. People, like me, are trying to make sense of it.  Just take a look at what I experienced Thursday as a good example.

As I opened up my laptop, good friend John Gilbert had sent me an email entitled “Have you seen this?” with a link to a new JAMA article, “Patient-centered medical home program results in little improvement in quality”.  The gist of the new publication is that the effectiveness of patient-centered medical homes (PCMH), a team-based model of primary care, for “improving quality and containing costs is unclear.”  In Pennsylvania, this study demonstrated the value of PCMHs on only one of eleven quality indicators.  The authors recommend the PCMH model “may need further refinement”, and that’s the point of quality improvement. (I’ve since learned that this article was the buzz last week, continuing into this week.)

Within an hour, and 25 emails later, my daily University of Minnesota News Brief hit my inbox with a headline “Minnesota's new way of seeing patients has improved health care results, researchers say”.   As I clicked through the media coverage of Doug Wholey’s and Michael Finch’s 150 page evaluation of Minnesota’s health care homes (HCHs) or PCMHs, I see different results. But even the media coverage of the same study is confusing.  One emphasized “physicians” and “medical care” while another discusses “preventive medicine” and “team treatment”.

The coverage admits that HCHs are a hot topic with a perplexing name.  Ironically, one of the problems is that the patients actually believe that the principles of the PCMH/HCH are already occurring; it is what they expect.   In Minnesota, health care homes demonstrated better results in terms of quality of care in most assessed measures, including optimal care for chronic diseases like asthma and diabetes.  There are some indicators of potential costs savings. What is clear from the reporting is that payers need data before they will reimburse for new models of care. 

Back to us—no wonder people are puzzled, and we are all asking ourselves:  “What do I believe?” “How does this guide us?” “What factors are at play to have such different results?” “How does this inform practice, education and the Nexus in Pennsylvania, Minnesota and the U.S.?” “What about people, families and communities?” “What does this mean for people who want data, information and evidence to show us the way?”   Today, we do not know.

As a Minnesotan, I received one last email as I traveled to Richmond: “Pack your bikini; leave your mukluks behind.  This will be good news for you.”  But, really, snow is conducive for an afternoon of reflection.