Clinical innovation is often about making small changes to an existing system. In some cases, the whole system is redesigned. These result in models of care that break away from what we’re used to.
 

• The Patient Centered Medical Home (PCMH)-- The PCMH is a new model for primary care redesign endorsed by the Pediatrics, Internal Medicine and Family Medicine specialty societies as well as many of the major healthcare payers (including the U.S. government). As the American College of Physicians explains:

A Patient-Centered Medical Home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes. The PCMH practice is responsible for providing for all of a patient’s health care needs or appropriately arranging care with other qualified professionals. This includes the provision of preventive services, treatment of acute and chronic illness, and assistance with end-of-life issues. It is a model of practice in which a team of health professionals, coordinated by a personal physician, works collaboratively to provide high levels of care, access and communication, care coordination and integration, and care quality and safety.

   

• The Chronic Care Model --This model, developed by Ed Wagner, serves as a useful paradigm for thinking about the kind of changes needed to develop a more functional healthcare system that is aligned at all levels with the needs of patients with an increasing burden of chronic illness.

• Retail Clinics--This model, often represented by the MinuteClinic chain, involves a nurse practitioner working in a retail setting, treating a limited number of conditions based on a strict set of protocols with a posted cash menu of prices. Some denounce this model as further fragmenting care and counterproductive to the longitudinal focus of primary care. Other however, see in it powerful lessons about what patients value in their care and how primary care must improve or have used the model to expand access to underserved populations. Read more at the California Healthcare Foundation issue page.

Some health care systems that are examples of innovative models of care are:

• Atul Gawande’s “The Hot Spotters” article highlights The Camden Coalition, Verisk Health, the Special Care Center, and others that provide aggressive care coordination and preventative care to the sickest patients. This follow-up addresses some of the concerns about this approach.
• Southcentral Foundation A Healthcare system that was the first primary care-based system to win the National Balridge Award for "unwavering commitment to excellence, dynamic management and proven results". Based in Anchorage, Alaska serving the Alaska Native population, and recently now cares for all employees of the organization whether Alaska Native or not.
• Group Health - An HMO based in Seattle, Washington, this organization made headlines for a couple of Health Affairs articles in which the authors clearly illustrated their transformation to team-based care with a focus on alternative visit types (phone, emails) and panel management. They were able to demonstrate improved outcomes, cost savings, and an improved patient experience, all three elements of the celebrated Triple Aim
• Cambridge Health Alliance - Team-based primary care for safety net health care delivery in the Boston area.
• Care Oregon - A Medicaid managed care plan based in Portland, Oregon, Care Oregon is an active health system leader for both the Institute for Healthcare Improvement and the Commonwealth Fund. They work hand in hand with Multnomah County (the county Portland resides in) to deliver team-based care enriched with a leading nurse care management program.
• The Boeing Intensive Outpatient Care Program (IOCP) – a medical home model for the highest-risk and highest-costing patients.