Becoming a PCMH: How one physician transformed his practice

Ever since James L. Holly, MD, began practicing family medicine in 1975, dictation and transcription frustrated him as a means of recording what transpired during patient visits. In 1998, two years after forming a group practice, he convinced his partners to invest in a $650,000 system for electronic health records.

“Everybody laughed at us,” recalls Holly, 72, co-founder and chief executive officer of Southeast Texas Medical Associates LLP, or SETMA for short, which consists of 44 multi-specialty providers and operates six clinics in the Beaumont area. “Needless to say, they stopped laughing a long time ago.”

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Leveraging the latest technology has been one of Holly’s fundamental best practices for preparing to transform his group into a Patient-Centered Medical Home (PCMH). Other principles entail building partnerships between individuals and their personal physicians, and when appropriate, involving patients’ family members in the decision-making process. 

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Within this framework, the personal physician becomes a patient’s first advocate in navigating the maze of comprehensive and continuous care, taking responsibility for ongoing medical needs as well as arranging care with other qualified professionals. This continuum includes all stages-from preventive services to acute and chronic care to end-of-life choices. “We believe that ‘medical home’ is the future,” Holly says, referring to the “triple aim” in health care-enlisting patients as collaborators in their own care to improve outcomes and lower costs. 

Holly led his 13-partner group in the efforts to receive PCMH recognition from four entities-The Joint Commission, the National Committee for Quality Assurance (NCQA) Tier III, the Accreditation Association for Ambulatory Health Care (AAAHC) and the Utilization Review Accreditation Commission (URAC). “We wanted to learn everything we could, and we discovered that each one gave us more insight,” he says.

In 2008, Holly and his partners formalized The SETMA Foundation, which assists eligible patients in covering co-payments and other medical expenses that may hinder them from obtaining care. Each year, the partners have contributed $500,000 to the foundation. The funds are used to provide for the care of SETMA patients, when it is needed, outside the medical group.

To make quality improvements in practice operations and patient care, Holly believes physicians need to generate computerized reports measuring their current performance against national standards. In other words, he suggests: “Face where we are, even if it’s not where we want to be.” Harnessing the “power of analytics” is the first step in setting goals on the road to progress.

Seven years ago, the practice began publishing quality metrics for each provider on its website. The statistics, updated quarterly, show how each physician performs in managing panels of patients. “Our patients are transparent with us, so we ought to be transparent with them,” says Holly, adjunct professor of family and community medicine at the University of Texas Health Science Center at San Antonio and clinical associate professor in the department of internal medicine at Texas A&M Health Science Center in Bryan, Texas.

Altering the dynamics of patient interactions is also a central component of the medical home model of care. By listening to a patient-and treating the whole person, not simply the disease-a physician can instill a sense of value, or worth, “which is the first thing necessary for successful treatment,” Holly explains. Feelings of hope and trust then fuel the power to make profound changes. “That’s all that a medical home is.”