Creating and Sustaining Care Teams in Primary Care: Perspectives From Innovative Patient-Centered Medical Homes

Objective: To learn from the experiences of innovative primary care practices that have successfully developed care teams. Research Design: A 21/2-day working conference was convened with representatives from 10 innovative primary care practices, content experts, and researchers to discuss experiences of developing care teams. Qualitative data included observation notes, transcripts of conference sessions and interviews, and narrative summaries of innovations. Case summaries of practices and an analysis matrix were created to identify common themes. Participants: Ten practices known nationally for innovations in team-based care participated in the conference represented by 1 to 2 practice members. Results: Two domains emerged related to creating effective teams and funding them. Participants emphasized the importance ofmaking practice values explicit and involving everyone in the change process, standardizing routine processes, and mitigating resistance. They also highlighted that team-based care adds comprehensiveness, not necessarily productivity. They, thus, highlighted the need for a long-term financial vision, including resourcefulness and alternate funding. Conclusions: Team-based care is possible and valuable in primary care. It is difficult to develop and sustain, however, and requires dedicated time and resources. The challenges these highly motivated practices described raise the question of feasibility for more average practices in the current funding environment.