It’s no secret that primary care is a critical aspect of health care improvement. But, points out Iora Health CEO Rushika Fernandopulle, problems persist when providers only have 7-minute patient visits and so much other work to do. Patient-centered medical homes attempt to address these issues, but they don’t always work. Fernandopulle describes three reasons why, and what needs to be done differently:

1. They’re too structural. You can certify your practice as a medical home, but how you structure your practice must change as well.
2. They don’t change the business model. “If you don’t change how you’re paid, you’re not going to change what you do,” says Fernandopulle. “And a lot of the right things to do involve seeing patients in a very different way, with different people, in different places.”
3. They add onto the current system. When Michelangelo was asked how he created the Pieta, he said, “I take a block of stone, and I chip away everything that’s not the Pieta.” According to Fernandopulle, that’s what we need to do in health care. “There’s beauty in health care; we’ve done it for thousands of years,” he says. But we’ve accumulated too much “junk” on top of it. “What we’re able to do when you start from scratch is actually take things away, and that’s how you get to good health care.”

From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.