Medical Home Implementation in Small Primary Care Practices: Provider Perspectives

Gimm, Gilbert; Want, Jay; Hough, Dan; Polk, Treniese; Rodan, Margaret; Nichols, Len M.

doi:10.3122/jabfm.2016.06.160077

Cited by 10 publications

(14 citation statements)

References 13 publications

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“…This finding is consistent with other studies that identify nurses as critical team members in enhancing care coordination. 2,6 Second, individualized patient care plans were viewed favorably as a way to improve care coordination and communication with the NCCs. However, providers held mixed views on the outcome incentive awards (OIAs).…”

Section: Discussionmentioning

confidence: 99%

“…Our team recruited eight panels that had participated in focus groups in a previous study of the CareFirst PCMH program. 6 Following up with the same group of providers allowed us to examine changes in their perceptions and use of program elements after several years of experience with PCMH program implementation. Panels in this study represented primary care practices focused on adult patients, with each panel comprised of 7 to 15 providers.…”

Section: Focus Group Participantsmentioning

confidence: 99%

“…5 Also, the cost of external PCMH certification by the National Committee for Quality Assurance (NCQA) may be a barrier for small practices. 6 As a result, small primary practices with one or two physicians have adopted relatively few PCMH processes. 7,8 The majority of PCMH evaluations have focused on cost, quality, or utilization outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings. 6,15 Provider perspectives can help to elucidate our understanding of which PCMH program components are effective or need further refinement. To address this information gap, this qualitative study analyzed how providers experienced specific elements of a payer-based PCMH model and identified several cross-cutting themes that can be applied to other payer-based PCMH initiatives.…”

Section: Introductionmentioning

confidence: 99%

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Provider Experiences with a Payer-Based PCMH Program

et al. 2019

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BACKGROUND: The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings. OBJECTIVE: The goal of this qualitative study was to analyze how providers experienced specific elements of a payer-based PCMH model and identify cross-cutting themes that can be applied to other payer-based PCMH initiatives. DESIGN: Observational qualitative study. PARTICIPANTS: A total of 65 individuals (which includes 57 primary care physicians) participated in focus group sessions. Telephone interviews were conducted with an additional 14 physicians and 2 practice administrators. APPROACH: Interviews and focus groups were recorded after obtaining the informed consent of participants. Written transcripts from the recordings were then imported into NVivo 11 for subsequent coding and qualitative analysis of themes. KEY RESULTS: We found that nurse care coordinators (NCCs) were the single most valuable and visible program element. Individual care plans served as effective tools of communication between the NCC and physician on patient care management goals and issues. The online data portal was viewed as the least valuable element. With regard to cross-cutting themes, some providers expressed a strained relationship with CareFirst due to communication challenges, a lack of trust, and differing priorities in selecting patients for care plans. CONCLUSION: Nurse care coordinators and the targeted use of individualized care plans are essential components in a payer-based PCMH program. Improving communication and trust in data reports are critical for effective implementation. Future research should examine provider experiences in other payer-based PCMH programs to see how interactions with payers affect program implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Focus Group Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Provider Experiences with a Payer-Based PCMH Program

et al. 2019

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“…This program came with limited practice requirements and external incentives. Using a qualitative methodology, Gimm et al 17 reports multiple stakeholders' views of the successes and challenges of this program.…”

mentioning

confidence: 99%

Bread and Butter of Family Medicine: Guidelines, Population Screening, Diagnostic Evaluations, and Practice Models

Seehusen¹,

Bowman²,

Neale³

2016

The Journal of the American Board of Family Medicine

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Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace

et al. 2021

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BACKGROUND: Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes. OBJECTIVE: To determine the market penetration of Medicare Shared Savings Program (MSSP) ACOs, PCMHs, and the meaningful use of EHRs among PCPs across urban and rural counties in Ohio. DESIGN: Retrospective, observational study of the percent of PCPs in a county who are affiliated with PCMH, ACO, and meaningful use (MU) of EHR. PARTICIPANTS: PCPs in all of Ohio's 88 counties from 2011 to 2015. MAIN MEASURES: Primary care market penetration of ACO, PCMH, and meaningful use of EHR KEY RESULTS: In 2015, the Ohio primary care market penetration of PCMH was 23.4%, ACO was 27.7%, MU stage 1 was 55.8%, and MU stage 2 was 26.6%. During the study period, PCMH and ACO market penetration increased faster in urban counties relative to rural counties, and market penetration of meaningful use of EHR increased faster in rural counties. CONCLUSIONS: Market penetration of PCMH and ACOs increased faster in urban markets compared to rural markets. However, the adoption of EHRs increased faster in rural markets. The results are a cause for optimism as well as a call to action: although recent efforts to increase PCMH and ACO adoption were less effective among the rural population in Ohio, federal programs to accelerate adoption of EHRs were overwhelmingly successful in rural areas.

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Medical Home Implementation in Small Primary Care Practices: Provider Perspectives

Cited by 10 publications

References 13 publications

Provider Experiences with a Payer-Based PCMH Program

Provider Experiences with a Payer-Based PCMH Program

Bread and Butter of Family Medicine: Guidelines, Population Screening, Diagnostic Evaluations, and Practice Models

Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace

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