Patient-Centered Medical Homes in the United States

Abstract

The concept of a medical home is receiving increased attention as a potential means to improve care and reduce costs. This study describes the characteristics and capabilities of practices that have achieved recognition of National Committee for Quality Assurance as a "patient-centered medical home" (PCMH). Both small and large practices demonstrate capabilities related to the goals of PCMH of accessible, coordinated, and patient-centered care; however, practices affiliated with larger organizations achieve higher levels of PCMH recognition compared with unaffiliated small practices. Efforts to support practices to implement medical home capabilities are needed, particularly in the use of data for population management and patient self-management.

A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices

“…Thus, it provides important insights for the majority of primary care practices in the U.S. 10 In contrast to previous reports, [11][12][13][14] we found that practice size posed no disadvantage in making the transition to a PCMH over time. However, the key to success was clearly the provision of support in the form of revised payment, on-site practice redesign expertise, and on-site care management personnel.…”

“…10 There is growing concern about the capacity of small practices to make the PCMH transition. [11][12][13][14] Early evaluation reports on successful transitions, while informative, 5,7,8,15 lack relevance for small practices. As others have reported, 11 smaller practices lack many of the characteristics associated with successful change in some demonstrations, such as a history of successful change.…”

“…Demonstrations have rarely utilized randomized designs, and most have either lacked comparison sites, 17 been implemented in older, sicker or specialized populations, 18 had comparisons of convenience, 5 or lacked revised payment arrangements, 19 thought to be essential to the transition. 2 While the number of practices recognized as PCMH by the National Committee for Quality Assurance (NCQA) is growing daily, 14,20 it is challenging for practices to change the wide range of practice components 8,[21][22][23][24] required by the multidimensional PCMH model. These reports include little detail on change along the PCMH dimensions 17 of enhanced access to a physician led team, continuity and coordination of comprehensive care, promotion of patient self-management, and use of evidence-based medicine facilitated by registries, health information technology and exchange.…”

Medical Home Transformation: A Gradual Process and a Continuum of Attainment

“…4 Advocates of medical homes often describe them as uniquely and markedly different from traditional practices, in both process and outcomes. 5 As a result, medical homes are often compared with non-medical homes.…”

The Cost to Successfully Apply for Level 3 Medical Home Recognition

“…13,14 Because of the level of investment required, one strategy for encouraging widespread adoption of the PCMH model has been to offer practices formal recognition as a PCMH by the National Committee for Quality Assurance (NCQA). 15 This recognition allows practices to publicly promote their status, which may bolster their reputation in the community and, in some cases, garner enhanced reimbursements from payers. To apply for recognition, however, practice staff and administrators need to understand the PCMH standards and application requirements.…”