A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Abstract

The patient-centered medical home could well be a transformative innovation-for some practices now, but for many others only in the long run.by Robert A. Berenson, Terry Hammons, David N. Gans, Stephen Zuckerman, Katie Merrell, William S. Underwood, and Aimee F. Williams ABSTRACT: The "patient-centered medical home" has been promoted as an enhanced model of primary care. Based on a literature review and interviews with practicing physicians, we find that medical home advocates and physicians have somewhat different, although not necessarily inconsistent, expectations of what the medical home should accomplish-from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions. As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care. T h e pat i e n t-c e n t e r e d m e d i c a l h o m e (PCMH) is the newest idea being promoted as a transformative health system innovation. Proponents believe that it will improve the quality of and patients' experiences with care and alter the trajectory of inflationary health care spending. 1 The PCMH has been proposed by four primary care physician specialty societies; has been endorsed by a range of purchaser, labor, and consumer organizations, including IBM, Merck and Company, the ERISA Industry Committee, and AARP; and is being tested in demonstrations by major public and private health plans, including Medicare, various Blue Cross and Blue Shield plans, UnitedHealthcare, and Aetna. 2 The medical P r a c t i c e R e d e s i g n H E A LT H A F F A I R S~Vo l u m e 2 7, N u m b e r 5 1 2 1 9

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

“…Larger practices and network-affiliated practices might already possess these capabilities due to economies of scale and highly-developed management. 24 Smaller practices may be less likely to engage in quality improvement activities. 25 To assess the current prevalence of recommended structural capabilities among primary care practices and evaluate their relationship to practice size and network affiliation, we conducted a statewide survey of over 400 primary care practice sites in Massachusetts.…”

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

“…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.…”

“…14 Thus, the evidence required to inform decisions about where to apply resources to facilitate or accelerate change is lacking. 23 This paper reports on a study, conducted by EmblemHealth, the largest health insurer based in New York, 26 addressing many of the current limitations in the growing evidence base. The study provides a unique view on the implementation of the PCMH in adult primary care using the first randomized, controlled, longitudinal trial that operationalizes the key principles of the PCMH model, including revised payment.…”

Can Integrating Health Literacy into the Patient-centered Medical Home Help us Weather the Perfect Storm?

“…Two issues receiving increasing attention as both challenges and opportunities are the invigorated efforts to improve health literacy [2][3][4][5][6][7] and advance the patient-centered medical home (PCMH) model of care. [8][9][10][11][12][13][14][15] While the two have been loosely linked, 16,17 the striking common threads between them have been largely ignored.…”