Measuring The Medical Home Infrastructure In Large Medical Groups

Abstract

The patient-centered medical home is taking center stage in discussions of primary care innovation as a new delivery model that provides comprehensive, coordinated care across the lifespan. Although the medical home is widely discussed by policymakers, payers, and other stakeholders, the extent to which physician practices have the infrastructure in place to function as medical homes is not known. Using data from the 2006-07 National Study of Physician Organizations, we examine the extent of adoption of medical home infrastructure components among large primary care and multispecialty medical groups and their association with medical group size and ownership.

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

“…3,4 Because ACO programs are likely to be dominated by currently eligible rather than newly integrated provider groups, 31 the sociodemographic differences between patients served by larger and smaller groups suggest that any clinical benefits achieved by ACOs may accrue disproportionately to white patients in more affluent areas. Previous research [11][12][13][14][15][16] and ACO program requirements 2,32 suggest that provider integration encouraged by ACO programs might be associated with enhanced abilities to monitor and improve quality of care, but we found that larger provider groups achieved smaller racial disparities in only two of six quality measures we analyzed. Finally, to the extent that new payment incentives improve the quality of care provided by ACOs, our findings and previous studies [17][18][19] suggest these potential gains may not be associated with consistently reduced racial disparities in quality.…”

United States Innovations in Healthcare Delivery

“…Using an index measuring twenty elements of the PCMH, Rittenhouse et al found an average of only seven elements present out of twenty in a 2008 study of relatively large medical groups. 16 As shown in Figure 1, the percentage of medical home elements (the mean index value) implemented only begins to increase in practices consisting of at least 65 physicians and to fulfi ll half of the recommended elements in practices larger than 140 physicians. Thus, smaller practices, which constitute the majority of providers in both the United States and most other countries, will require considerable support and technical assistance to become fully functioning medical homes.…”

Medicare's Transitional Care Payment — A Step toward the Medical Home

“…The Medicaid provision would build on similar efforts used in North Carolina and other states seeking to enhance chronic care management and provide for a team-based approach to enhance primary care. 51 These policies would reduce national health spending, relative to currently projected levels, by an estimated $175 billion through 2020.…”