Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?

Abstract

PURPOSELittle is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.METHODS As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audiorecorded and fully transcribed. Transcripts were analyzed and thematically coded.RESULTS PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients fi rst. Motivations for implementing specifi c PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics.CONCLUSIONS Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.

Minnesota’s Early Experience with Medical Home Implementation: Viewpoints from the Front Lines

“…[4][5][6][7][8][9][10][11] Facilitators and barriers to the creation of a successful PCMH have been explored in a limited number of heterogeneous settings, including small practices, large group practices, high-performing practices, and safety net clinics. [12][13][14][15][16][17] To date, significant challenges have been identified; specifically, the investment of resources for infrastructure changes and the leadership skills needed to guide an organization through paradigm-shifting cultural change. 5,14,18 Common facilitators have included valuing innovation, quality improvement, and patient-centeredness.…”

“…5,14,18 Common facilitators have included valuing innovation, quality improvement, and patient-centeredness. 12,13,16 We sought to augment the literature on motivations, barriers, and facilitators to PCMH implementation by describing a large-scale initiative with some unique features.…”

National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Recognition Is Suboptimal Even Among Innovative Primary Care Practices

“…1 Previous research has shown that the decision to pursue NCQA PCMH recognition often is based on financial incentives. 2,3 In addition, the desire to become a patient-centered practice and to seek NCQA recognition are not necessarily aligned: "PCMH recognition per se at times amounts to a small incentive to change labels." 2 True transformation to a PCMH requires a dramatic shift in practice culture and mental models.…”

“…2,3 In addition, the desire to become a patient-centered practice and to seek NCQA recognition are not necessarily aligned: "PCMH recognition per se at times amounts to a small incentive to change labels." 2 True transformation to a PCMH requires a dramatic shift in practice culture and mental models. 4 As part of a study of primary care workforce innovations funded by The Robert Wood Johnson Foundation, we consulted with 387 national experts in primary care research, using both purposeful and snowball sampling, to identify a set of 131 practices that experts knew to be (1) high quality, (2) clinically excellent settings, and (3) doing something innovative with their staffing (Table 1).…”

Capsule Commentary on O’Malley et al., Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

“…2 Payers would want to know whether the money is best spent on supporting PCMH at a certain level or on paying for team care directly. At present, this study provides valuable lessons from the frontline on how successful PCMHs have overcome challenges to successfully develop and sustain a teamwork approach.…”