Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes

Abstract

The patient-centered medical home has become a prominent model for reforming the way health care is delivered to patients. The model offers a robust system of primary care combined with practice innovations and new payment methods. But scant information exists about the extent to which typical US physician practices have implemented this model and its processes of care, or about the factors associated with implementation. In this article we provide the first national data on the use of medical home processes such as chronic disease registries, nurse care managers, and systems to incorporate patient feedback, among 1,325 small and medium-size physician practices. We found that on average, practices used just one-fifth of the patientcentered medical home processes measured as part of this study. We also identify internal capabilities and external incentives associated with the greater use of medical home processes.T he patient-centered medical home model of health care delivery system reform was featured prominently in the Affordable Care Act of 2010. The model was developed by the primary care specialty societies in 2007. It has been endorsed by a broad coalition of purchasers, payers, providers, consumers, and other health care stakeholders. It emphasizes a robust system of primary care combined with practice innovations and new payment models.

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.…”

Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis

“…This finding is consistent with results of previous studies in physician organizations, 10,11,16 yet novel in its specific focus on HCs nationwide. We asked HCs whether the clinic or individual providers could receive financial incentives for achieving goals such as high patient satisfaction and certain clinical care targets.…”

“…[5][6][7][8] It is important to identify potential ways to increase the capability of HCs to serve as PCMHs, and specifically to identify key characteristics associated with PCMH capability in HCs. Previous studies have examined similar questions in a variety of settings using different outcomes, including: medical home processes, [9][10][11] capacity, 12,13 and infrastructure, 14,15 care management processes, 16 structural capabilities, 17,18 program implementation progress index, 19 and the percentage point or the level of recognition achieved on the National Committee on Quality Assurance (NCQA) PCMH standards. [20][21][22][23] These studies have identified a few characteristics associated with medical home capability, such as practice size, type, and ownership, external incentives, organizational relationships, health information technology (HIT), and patient and neighborhood demographics and socioeconomic characteristics.…”

“…[24][25][26] However, these studies are limited in their ability to identify specific characteristics associated with PCMH capability in HCs and the magnitude of their impact. Most studies have focused on non-HCspecific settings such as physician organizations, family medicine practices, and Veterans Health Administration clinics, [9][10][11][12][13][14][15][16][17][18][19][20][21][22] which differ from HCs in financing, patient populations, payer mix, disease burden, and surrounding communities. To our knowledge, only one study has been conducted in HCs, among 50 safety net clinics in New Orleans.…”

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

“…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.…”