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Improving Value

Medical Homes

In its landmark 2001 report Crossing the Quality Chasm, the Institute of Medicine (IOM) identified patient-centeredness as one of six aims for the healthcare system.  

Patient-Centered Medical Homes (PCMHs) aim to incentivize a focus on primary care and coordination among providers, with the objective of placing the patient at the center of the care relationship. PCMHs are frequently discussed as a key part of the solution to inefficient medical care delivery in the United States. PCMHs promote coordinated, high quality healthcare centered around the patient’s needs and have been touted by their supporters as a way to improve quality and control costs.

The PCMH model strives to provide patients with what they say they want in healthcare–having a personal relationship with their doctor; feeling valued and not like a number; having the physician treat the whole person and not just certain symptoms; having adequate time to talk to the doctor and not feeling rushed; and physician bedside manner and listening skills.1

Financial incentives are crucial to the success and sustainability of the PCMH model  and play an important role in the potential success of the model. Providers in PCMHs are reimbursed for activities that are not paid for in a traditional primary care setting, such as care coordination services, patient communication, telephone and email encounters, population health management, and quality improvement.

The PCMH has received a great deal of attention recently as a way of organizing the delivery of primary care, yet only an estimated 15%  of primary care is delivered through the medical home model today.2 Many policymakers and advocates lack familiarity with the concept and early evidence is mixed. Furthermore, lack of uniformity in the design of PCMHs contributes to policymaker and consumer confusion. Despite general agreement that primary care should be coordinated and patient-centered, no consensus exists on a single operational definition of the medical home or the investments required.

While experts agree that the goals of the PCMH are very worthy, there are varying views on the characteristics of a “good” PCMH, how the transformation should occur, and how results should be measured.  As there is no single definition for a PMCH and there is no one organization responsible for recognizing, accrediting, and/or defining the medical home model,3 each PCMH may look different while still attempting to address and fulfill the same general goals.  While the concept is well aligned with the way patients would like to receive healthcare, more research is needed to determine the most effective PCMH models, the best way to transition from traditional practice into a PCMH, and to improve our methods for measuring the consumer experience.

Notes

1.  For example, see Quincy and Kleimann, Engaging Consumers on Healthcare Cost and Value Issues, Consumers Union (October 2014); Talking about Healthcare Payment Reform with U.S. Consumers: Key Communications Findings from Focus Groups, April 2011, Robert Wood Johnson Foundation; and Schleifer, David, et al., Curbing Health-Care Costs: Are Citizens Ready to Wrestle with Tough Choices?, Public Agenda and Kettering Foundation (2014).

2. Auerbach, David I., et al., “Nurse-Managed Health Centers and Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage,” Health Affairs, Vol. 32, No. 11.

3. Klein, David B., et al., “The Patient-Centered Medical Home: A Future Standard for American Healthcare?,” Public Administration Review (April 2013).

Resources:

Burack, Victoria, Patient Centered Medical Homes: Promising but More Evidence is Needed, Consumers Union (March 2014).