Patient-Centered Medical Home Evaluations: Let’s Keep Them All In Context

Since the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP) and American Osteopathic Association (AOA) issued their Joint Principles of the Patient-Centered Medical Home in 2007, there has been an explosion in medical home transformation activity in the United States.  According to the National Committee for Quality Assurance(NCQA), which offers one of multiple medical home recognition programs in the U.S., 5,739 practices representing 27,820 clinicians had received NCQA medical home recognition status as of May 2013.

Medical homes have represented a promising approach to improving care for patients, reducing avoidable utilization, and improving professional satisfaction for clinicians.  Extensive research by Ed Wagner and colleagues provided an evidence-supported basis for optimism, but only over the last several years has the model been implemented broadly.

Taking concepts tested in small application to broader context is challenging, as experience has shown.  The state of Pennsylvania, along with its community of primary care practices and insurers, has been committed to testing and adopting the medical home model.  A key catalyzing effort was the Pennsylvania Chronic Care Initiative.

About the Pennsylvania Chronic Care Initiative

In 2006 a coalition of health care provider and insurer leaders from across the state began discussions about how they might jointly support the transformation of primary care delivery in Pennsylvania.  The resulting Pennsylvania Chronic Care Initiative became the first large-scale multi-payer medical home initiative in the U.S.  Implemented in four regional rollouts between May 2008 and October 2009, the initiative came to include over 400 physicians funded by a dozen health plans.  The effort in all four regions was to build practice infrastructure, initially focusing on the management of diabetes in adults and asthma in children as target conditions.

The Chronic Care Initiative has been an exercise in delivery system transformation; an effort to demonstrate how primary care practices and insurers, supported by a host of other stakeholders, could better serve Pennsylvania.  It was designed with the understanding that the participants would learn from their collective experience and that the model would evolve over time mirroring reflective continuous quality improvement at the practice level.  The Southeast region was the first implementation.  Each subsequent regional rollout benefitted from the experience of its predecessors, increasingly expanding focus from development of practice infrastructure to better care management and direct attention to responsibly avoiding unnecessary health care costs.